There is more to a postmortem examination than solving crime

Saturday February 2 2019

 

By Dr Sylvester Onzivua

A lawyer recently asked a doctor to explain the difference between an autopsy and a postmortem and why doctors carry out postmortem examinations even though the cause of death is known. The word ‘postmortem’ means ‘after death’ and the postmortem examination is an examination of the dead body for legal, medical or scientific reasons (including research purposes).
The word ‘autopsy’ means ‘see for yourself’ and is used interchangeably with postmortem examination. The more accurate but rarely used term is ‘necropsy’, which means the examination of a dead body. The postmortem examination is perhaps one of the dreaded and poorly understood medical procedures.

Types of postmortem examinations
There are generally two types of postmortem examinations, the medical and the medico-legal (forensic) postmortem examinations.
The medical postmortem is usually carried out following a request from a physician who attended to the deceased or from relatives of the deceased who would like to know the cause of death of their beloved person. A physician’s interest may also be to know the cause of death and the complications of the disease, and why the patient did not respond to the treatment administered.
The medical postmortem examination is a great teaching tool in medicine. No wonder a professor of pathology used to tell his students that the dead make us wiser and the mortuary has often been called the ‘house of wisdom’.

The medical postmortem examination is a kind of disclosure; it puts to rest the conspiracy theories that often follow a death. And there is no better time to sort out any controversies about the cause of death than immediately by a postmortem examination.
Many times, there is an assumption that the cause of death is known but postmortem studies have shown that in up to 70 per cent of cases, the presumed cause of death is different from the actual cause of death. The postmortem examination is therefore the most accurate means of establishing the cause of death, thereby providing the correct statistics on the causes of death.

Investigating disease
The use of the postmortem in the investigation of new and emerging diseases cannot be overstated. Not too long ago, a number of deaths were reported in the Kitgum sub-region.
The patients presented with abnormal bleeding and deaths occurred within a short time of onset of the sickness.
However, the health workers attending to the patients did not develop the disease. This made the diagnosis of the dreaded viral haemorrhagic fevers unlikely. Postmortem examinations pointed to an outbreak of yellow fever, which was subsequently confirmed when blood examinations were carried out.
A strange disease affecting children is currently ravaging some areas of northern Uganda. The postmortem examinations so far carried out indicate that the disease has affected children born between 1995 and 2005 and who lived in specific locations. Postmortem examinations also show that the disease affects the brains of the children.

Carrying out a medical postmortem
A medical postmortem involves reviewing the history of the illness and the clinical notes including the treatment administered. This is very important and guides the pathologist whether or not to do a postmortem. Postmortems for deaths due to viral haemorrhagic fevers are not recommended in ordinary mortuaries.
In the cause of a medical postmortem, a body is dissected and the organs taken out of the body and individually examined.
The diseased parts and other relevant organs are then sampled for further analysis. This analysis is done in specialised laboratories and the samples examined under a microscope. It is for this reason that a pathologist is best qualified to carry out a medical postmortem.

Special investigations such as examination of blood or culture of micro-organisms may also be carried out. It is prudent that a complete postmortem and investigations are carried out before releasing the postmortem results, which should be consistent with the circumstances of the death. It is certainly unwise and unconvincing to state that a person died of a heart disease when the person had no history of such a disease in his or her life.

Questions to address

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The medical postmortem is also an audit of the management of the patient as well as the entire health care system. When a particular cause of death is established it is then prudent to ask the following:
• Could the patient have been saved, and if so why was the patient not saved?
• Could this disease have been prevented?
• What can be done in the community to prevent such deaths from occurring?

• When did the patient report for treatment?
• What factors in the community and health care system prevented the patient from reporting in time for treatment? Could it be a problem of distance from the health unit?
• Was the appropriate care given to the patient at the health unit? This will involve the review of who attended to the patient, the time the patient was attended to and the treatment administered.
• Why the patient did not respond to the treatment? What alternative drugs could have been given to the patient and why these were not given.

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