Hospital autopsy: standardised questionnaire survey to determine junior doctors' perceptions

Despite the recommendations of the Joint Working Party of the Royal College of Pathologists, the Royal College of Physicians of London, and the Royal College of Surgeons of England, the rate at which hospital postmortem examinations are carried out continues to decline.¹ We aimed to find reasons why doctors request an autopsy, whether the findings were communicated to the doctors who requested it, and the effects of such communication on the practice of junior doctors.

Methods and results

In July 2000, we sent a standardised questionnaire to junior doctors working in acute medical and surgical specialties in three hospitals in Mid-Trent. The doctors were asked what the reasons were for requesting a hospital (non-coroner's) postmortem examination, whether they were told when the examination was taking place, and whether they attended. They were also asked how often they were informed of the results of such an examination, either by the pathologist or by their consultant, and whether the results of an autopsy had ever changed their practice.

Results

We distributed the questionnaire to 96 junior doctors and it was returned by 82 (28 junior house officers, 30 senior house officers, and 24 specialist registrars). Of these, 18 were unable to complete the survey as they had never requested a non-coroner's postmortem examination. The results from the remaining 64 respondents are summarised in the table. “Consultant request” and “cause of death unknown” were the most common reasons for requesting an autopsy. The reasons given to relatives when asking permission for autopsy ranged from “uncertain cause of death” to “medical curiosity.” Only eight respondents who had requested a postmortem had been told when it was taking place and only four had been able to attend. Almost half had never been informed of the results. Consequently, a similar number stated that they had never changed their practice on the evidence of autopsy findings. Four respondents reported that the results of an autopsy had, however, frequently changed future patient management. However, 75% of junior doctors still believed that the autopsy was a useful tool, with most stating that it was there to help establish an unknown cause of death in a patient.

Comment

This study indicates that the recommendations of the joint working party have not been implemented and that communication between pathologists and junior doctors remains poor. The joint working party recommends that “responsibility for obtaining permission for an autopsy should lie with the consultant in charge of the case.” In the current study, the majority of junior doctors requested an autopsy themselves and most were successful in obtaining permission from the relatives. The party also recommends that “the autopsy or at least a demonstration of the major findings should be attended by a member of the clinical team.”

Autopsy findings differ noticeably from clinical diagnoses in 10% of cases. As awareness of clinical errors increases both within the profession and in the general public, feedback from postmortem examinations to clinicians responsible for patient care must be given.

Table.

Junior doctors' responses to a questionnaire on postmortem examinations

Question	No (n=64)
Reasons for autopsy*:
Consultant's request	38
Cause of death unknown	36
Medical education	10
Family's request	2
No reason given	5
Doctors informed of autopsy taking place:	8
Respondents able to attend autopsy	4
Doctors informed of autopsy results:
Never	30
In 25% of cases	16
In 50% of cases	10
In 75% of cases	2
Always	4
Change in practice as a result of autopsy:
No	28
Sometimes	26
Often	4

^*Respondents were allowed to cite more than one reason.