Death of the teaching autopsy

Editor—Like Underwood, I, too, lament the demise of the postmortem examination.¹ He points out that 90% of postmortem examinations in British hospitals are now coroners' cases. However, neither he nor O'Grady mentions that a significant financial incentive exists for many pathologists to perform a coroner's postmortem examination rather than a hospital examination.¹

As a naive senior house officer I recall pleading with a consultant pathologist to perform a hospital postmortem examination on one of my patients, mainly for teaching purposes. He was insistent I referred the case to the coroner, even though I was clear as to the cause of death and there were no suspicious circumstances.

I discovered only later that consultant pathologists at that hospital (but not my current institution) received a substantial payment for each coroner's postmortem examination that they performed. When a pathologist performs such an examination the report and findings belong to the coroner and the teaching of doctors and medical students becomes an incidental issue.

I have little time for the witch hunt that followed the retention of organs from coroners' postmortem examinations in the United Kingdom, but perhaps it did focus minds on the difference between a hospital and a coroner's examination. Isn't it about time that personal financial gain was taken out of the equation?