Skip to main content
NCBI home page
The Ulster Medical Journal logoLink to The Ulster Medical Journal
. 2000 Nov;69(2):83–89.

The declining autopsy rate and clinicians' attitudes.

M B Loughrey 1, W G McCluggage 1, P G Toner 1
PMCID: PMC2449188  PMID: 11196736

Abstract

The autopsy rate has been declining worldwide for decades. This study determined the overall and differential autopsy rates for the Royal Victoria Hospital, Belfast for the years 1997-1999 inclusive. Trends were examined by comparison with previously collected data for the years 1990, 1991 and 1993. Reasons for the decline in autopsy rates as perceived by hospital clinicians were assessed by means of a questionnaire. Over the last decade, there has been a steady decline in the overall autopsy rate from 30.4% in 1990 to 18.4% in 1999. This is due to a decrease in the hospital autopsy rate from 21.6% in 1990 to 7.9% in 1999. The coroner's autopsy rate has remained comparatively unchanged at around 11%. The decline in the overall and hospital autopsy rates involves all of the principal bedholding directorates, but is most dramatic in medicine, surgery and intensive care, where hospital autopsy rates are currently 7% or less. The main reasons for this decline as perceived by clinicians are difficulty in obtaining consent from relatives and advances in modern diagnostic techniques. The findings of this enquiry are in keeping with trends elsewhere, despite repeated studies which clearly demonstrate the continuing value of the autopsy in clinical practice. Recent publicity concerning the retention of organs can only have an adverse affect. Pathologists and clinicians who value the autopsy must become actively engaged in both public and medical education. Renewed emphasis must be placed on the importance of the autopsy in teaching, training and clinically relevant research, and as a means of medical audit.

Full text

PDF
83

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Adickes E. D., Sims K. L. Enhancing autopsy performance and reporting. A system for a 5-day completion time. Arch Pathol Lab Med. 1996 Mar;120(3):249–253. [PubMed] [Google Scholar]
  2. Anderson N. H., Shanks J. H., McCluggage G. W., Toner P. G. Necropsies in clinical audit. J Clin Pathol. 1989 Sep;42(9):897–901. doi: 10.1136/jcp.42.9.897. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Barendregt W. B., de Boer H. H., Kubat K. Autopsy analysis in surgical patients: a basis for clinical audit. Br J Surg. 1992 Dec;79(12):1297–1299. doi: 10.1002/bjs.1800791218. [DOI] [PubMed] [Google Scholar]
  4. Birdi K. S., Bunce D. J., Start R. D., Cotton D. W. Clinician beliefs underlying autopsy requests. Postgrad Med J. 1996 Apr;72(846):224–228. doi: 10.1136/pgmj.72.846.224. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Cameron H. M., McGoogan E., Watson H. Necropsy: a yardstick for clinical diagnoses. Br Med J. 1980 Oct 11;281(6246):985–988. doi: 10.1136/bmj.281.6246.985. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Charlton R. Autopsy and medical education: a review. J R Soc Med. 1994 Apr;87(4):232–236. [PMC free article] [PubMed] [Google Scholar]
  7. Frederikson L., Bull P. An appraisal of the current status of communication skills training in British medical schools. Soc Sci Med. 1992 Mar;34(5):515–522. doi: 10.1016/0277-9536(92)90207-7. [DOI] [PubMed] [Google Scholar]
  8. Goldman L., Sayson R., Robbins S., Cohn L. H., Bettmann M., Weisberg M. The value of the autopsy in three medical eras. N Engl J Med. 1983 Apr 28;308(17):1000–1005. doi: 10.1056/NEJM198304283081704. [DOI] [PubMed] [Google Scholar]
  9. Lauder I. Auditing necropsies. BMJ. 1991 Nov 16;303(6812):1214–1215. doi: 10.1136/bmj.303.6812.1214. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. McKelvie P. A., Rode J. Autopsy rate and a clinicopathological audit in an Australian metropolitan hospital--cause for concern? Med J Aust. 1992 Apr 6;156(7):456–462. doi: 10.5694/j.1326-5377.1992.tb126470.x. [DOI] [PubMed] [Google Scholar]
  11. Sherwood S. J., Start R. D. Asking relatives for permission for a post mortem examination. Postgrad Med J. 1995 May;71(835):269–272. doi: 10.1136/pgmj.71.835.269. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Start R. D., Hector-Taylor M. J., Cotton D. W., Startup M., Parsons M. A., Kennedy A. Factors which influence necropsy requests: a psychological approach. J Clin Pathol. 1992 Mar;45(3):254–257. doi: 10.1136/jcp.45.3.254. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Start R. D., McCulloch T. A., Benbow E. W., Lauder I., Underwood J. C. Clinical necropsy rates during the 1980s: the continued decline. J Pathol. 1993 Sep;171(1):63–66. doi: 10.1002/path.1711710113. [DOI] [PubMed] [Google Scholar]
  14. Whitty P., Parker C., Prieto-Ramos F., al-Kharusi S. Communication of results of necropsies in north east Thames region. BMJ. 1991 Nov 16;303(6812):1244–1246. doi: 10.1136/bmj.303.6812.1244. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Zaitoun A. M., Fernandez C. The value of histological examination in the audit of hospital autopsies: a quantitative approach. Pathology. 1998 May;30(2):100–104. doi: 10.1080/00313029800169036. [DOI] [PubMed] [Google Scholar]

Articles from The Ulster Medical Journal are provided here courtesy of Ulster Medical Society

RESOURCES