Death of the teaching autopsy: Hospital and coroners' postmortem examinations are different, not least in payment
BMJ 2004; 328 doi: https://doi.org/10.1136/bmj.328.7432.165-a (Published 15 January 2004) Cite this as: BMJ 2004;328:165
All rapid responses
Rapid responses are electronic comments to the editor. They enable our users to debate issues raised in articles published on bmj.com. A rapid response is first posted online. If you need the URL (web address) of an individual response, simply click on the response headline and copy the URL from the browser window. A proportion of responses will, after editing, be published online and in the print journal as letters, which are indexed in PubMed. Rapid responses are not indexed in PubMed and they are not journal articles. The BMJ reserves the right to remove responses which are being wilfully misrepresented as published articles or when it is brought to our attention that a response spreads misinformation.
From March 2022, the word limit for rapid responses will be 600 words not including references and author details. We will no longer post responses that exceed this limit.
The word limit for letters selected from posted responses remains 300 words.
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
Competing interests: No competing interests
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.
Competing interests: No competing interests
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
Competing interests: No competing interests