A lamentable lack of curiosity, Oh Coroner.

Cause of death: 1a) Moyda!

There used to be an old medical joke. It went, “Don’t worry, we’ll soon know what’s wrong with you…just as soon as we’ve got the autopsy findings.”

It’s silliness is matched only by this joke,

Q: "Do you recall the time that you examined the body?"
A: "The autopsy started around 8:30 p.m.."
Q: "And Mr. Dennington was dead at the time?"
A: "No, he was sitting on the table wondering why I was doing an autopsy."

And then there’s this classic lawyer joke,

Q: "Doctor, before you performed the autopsy, did you check for a pulse?" A: "No."
Q: "Did you check for blood pressure?"
A: "No."
Q: "Did you check for breathing?"
A: "No."
Q: "So, then it is possible that the patient was alive when you began the autopsy?"
A: "No."
Q: "How can you be so sure, Doctor?"
A: "Because his brain was sitting on my desk in a jar."
Q: "But could the patient have still been alive nevertheless?"
A: "It is possible that he could have been alive and practicing law somewhere."

Now it seems as if the lawyer joke might apply to the coroner in Staffordshire. And the old medical joke may as well be a throwback to an earlier age as no one’s doing PMs any more.

One of the strengths of medicine is that ultimately we learn from death. It’s called pathology, or morbid anatomy, and the sad fact is that much medicine has been learned from studying patients who have died. It’s the ultimate audit of medicine- we can directly see the path to and the consequences of our mistakes.

Nothing quite replaces the post mortem as a venue for direct hard factual learning about medicine. It’s not pleasant, but it’s real death in all its glory. It’s also sobering for doctors as they realise how little of the pathology present they had discovered in life. In addition, any pathologist will tell you that the percentage of post mortem examinations that find a cause of death that is very different to the suspected cause at the time of death, is highly statistically significant. The true value of pathology is lost behind the TV glamour of sexy young pathologists doing the Police's job and solving murders whilst swimming in a sea of gonadotrophins. The truth, as any doctor will tell you is more like a combined Asperger's/OCD drop-in clinic at a Star Trek fans' convention than Silent Witness.

And so to hear about the excess mortality rate in Staffordshire, and then to realise that the local coroner is being awkward about helping with the enquiry, and prides himself on not doing many post mortems ("I see it as a good thing rather than a bad thing if you can reduce autopsy rates”) adds to Dr Rant’s pessimistic assessment as to whether anyone in the government, NHS or legal hierarchies really gives a damn about anything to do with people dying or quality of life and care.

If we want to start picking up patterns of mortality, then we need each death to be examined independently, and to do more post mortems. At present it seems as if coroners notice nothing, (and will notice even less if they reduce their numbers of post mortems), the hospitals have no overall view, and doctors produce bland certificates, which conceal as much as they reveal. It’s as though we are all in a masquerade dance in which all deaths are entirely natural, and we mustn’t upset the relatives.

It’s a lamentable lack of curiosity, and it’s time that doctors got less squeamish about asking relatives about doing PMs, and that relatives got less squeamish about agreeing to PMs, and that coroners started to show a bit more curiosity into how and why the patients really died. And the Home Office needs to be willing to fund coroners to get post mortems when necessary.

If we actually want to know about the quality of medical services we need to look at deaths closely. Perhaps it is time for a medical coroner to be appointed? After all Julian Tudor-Hart only suggested such an idea 22 years ago.

But he was a real doctor, and such are no longer welcome in the NHS.