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01/26/2006: "Never Believe a Death Certificate"
Ask a member of the public what the reason is for doing an autopsy (never call it a 'necropsy' by the way) and you will probably be told that it is to find out the cause of death; this is a very sensible answer since that is what crime stories on TV, radio and printed page (including mine, I admit) tell them. There is, however, another and equally important reason for doing post mortems, one that is not suited to the ends of the crime writer. That is to determine what diseases people have and die from; in other words, a public health role. The autopsy is the most accurate method of determining what is killing the public in this country. Study after study (and not all by pathologists) has shown that clinical impression, blood investigations and all imaging techniques get it wrong a significant percentage of the time. In something like 25% of cases the PM finds something that the clinician didn't know about but would like to have done; in 10% of cases that 'something' would have affected the clinical management of the patient.
So what does this mean?
Well, for a start off, it means that a significant percentage of the death certificates in this country are inaccurate, and that means that the Public Health authorities only have a hazy picture of what people are dying of. That, in itself, might not be too catastrophic but we now have the Human Tissue Act which is one of the most misguided pieces of legislation by a government that seems to excel at such stupidity. Because of this, when a Coroner's post mortem is done, I cannot by law doing anything other than direct my investigation towards finding a cause of death. If I find something that I think requires further investigation - that might, for instance, be a familial disease with consequences for the rest of the family - I will potentially be imprisoned if I take small samples and look at them microscopically. If I find a rare disease (again not related to the cause of death) the educational value of taking a sample to show to junior doctors or lab staff has now gone; similarly so, if samples are required for research.
All of this was done to stop abuses such as Alder Hey, and that is a worthy objective, but I can't help feeling that once again potential criminals are being created rather than the existing ones dealt with.
Keith McCarthy on Thursday, January 26th 2006 @ 09:11 AM GMT [link]