How post-mortems save lives

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 don't 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 can't find anything about them or about their disease after death, and repeated research has shown that that's 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 there's 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 it's a combination of things. I think partly people don't think it's necessary any more because people have had scans and they think they've got a definite diagnosis before death. So they don't think there's any point, and nothing else will be gained, and I don't think that's true. I do think there's an aversion to having post-mortems because of misconceptions that they're not respectful and dignified procedures, and that people feel, when somebody's 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, what's 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 weren't going to use them again. So we know that a percentage of trainees are no longer training to do those post-mortems but, actually, that's not really why the number of people available to do them is falling. It's really because of other pressures on people who are perfectly capable and trained to do post-mortems, who just don't have time to do it. Perhaps their hospitals have said that it's not a priority for them and they're 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 aren't being valued for the benefits that they can provide.

Chris - And what's going to be the impact of that downstream?

Suzy - I think there's a real worry that the post mortem service, and by that I include the coronial service because it's the same doctors providing both types of post-mortem, that it will collapse in some areas. That if you haven't got enough people that are able or willing to do post-mortems, then the service can't be provided and, of course, that's bad news for relatives because they're not getting the answers they need, and they're not perhaps getting them as quickly as they ought to.