Death of the teaching autopsy

Editor—McDermott accepts that he is in conflict with his professional bodies when he champions the idea of consultant histopathologists being responsible for obtaining consent for autopsy.¹

He describes a series of pre-autopsy meetings. These “often difficult negotiations” with families covered a high proportion of the 83 autopsies he performed in the 32 months under study. They usually included input from a member of clinical medical staff, a consultant pathologist, a social worker, nursing staff, with or without a chaplain. A disproportionate 46% of meetings or autopsy related work occurred during a weekend or public holiday. He states that this work had to take precedence over other work—presumably diagnostic work for living children—and presumably also over his family life.

His enthusiasm is laudable, but he is living in a completely different world from the rest of us. Eighty three autopsies in 32 months is equivalent to 31 a year. In my department we each do about 140 a year in addition to an individual diagnostic workload of adult cytology and biopsy and resection specimens that is several multiples of a paediatric pathologist's annual quota. A cost per case analysis of his autopsy practice, including the costs of ancillary staff, would be informative.

Many pathologists did not, and many trainees will not, enter the specialty with a desire or ability to embark on negotiations with grieving relatives and social workers. Clinicans, who already have a relationship with the family and can explain the clinical benefits to be derived from the results of an autopsy should request the examination if they believe that it will be of benefit to the family or future siblings. Of course pathologists must support clinicians with training and explanation of what the procedure will entail.