Death of the teaching autopsy

Editor—O'Grady identifies several reasons why autopsy rates have been falling worldwide, in particular why students in New Zealand are now banned from attending autopsies, with resultant loss of undergraduate teaching opportunities.¹ However, attending and watching an autopsy are not the only educationally relevant facets of autopsies: their findings are important to all clinicians, including general practitioners.

Whitty et al found that autopsy findings (excluding coroners' reports) were poorly communicated to general practitioners in four districts in the north east Thames region. They received reports from only 39 of the 89 (47%) autopsies performed on their patients.²

In our study of 578 deaths in a general practice (97.8% of all practice deaths) over 15 years the value of a death register in contributing to clinical governance was severely curtailed by lack of cause of death information.³ Overall, 143 (24.7%) deaths were reported to the coroner, a percentage comparable with the average for all deaths in the United Kingdom. However, in only four (2.8%) of these deaths was the practice routinely sent a coroner's report on the results of the autopsy. After contacting relevant coroners specifically to request cause of death and autopsy information, no report was provided on 65 (61.3%) occasions (table), an experience similar to that reported from Manchester.⁴ Given the pivotal position of general practice in the NHS, these findings point to significant disconnection of autopsy services from clinical services.

Table 1.

Frequency with which coroners' reports were received in an inner London general practice between August 1985 and July 2000³

Coroner's report	Frequency (%)
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)

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.¹ As Underwood says in his commentary, 90% of all autopsies in the United Kingdom are now performed by coroners, so it is not surprising that clinicians should feel unable to advocate autopsies. Failure to feed back autopsy findings to general practitioners is a lost educational opportunity on an enormous scale that could fairly easily be corrected.