Experts agree, Russia might soon lose its ability to verify the health of its people

Because pathologists work out of the sight of the public in medical laboratories, their essential role in the quality of medicine that is delivered in a nation is typically undervalued. This is even truer of the contribution pathologists make when they conduct autopsies to investigate and identify a patient’s full range of ailments and health conditions at the time of death.

In Russia, leading pathologists are beginning to educate the public about these points. Fewer than 60% of Russians are autopsied when they die. That’s according to the Russian Society of Pathologists, whose President met recently with the members of the Public Chamber to discuss the lack of adequate postmortem services in Russia.

During the meeting, Lev Kaktursky, President of the Russian Society of Pathologists, and Director of the Institute of Human Morphology, joined with doctors to complain about the declining number of autopsies, and to warn Russian politicians that the country was in danger of not being able to ascertain the health of its people.

Number of Deaths Not Accompanied by an Autopsy

Many clinical laboratory professionals grew up during a time when Pravda was the news service mouthpiece for the Soviet Union. Today, Russians enjoy greater freedoms, and Pravda has a role as a news outlet.

In a Pravda article, Kaktursky was quoted as saying that:

• “Fewer than 60% of people who pass away in [Russian] hospitals get an autopsy,
• “[of] Russians who die at home, an autopsy is conducted only in 10-15% of cases,
• “The share of [Russians] who died at home in 2008-2010 was 80%.”

He went on to note that “the low number of postmortem studies conducted in Russia does not allow health authorities to obtain accurate information about the causes of their death. In addition, defects in clinical diagnosis, and associated faults of clinical work, remain out of sight of the leaders of medical institutions.”

(Members of the Russian Society of Pathologists’ Presidium from a conference at Tula in February 2009. From Left: O. D. Mishnev, M.D., Professor, Chief Pathologist of the Ministry of Public Health and Social Development; P. V. Kakturskiy, Professor, President of RSP; O. A. Trusov, M.D., Professor, RSP Presidium member; А. I. Shchogolev, M.D., Professor, the Secretary General of RSP; А. P. Rakshu, M.D., Professor; and, D. S. Melnichenko, Head of Morbid Anatomy Department of the Consulting and Diagnostic Center No.1. Photo copyright BioVitrum.)

Dark Daily observes that Kaktursky’s comment above directly refers to the situation where the Russian healthcare system lacks many of the institutional safeguards designed to ensure that a physician provides appropriate care to a patient, and that medical errors are detected in a timely fashion. Over the past 100 years, pathologists in the United States have played an important role in monitoring the quality of surgical services and the quality of diagnoses provided by physicians.

Kaktursky also stated that “the reason for it was the fact that pathologists reported to hospital administrators not interested in the discrepancies between diagnoses.” He suggested “converting pathological service to an autonomous structure with the creation of pathological offices not reporting to medical institutions.”

Kaktursky claimed that one reason for the declining rate of autopsies was the “desire” on the part of funeral businesses to arrange the services quickly. He proposed a new law that would require autopsies for all deaths, and that would also take into account any notarized document that expressed the while-living “will” of the individual as to the post-death use of their organs and tissues. Predictably, so-called Russian experts rejected Kaktursky’s suggestions stating that “the bill contains provisions that prevent the improvement of the situation.”

Misperceptions Lead to a Lack of Certified Pathologists in Russia

In most nations, pathologists are generally held in the same high regard as primary care physicians. Apparently, not so in Russia.

“Most of the time we work with the biopsy material,” said Valentine Sergeichenko, a Moscow pathologist, in the Pravda article. “We are diagnosticians and radiologists. We are also clinicians, physicians and surgeons. Most people think that we work with corpses. Yet, in reality, when a pathologist examines biopsy material obtained, for example, from a patient suffering from [a] benign (or malignant) breast tumor, the life of the patient depends on our conclusion.

“Autopsies that are believed to be our main job, unfortunately, may soon become the past,” he continued. “Why unfortunately? Until 1990, we were conducting autopsies in nearly 70% of all deaths. This allowed us to know the cause of death and mortality rates from various types of pathologies. Most importantly, we were able to establish the reasons for misdiagnosis, and our conclusions were a learning material of practitioners.

“In 1991, the Duma passed a law that autopsy can be done only with the relatives’ consent,” Sergeichenko explained. “This may cause impunity for physicians. The patients will die, they will be buried, and no one will be asking questions. Moscow and other regions adopted sub-laws stating that if a patient had at least some medical procedures after the admission to a hospital, the autopsy was mandatory.

“Yet, Russian people found some loopholes,” he added. “The relatives of the deceased would give doctors money in an envelope. The doctors would indicate the causes of death communicated to them by the relatives. Five to six years later, we will encounter a situation where doctors will absolutely not be afraid of making mistakes,” Sergeichenko conclude.

The Effects of an Aging Pathologist Population

“The profession is not popular among youth due to low salary,” Sergeichenko conceded. “In any other developed country, a pathologist is paid only a little less than a surgeon, because in the West people realize that without the pathological anatomy it is impossible to properly diagnose.”

Thus, Russia may be facing a crisis. According to the Pravda article, in 2010:

• more than half of the Russian forensic experts were over 60 years old,
• 40-45% were close to the retirement age, and,
• no more than 2-3% of pathologists were young people under the age of 30.

Pathologists and clinical laboratory managers in the United States and other advanced nations will immediately recognize the problems described by the Russian pathologists. In countries around the world, the ratio of autopsies performed to deaths has steadily declined. Cost savings may have resulted, but the lack of this vital clinical information makes it more difficult to ascertain the accuracy of diagnosis and the actual contributing causes of death.

In recent months, the Public Broadcasting System (PBS) televised a FRONTLINE investigation into the shortage of forensic pathologists, and the declining number of autopsies performed in the United States. The program is titled “Post Mortem: Death Investigation in America.”

Despite the differences in clinical practices from one country to the next, many of the primary issues in healthcare are the same. In Russia, the aging pathology workforce, the inadequate number of pathologists, and the decline in the number of autopsies performed are trends that have their parallels in many other countries.

Related Information:

What Makes a Person Become a Pathologist? (Pravda)

Anatomopathology Becomes a Vanishing Profession