Rapid Responses to:

LETTERS: John C Alcolado Death of the teaching autopsy: Hospital and coroners' postmortem examinations are different, not least in payment BMJ 2004; 328: 165-a [Full text]

Rapid Responses: Submit a response to this article

Rapid Responses published:

One bad apple

Simon Rose   (16 January 2004)

Is it really one bad apple?

Umesh Prabhu   (17 January 2004)

Monetry gain is pathetic in coroners post mortems

MARY N. SHEPPARD   (21 January 2004)

One bad apple 16 January 2004
Simon Rose, Consultant Histopathologist RUH Bath BA1 3NR Send response to journal: Re: One bad apple	JC Alcolado (letters 17th Jan) describes a consultant pathologist insisting that a case be referred to the Coroner for an autopsy and he implies that this was for financial gain (which, from his account, seems possible). Such behaviour by any of the 6 consultants in my department would be completely unacceptable and I am sure that the vast majority of histopathologists in the UK would agree. His suggestion that financial gain be taken out of the equation could perhaps be applied to many fields of medicine, although the new contract would imply that this is not current policy. I would gladly stop doing my extracontractural Coroner's work and forgo the relatively small income derived from it. Indeed, we have recently turned down the offer of an increase in this work despite what Dr. Alcolado views as the "substantial payment" offered! Competing interests: I perform Coronial autopsies - see text.
Is it really one bad apple? 17 January 2004
Umesh Prabhu, Consultant Paediatrician The Pennine Acute Hospitals Trust Send response to journal: Re: Is it really one bad apple?	I congratulate Dr. Alcoldo for his bravery and do sympathise with Dr. Rose and understand his comments. Unfortunately we got to too many bad apples in our profession. Of course vast majority doctors do work hard and provide excellent quality of care but unfortunate reality is that for a long period too many bad apples have been tolerated in our profession and even the profession has shied away from addressing these bad apples. Here are some examples in which 'bad apples behave and bring the profession in to disrepute. a) Arrogant, rude and abrupt mannerism toward patients and staff. b) Providing poor quality care c) Keeping long waiting list for private practice d) NHS lists are practically empty but lots of waiting list initiatives. f) Refusing to allow experienced middle grades to carry out procedures in the name of quality (reality is waiting list money and private practice) g) Bullying, harassment and subtle racism h) Undermining other members of the team. i) More medico-legal work and other paid work during NHS time. Of course there will always be 'bad apples' but one bad apple, which is left untouched, will either spoil other good apples or tarnish the group of apples where most apples are good. Competing interests: None declared
Monetry gain is pathetic in coroners post mortems 21 January 2004
MARY N. SHEPPARD, consultant pathologist royal brompton and Harefield hospital Trust, sydney st london sw3 6np Send response to journal: Re: Monetry gain is pathetic in coroners post mortems	I read the letter from Alcolado in disbelief!. He remembers as a house officer requesting a postmortem and being forced to make it a coroners at the request of a pathologist. First let me make it clear, nobody can force someone to make a death into a coroner's post mortem if a cause of death is established. The doctor simply signs the death certificate to this effect. I know of no pathologist who can bend the ear of the coroner to this extent!. It is the opposide in my experience, cases are often not referrred to the coroner who should be and are not i.e. post operative deaths. Secondly the idea that the pathologist receive "a substantial payment" for each cornoners post mortem is laughable. I get the princely sum of £78 for each post mortem case I do and this often involves 4-6 hours of work because I deal with complex post operative deaths usually requiring detailed examination and histology. As a matter of fact the BMA is looking into the pathetic fees for coroners autopsies and campaigning for a marked increase. The pathologist who forced John A. Alcolado to turn a case into a coroners must have been indeed desperate to waste his/her precious time for this substantial sum of £78!. Also all coroners cases in my hospital are actively used for teaching and audit purposes. Yes we need to retain the autopsy for the invaluable clinicopathological correlation, training, teaching,audit and epidemiological service it provides. Personal financial gain while being a powerful incentive, is singularly lacking, given the time I devote to my "average post mortem". Competing interests: None declared