Health care must be both evidence based and humanity based

Editor—Jane Turner and Beverley Raphael missed several opportunities in their editorial on requesting necropsies and breaking other bad news.1

Firstly, they missed the opportunity to move away from the tendency of experts to lead from the rear, exhorting the troops at the front line to do more and do it better. It ought to be a principle that at least one coauthor of such editorials should work in a specialty targeted for advice and have day to day involvement in requesting necropsies.

Secondly, they missed the opportunity to criticise the notion of the necropsy as “the final audit” and to reinforce the point that these procedures are no more error free than any other process of gathering information. There is too little scientific evidence on the reliability, sensitivity, and specificity of necropsy data to permit this view to remain unchallenged.

Thirdly, they failed to recognise that changing the attitudes of doctors requires more than mere instruction. Medical students' attitudes change—and not always for the better—during their training, but the process is gradual and is little affected by formal educational courses. Behaviour patterns can, however, be modified, and the first step is to make it clear that clinical examinations will include marks for empathic interpersonal communication.

Fourthly, and most importantly, the authors failed to acknowledge the importance of the structural context of acute health care. The …