Medical Research: What is the background for this study? What are the main findings?
Mr. Turnbull: Autopsy has been used to advance medical knowledge and understanding of pathological processes for millennia but increasing evidence indicates its decline in the UK and elsewhere. This study not only confirms that but suggests autopsy for learning purposes has almost disappeared.
In the United Kingdom autopsy is divided into medico-legal autopsy (that required by law under the jurisdiction of HM Coroner) and consented autopsy (performed with the consent of the bereaved or their family). Over the past half-century, small single site studies have noted a marked decline in consented autopsy rates, however there has been no study for over 20 years to determine the extent of the decline nationwide.
This study examined all acute NHS Trusts within England, NHS Boards in Scotland and Wales and Social Care Trusts in Northern Ireland. We found that the average autopsy rate (the percentage of adult inpatient deaths which under go consented autopsy) in the United Kingdom in 2013 was only 0.7%. The study showed that in nearly a quarter (23%) of all NHS Trusts in the United Kingdom, consented autopsy is now extinct.
These findings may have implications for training, for research and for learning from mortality – a key aspect of patient safety.
Medical Research: What should clinicians and patients take away from your report?
Mr. Turnbull: Consented autopsy has the potential to bring multiple benefits to the medical community by aiding in clinical audit, quality assurance, public health, misdiagnosis (a key contributor to avoidable harm), epidemiology and the teaching of trainee pathologists and medical students. For many of today’s consultants and professors, autopsy may have been a frequent and important educational experience yet now the majority of medical students graduate having never seen an autopsy performed.
Families may request an autopsy or be approached for consent following the loss of a relative. Unfortunately this practice is dwindling despite research showing that autopsy can help relieve feelings of guilt and aid closure. It may also reveal underlying inheritable medical conditions which would have important implications for the health of their children.
Clinicians and patients should understand that autopsy, which once was of vital importance, has been reduced to a rarity in modern medicine – for the better or the worse. Unless the medical and lay community act now then consented autopsy shall soon be extinct along with all the benefits it can bring. This may be a societal decision but if clinicians recognise an importance in autopsy, they should act soon to prevent its demise.
Medical Research: What recommendations do you have for future research as a result of this study?
Mr. Turnbull: Further research should be focused on quantifying the benefits of autopsy and examining the reasons for the decline in numbers. It should look at the impact that low autopsy figures have on patient safety, clinical audit and research, public health, and teaching. Ultimately, while this research and the debate on consent autopsy occurs, unless action is swiftly taken it shall be too late to revive this tried and tested method. It should examine whether alternative methods of understanding the cause of death are valid and whether limited, focused autopsy has a role.