Kemal KÖSEMEHMETOĞLU, Alp USUBÜTÜN, Ali Rıza TÜMER

Autopsy status and pathologists’ attitude towards autopsy in Turkey

Amaç: Dunyada otopsi uygulamasının son zamanlardaki duşuş eilimi engellenmeye calışılırken, Turkiye’de zaten duşuk, pratik olarak sıfıra yakın, bir otopsi bilancosu ile karşı karşıyayız. Bu calışmada, Turkiye’de otopsinin durumunu belirledik ve deerlendirdik; patologların otopsi hakkındaki tutumlarını ortaya koyduk; ayrıca şu andaki otopsi bilancosuna neden olan faktorleri belirledik ve bunların dier ulkelerde ortaya konulan faktorlerden farklı olup olmadıını tartıştık. Metodlar: Patoloji uzman ve asistanlarına yonelik anket calışması hazırlandı ve 50 universiteden 1995–2003 yılları arasında yapılmış otopsi sayıları istendi. Sonuçlar: Ankete 47 patolog ve 38 patoloji asistanı katıldı. Patologlar tarafından yapılan ortalama otopsi sayısı 36,65 (medyan 15)’ti. Ankete katılanlardan %35,3’u hic otopsi istemi almamıştı. Patologların %60’ı otopsi yapma konusunda istekliydi ve bunların buyuk counluu universite hastanesinde calışmaktaydı. Katımcıların yarısı teorik eitimden yoksundu ve yaklaşık %20’si kanuni duzenlemelerden haberdar deildi. Patologların buyuk kısmı, otopsi izin grubunda yer almak istememektedir. 50 universiteden 17’si (%34) otopsi sayılarını gonderdi. Yılda yapılan en yuksek erişkin otopsi sayısı 6.88, pediatrik otopsi sayısı 148,75’ti. Cevap veren universitelerin 10’unda (%59) erişkin medikal otopsi yapılmıyordu. Az sayıda yapılmasına ramen erişkin otopsi sayısında zaman icinde bir duşme trendi dikkati cekti. Tartışma: Turkiye’deki otopsi sayısının az olmasının nedenleri arasında sosyokulturel ozelliklerden ziyade, patologların ve muhtemelen klinisyenlerin motivasyon eksiklii yanı sıra otopsi yapılmasını destekleyici yasal ve yonetimsel deişikliklerin yokluu on plandadır.

Türkiye’de otopsinin durumu ve Patologların otopsi hakkındaki tutumları

While there have been efforts to slow the recent declining trend in autopsy practice in the world, in Turkey there is already a low level of medical autopsy audit, practically nearing zero. In this study, we determine and evaluate the autopsy status in Turkey; reveal pathologists’ attitudes towards autopsy practice; propose several factors to explain current autopsy audit; and discuss differences in Turkey’s autopsy practice with that of the rest of the world. Materials and Methods: We directed a questionnaire to 85 pathologists and requested autopsy numbers from 50 universities for the period 1995 to 2003.Results: Mean values of attended and performed autopsy by pathologists were 24.89 and 21.56, respectively, while medians were both 7. Nearly 60% of pathologists expressed their willingness to perform autopsy, mainly in university hospitals. Half of those attending autopsy were not theoretically trained regarding autopsy performance and only 11.8% were aware of legislative procedures. The majority of pathologists agreed that they should not take part in the consent meeting with parents of the deceased. Seventeen of 50 pathology departments of universities (34%) responded to our request for autopsy audit. From the responders, the highest medical adult and perinatal autopsy numbers/year were 4.25 and 148.75, respectively. Adult medical autopsy was not performed in 10 (59%) of the responding universities. Despite the already low rate of adult autopsy, we determined a significant declining trend over the period studied.Conclusions: We concluded that pathologists and possibly clinicians are not aware of or underestimate the crucial importance of data gathered by autopsy and this seems to have the most important influence on the low autopsy audit in Turkey.

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