25% of autopsies substandard

The big news in histopathology at the moment is the release of the latest report from NCEPOD (National Confidential Enquiry into Patient Outcome and Death). This year the report is ‘The Coroner's Autopsy: Do we deserve better?’ My printer churned it out at the weekend and it makes for interesting reading. Of course many pathologists will rightly say ‘I told you so’ about much of it, but at least we now have evidence for our grumblings. One of the things that struck me, apart from the annoying lack of contents and page numbers in the pdf I downloaded, was the discussion of the purpose of the coronial autopsy (found in section 4 of the report). The authors suggested a range of possible answers to this:

1. To consider and exclude homicide

2. To consider and exclude unnatural death

3. To provide an acceptable – though not necessarily correct – medical cause of death for registration purposes

4. To provide the correct medical cause of death and accurate data for national statistics

5. To provide an account of sufficient, accurate detail to address any concerns from the next of kin and to be useful to them

6. To provide detailed information for medical audit and explanation of events following medical interventions

7. To provide the basis for a publishable case report

The authors thought that the current coronial autopsy fulfils the first 3 at least. I think (hope?) in most cases it should also fulfil the fourth. In an ideal world I’d like to think it would fulfil 1-6, as well as serve other purposes such as training and research, with appropriate consent.

Overall the authors found that 25% of coronial autopsy reports were ‘poor’ or ‘unacceptable’ according to their criteria. Note that they were reviewing the autopsy report and additional information available to the pathologist, not standing and watching the autopsy being done – an impossible task when reviewing over 1500 autopsies done across England, Wales and beyond in the space of one week! However a poor report doesn’t necessarily mean the autopsy itself was badly done, and a badly done autopsy might be disguised to some extent by a well written report.

One point made in the report is that if 25% of surgical operations were substandard there would be an outcry and it is because of the lack of knowledge on this issue amongst the public that there is no protest about the state of coronial autopsies. Despite this, since the publication of the report there has still been little outcry. Why not?

Well I don’t know but I’m going to have a think about it, and I’m going to say more about the report later. In the meantime, you can read it yourself here.