Postmortem examinations: general practitioners' knowledge, behaviour, and attitudesBMJ 1994; 308 doi: https://doi.org/10.1136/bmj.308.6936.1080 (Published 23 April 1994) Cite this as: BMJ 1994;308:1080
- A Berlin,
- R Wagstaff,
- R Bhopal,
- J Spencer
- Department of General Practice, St Mary's Hospital Medical School, Lisson Grove Health Centre, London NW8 8EG.
- Department of Primary Health Care, University of Newcastle upon Tyne, Newcastle upon Tyne NE2 4HH Department of Epidemiology and Public Health Medicine
- Correspondence to: Dr
- Accepted 7 February 1994
Postmortem examinations help to educate doctors and may reassure the relatives of the person who has died.1 They provide information that may alter the future clinical management and outcome of a condition2; help ensure and indicate the quality of death cerification, on which mortality statistics are based; and may provide some indication of the quality of a patient's care. About a fifth of deaths are followed by a postmortem examination; three quarters of these are requested by coroners for legal, not medical, reasons.3 General practitioners issue over a quarter of death certificates (S Denley and A Berlin, unpublished data, 1992), but rarely request postmortem examinations; exact figures are difficult to obtain. We assessed the knowledge, attitudes, and behaviour of general practitioners with respect to postmortem examinations and reports.
Methods and results
All general practitioners in the areas covered by Newcastle and Sunderland Family Health Services Authorities, in north east England, were sent a questionnaire about their patients' deaths. We asked, among other questions, whether the doctor had requested a postmortem examination or report and for her or his opinions on the value and availability of postmortem examinations. A covering letter and prepaid envelope were enclosed. A reminder and a second copy of the questionnaire were sent after two weeks, and after a further two weeks the remaining non-respondents in Newcastle were followed up by a telephone call to their practice managers. Telephone follow up was not done in Sunderland because in Newcastle it resulted in only two additional responses.
Two hundred and thirty of the 305 questionnaires sent out were returned, of which 227 (74%) could be analysed as they were complete (126/161 (78%) from Newcastle and 101 (144 (70%) from Sunderland). As the findings from both cities showed no significant differences we combined the data.
The table shows the main findings of the survey. A sixth of general practitioners did not know that they could request a postmortem examination for clinical reasons without contacting a coroner, and half had never done so while in general practice. A sixth of general practitioners had requested a postmortem examination in the past year, although most had requested a postmortem report at some time. Information gained from postmortem examinations was perceived as useful: almost all general practitioners reported that they would value receiving copies of all postmortem reports and that coroners and hospital pathologists should supply reports routinely, although most did not think that coroners should charge for postmortem reports. Almost half of general practitioners thought that more postmortem examinations should be requested to improve audit of deaths.
The report Autopsy and Audit stated that requests from general practitioners for postmortem examinations should be encouraged.3 Though most general practitioners regard postmortem examinations as valuable, however, few request them and some are not even aware that they can do so. This may be because arranging one from the community is difficult: one general practitioner commented that it required several telephone calls and a visit to the pathologist. Furthermore, whether sufficient facilities exist to cope with an increase in requests is unclear.
Our most notable finding was the overwhelming demand among the general practitioners for postmortem reports. Local pathologists and coroners do not routinely supply reports to the general practitioner, but general practitioners clearly want them to. Similar findings have been reported elsewhere.5
Irrespective of who requests postmortem examinations, the benefits of the findings may be lost if reports are not readily available to the relevant doctors, whether they work in a hospital or in the community. We propose that a copy of every postmortem report should be sent to the family health services authority, which could forward it to the appropriate general practitioner.
We thank Sharon Denley for her help with the survey and the database and Rosie Stacy for comments on the drafts. This project was funded by the Department of Health.