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Education And Debate

Death of the teaching autopsy

BMJ 2003; 327 doi: https://doi.org/10.1136/bmj.327.7418.802 (Published 02 October 2003) Cite this as: BMJ 2003;327:802

Rapid Response:

Autopsy findings are important to all clinicians, including general practitioners.

Dear Richard Smith

In his article, ‘Death of the teaching autopsy’, Gregory O’Grady
identifies several reasons why autopsy rates have been falling worldwide,
and why, in particular, students in New Zealand are now banned from
attending autopsies (a consequence of unconsented organ retention
practices), with resultant loss of undergraduate teaching
opportunities.(1) However, the processes of attending and watching an
autopsy are not the only educationally relevant facets of autopsies.
Autopsy findings are important to all clinicians, including general
practitioners.

In 1991, Whitty et al (2) found that autopsy findings (excluding
coroner’s reports) were poorly communicated to GPs in four districts in
the North East Thames Region. GPs received reports from only 39 of 89
(47%) autopsies performed on their patients. In our study of deaths in a
general practice (n=578) which ascertained 97.8% of all practice deaths
over a 15 year period, the value of a death register in contributing to
clinical governance was severely curtailed by lack of cause of death
information. (3) Over the 15 year period, 143 (24.7%) deaths were reported
to the coroner, a percentage comparable to the UK average for all deaths.
However, in only 4 (2.8%) of these deaths was the practice routinely sent
a coroner’s report on the results of the autopsy investigation. After
contacting relevant coroners specifically to request cause of death and
autopsy information, no report was provided on 65 (61.3%) occasions (see
table), an experience similar to that reported from Manchester.(4) Given
the pivotal position of general practice within the UK NHS, these findings
point to significant disconnection of autopsy services from clinical
services.

O’Grady laments the development of a vicious circle, whereby lack of
student contact with autopsies means clinicians will no longer be
‘advocates of autopsies’. Since 90% of all autopsies in the UK are now
performed by coroners (5) it is not surprising clinicians should feel
unable to advocate autopsies. Failure to feedback autopsy information to
GPs represents a lost educational opportunity on an enormous scale, which
could fairly easily be corrected.

Frequency with which coroner’s reports were received (August 1985 to
July 2000) by an inner London general practice.

Coroner’s report	    Freq	  %
Received unsolicited	       4	  2.8
Requested and received	      41	 28.7
Requested not received	      65	 45.5
Not requested/not received    27	 18.9
Verbal information only	       6	  4.2
Total	                     143        100.0

Yours sincerely

Brian Hurwitz

Professor of Medicine and the Arts and GP Principal

King’s College Strand, London WC2R 2LS.

Brian.hurwitz@kcl.ac.uk

Berry Beaumont

GP Principal

2 Mitchison Road,
London N1 3NG.

1. O’Grady G. Death of the teaching autopsy. BMJ 2003; 327: 802-3

2. Whitty P, Parker C, Pietro-Ramos F,Al Kharusi S. Communication of
results of necropsies in north east Thames region. BMJ 1991; 303: 1244-
1246.

3. Beaumont B, Hurwitz B. Is it possible and is it worth keeping
track of deaths within general practice? Results of a 15 year
observational study. In press QSHC (expected date publication Oct 2003).

4. Webb R, Esmail A. An analysis of practice-level mortality data to
inform a health needs assessment. BJGP 2002; 52: 296-299.

5. Underwood J. Commentary: Resuscitating the teaching autopsy. BMJ
2003; 327: 803-4.

Competing interests:  
None declared

Competing interests: Coroner’s report Freq %Received unsolicited 4 2.8Requested and received 41 28.7Requested not received 65 45.5Not requested/not received 27 18.9Verbal information only 6 4.2Total 143 100.0

06 October 2003
Brian S Hurwitz
Professor of Medicine and the Arts, King's College, London
Berry Beaumont
King’s College Strand, London WC2R 2LS.