Author’s reply

Abstract

I thank Professor Stuart for his comments. The discrepancies between clinical and autopsy diagnoses and the inaccuracies of death certification as cited by Cameron et al. are well known¹ and bear reiteration.

The centralisation of autopsies may be a practical approach to a thorny problem. Ideally, every hospital would have a decedent affairs programme which assures a high autopsy rate; there would be a modern autopsy facility staffed by expert prosectors, supervised by knowledgeable and interested pathologists, all paid for by ‘the healthcare system’. The attending clinician would attend the autopsy and gain immediate knowledge and benefit. In most American hospitals that ideal is simply not available.

The regionalisation of autopsies in a single facility under the auspices of a medical school or medical examiner’s (coroner’s) office would optimise the utilisation of scarce resources. One university medical centre in the United States has already done this: it contracts with 23 community hospitals, both locally and up to 200 miles away. The community hospitals’ pathologists do not do autopsies, the community hospitals do not need to invest in space and personnel and these savings are passed on to the university as payment for performing the autopsy. The university thus gets sufficient numbers of autopsies for medical student and resident training, the autopsies are performed by people who are skilled and interested in doing them and there is sufficient material for research and publication, allowing the university to attract pathologists dedicated to the autopsy. With modern information and imaging systems, autopsy reporting is prompt and the distances are no problem.

Is such centralisation ideal? No! But is it a potential viable alternative? Yes! Is it a ‘ghetto of the dead’? Perhaps, but with a marquee that reads: Hic locus est ubi mors gaudet succurrere vitae (This is the place where the dead give sustenance to the living).