The truth is disappearing, along with Post Mortems and those who did them..

When my father died in March his death certificate said “old age”. He was 91.. On the day before he died he complained “I think my insides have died”, and although he recovered that evening he died the following day. I suspect septiciaemic shock due to bowel ischaemia was the real cause… but does it matter? Accuracy is less important with age, but we do know that even in intensive care units there are errors.

Post Mortems (PMs) are absolute. There is no better way to make a diagnosis determining cause of death, and all medical students are taught to respect the ultimate truth displayed by a properly conducted PM. They are an excellent opportunity to learn, and were well attended when I was a student. There was an excellent standard of teaching (and humiliation with good humour), if one was unable to answer a pertinent question. Quality in PMs is easier to measure than the quality of death or dying. Unfortunately there is a perverse incentive (PI) for hospitals to reduce number of PMs to help their finances…… A study in American ICUs in 2006 (where one would expect the most accurate information) showed that the true cause of 40% of deaths was Multiple Organ Dysfuction Syndrome (MODS), and an earlier study showed 40% inaccuracies…

As they are rationed out, the truth is disappearing in the UK Regions, along with Post Mortems. Once those with the skills are retired it will take generations to replace them..

Medical Xpress o June 15th 2015 reported: UK hospital post mortems on verge of extinction, survey reveals

The UK hospital post mortem is on the verge of extinction, having already disappeared completely in around a quarter of NHS trusts, reveals a survey published online in the Journal of Clinical Pathology.

Post mortems are carried out in only just over half of one per cent of all UK hospital deaths, the responses show.

The practice of post mortem examination or dates back to mummification and human dissection in 3000 BC, but is thought to have entered in its current form in the 1800s.

The researchers base their findings on Freedom of Information (FOI) requests submitted to 160 NHS acute trusts in England, 14 NHS health boards in Scotland and 7 in Wales, and 5 social care trusts in Northern Ireland.

The requests asked about the number of post mortems carried out in 2013 as a percentage of all adult inpatient deaths in each trust. Out of the 186 NHS trusts contacted, 184 replied, giving a response rate of 99%.

The average post mortem rate was just over half of 1 per cent of all hospital deaths (0.69%), but it varied across the four UK countries.

The average rate was lowest in Northern Ireland (0.46%) and highest in Scotland at 2.13%. The equivalent figures were 0.51% in England and 0.65% in Wales. These figures are lower than recent studies have suggested, say the researchers.

The procedure had disappeared completely in almost one in four (23%; 38) trusts, the figures show, and most trusts (86%; 143) had a post mortem rate of less than 1%.

And in only 1.8% of specialist trusts did rates exceed 5%—the figure previously published for non-teaching hospitals.

The findings prompt the researchers to comment that the decline in the hospital post mortem has been relentless and has even accelerated in recent years.

“For better or worse, the practice is on the verge of extinction,” they write. But few healthcare professionals or politicians will be aware of this trend, they say, adding: “Consequently, little has been done to address the falling rates, and the implications of this are not yet fully understood, nor are the consequences.”

“Given that 86% of trusts/boards in the UK now have a hospital autopsy rate of [less than] 1%, we must pose the question whether a revival in autopsy is possible?” they say.

“Hospital autopsy now accounts for approximately 1.2% of total autopsies,” they continue. “With such low numbers, questions must be asked regarding the effect such decline has on quality assurance, public health, misdiagnosis (a key contributor to avoidable harms), audit, and the teaching of both medical students and trainee pathologists,” they conclude.

More information: Hospital autopsy: endangered or extinct? Journal of Clinical Pathology, DOI: 10.1136/jclinpath-2014-202700

Provided by: British Medical Journal

and on September 23rd 2015: Hospital trusts fall short of recommended standards on post mortem consent

What do people die of? Mortality rates and data for every cause of death in 2011 visualised

Hospital Death Causes: Hospital Records need to be reformed

Data errors ‘caused high death rates’ at hospital

NHS Weekend: Action demanded over death risk – shocking increase in risk of death…

Some hospitals double odds of death from a heart attack. Survival is better if you live in a city with a tertiary centre..

NHS plan to slash cancer deaths

Child deaths highest in poor areas, Public Health Wales finds – 70% variation in Wales

Quality of death – is not talked about – General Practice is “Closing Down” …

Just cry at the bribery, and the Death of the Goose that used to lay the golden eggs that used to make the Health Service(s) so efficient, and the envy of the world.

This entry was posted in A Personal View, Perverse Incentives, Professionals, Rationing, Stories in the Media on by .

About Roger Burns - retired GP

I am a retired GP and medical educator. I have supported patient participation throughout my career, and my practice, St Thomas; Surgery, has had a longstanding and active Patient Participation Group (PPG). I support the idea of Community Health Councils, although I feel they should be funded at arms length from government. I have taught GP trainees for 30 years, and been a Programme Director for GP training in Pembrokeshire 20 years. I served on the Pembrokeshire LHG and LHB for a total of 10 years. I completed an MBA in 1996, and I along with most others, never had an exit interview from any job in the NHS! I completed an MBA in 1996, and was a runner up for the Adam Smith prize for economy and efficiency in government in that year. This was owing to a suggestion (St Thomas' Mutual) that practices had incentives for saving by being allowed to buy rationed out services in the following year.

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