Dr Suzy Lishman, President of the UKís Royal College of Pathologists
It sounds counter-intuitive but conducting post-mortems can help save the lives of the living as Suzy Lishman explained to Chris Smith...
Suzy - I donít think we can underestimate just how valuable post-mortems are. And I think people often believe because we now have very sophisticated scanning equipment and we can do lots of tests before people die, that we canít find anything about them or about their disease after death, and repeated research has shown that thatís just not true. We know that around a quarter of post-mortems find really significant findings that may have made a difference to the way in which that person would have been treated had they been known about before their death.
Chris - How many people are having post-mortems now?
Suzy - Around 200,000 people a year have a post-mortem at the request of the coroner, and we know that the vast majority of post mortems done in this country are coroners post-mortems. Only a very small number are done at the request of the doctors or the family. So the numbers have been falling, particularly these consented post-mortems have been falling for some time. And thereís a real problem with that because the coroner's job is just to find out why somebody died as well as who they were, where they died, and just some basic facts like that. Whereas, a consented hospital post-mortem can really do into much more detail and give the family much more information about what happened to their loved one, and the effects of any treatments they might have had, and whether there are any implications for the surviving family.
Chris - And why have numbers fallen?
Suzy - I think itís a combination of things. I think partly people donít think itís necessary any more because people have had scans and they think theyíve got a definite diagnosis before death. So they donít think thereís any point, and nothing else will be gained, and I donít think thatís true. I do think thereís an aversion to having post-mortems because of misconceptions that theyíre not respectful and dignified procedures, and that people feel, when somebodyís died, that they don't want to put them through anything else. And also, I think, hospitals are coming under increasing pressure to do more and more work with fewer and fewer people and so there are not enough pathologists, with enough time to dedicate to doing more and more of these post-mortems. So they're one of the first things to go when the pressure goes up.
Chris - When you say there are not enough people doing this, whatís the evidence of that? Have we actually got a drop in the number of trainees going into pathology as a specialism?
Suzy - The numbers of people training in pathology have stayed relatively constant, although we believe that we need more people than we currently have allocation for. Pathologists now now longer have to do post-mortems as part of their qualifying final exam and that was introduced because we knew that, in a lot of departments, pathologists never did a post mortem again after they became consultants and after they qualified, and so there was no real need for them to learn those techniques if they werenít going to use them again. So we know that a percentage of trainees are no longer training to do those post-mortems but, actually, thatís not really why the number of people available to do them is falling. Itís really because of other pressures on people who are perfectly capable and trained to do post-mortems, who just donít have time to do it. Perhaps their hospitals have said that itís not a priority for them and theyíre so busy making diagnoses for the living, and there are so many targets, for example, to diagnose cancers quickly, that post mortems have really lost out and arenít being valued for the benefits that they can provide.
Chris - And whatís going to be the impact of that downstream?
Suzy - I think thereís a real worry that the post mortem service, and by that I include the coronial service because itís the same doctors providing both types of post-mortem, that it will collapse in some areas. That if you havenít got enough people that are able or willing to do post-mortems, then the service canít be provided and, of course, thatís bad news for relatives because theyíre not getting the answers they need, and theyíre not perhaps getting them as quickly as they ought to.