Book Review

Understanding the Autopsy

N Engl J Med 1994; 330:1165-1166April 21, 1994

Article

Understanding the Autopsy
By Samuel B. Burgess. 213 pp. Burnsville, N.C., Celo Valley Books, 1992. $22.50. ISBN: 0-923687-26-2

Burgess has written a concise book packed with a great body of knowledge about many aspects of the autopsy. It is one of the few works available to the lay public on this important subject. I share the author's opinion that the autopsy can and does play an important part in societal health issues. The number of autopsies performed in the United States has decreased over the years. Perhaps one way to prevent further decline is to educate members of the public about the performance of the autopsy and to expose them to its value. Informing the public about the procedure may address worries and prompt people to request an autopsy personally or consent to one when asked by a physician.

The book is divided into 17 chapters. Some will help the lay reader gain a greater understanding of the autopsy, such as the chapters on its history and techniques, the autopsy report, the cause of death, and obtaining permission to perform the procedure. Others will be of general interest -- for example, the chapters on the tools of the autopsy and the autopsy and religion. There are chapters, such as that on the special tools of the autopsy -- the microscope and microtome -- that contain great detail and are interesting to read, but are not directly related to the autopsy and indicate a personal interest of the author.

I was somewhat disappointed that important chapters such as those on the value of the autopsy in medical education and the role of the autopsy in quality control in health care were not emphasized sufficiently. Furthermore, the section on the quality of care largely relates to issues in surgical pathology rather than the autopsy. Emphasis on the important role of the autopsy in education and the control of the quality of health care may help families decide to give consent for an autopsy.

Finally I must take issue with a number of statements made by the author, such as the “pathologist is also the policeman, or at least the detective of the medical staff. His vantage point is such that he can see if the practice of any member of the medical staff is not up to acceptable standards.” This attitude creates an adversarial relationship between colleagues and could lead clinicians to order fewer autopsies. The pathologist should never be regarded as a police officer, but rather as a colleague doing his or her job in elucidating the effects of treatment, discovering the cause of death, and often confirming the clinician's premortem diagnosis. Although the autopsy has a role in the ultimate control of the quality of health care, the pathologist should not carry it out in isolation but together with all concerned clinicians in the hospital. I would also question the wisdom, particularly in a book written specifically for the lay public, of referring to pathologists as lazy and stupid and making such statements as “the pathologist is delighted to embarrass the clinicians.” There is little to be achieved by such comments, which in my experience are false and only serve to create a harmful impression of our specialty.

In summary, I would hope that this small book will be responsible for kindling a new interest in the autopsy among the lay public and will convince them that the autopsy is clearly of importance to society.

Cyril Abrahams, M.D.
University of Chicago, Chicago, IL 60637