Table 3

Quotes illustrating concerns of less invasive autopsy

ThemeIllustrative quotes
Concerns
Not reaching same level of certaintyIt’s kind of my job to write a report where we really are saying ‘look, we’ve done everything we possibly could’. Paediatric pathologist 2
Missing or misdiagnosisIn sepsis or infection actually sometimes the most important thing is the sort of microbiology and sometimes it’s the combination of things which really sort of helps you… you might miss that with a minimally invasive approach. Paediatric pathologist 1
Inappropriate uptakeI think a lot of patients would take it up, but I’m worried that some patients would take it up inappropriately and not get the information out of it they’d think they were going to get. Obstetrician 1
Importance of validation and guidanceI think you need to make sure the right type of post-mortem is offered to the right type of patient. Obstetrician 1
There’s the issue of can you trust the results? And that’s still ongoing. Coroner 1
Unsuitability of imaging in
certain circumstances
Sepsis, blood infection, you wouldn’t necessarily see any MRI changes, I wouldn’t have thought. Consultant ICU3
There’s still a question of whether scans are great for abdominal regions, aneurisms etc. Coroner 1
Value add of postdeath over predeath imagingIs there much mileage in doing a post-death imaging when we’ve already done pre-death imaging? That needs researching, is it something useful? Are you going to see any changes? I don’t know, possibly. Consultant ICU 1
Tissue required for DNA analysisMost of the time what you need is tissue or DNA. And that’s the sort of information on which future pregnancies are advised. Consultant ICU 4
Potential for false negativesI’ve had one recently where there was a tiny cardiac lesion that I didn’t see when I was doing the autopsy, that I only saw on the slides… I’m sort of reflecting saying you would definitely have missed that on a minimally invasive autopsy. Paediatric pathologist 2
De-skilling workforceMy concern is that…if we go down that [NIA] route do we deskill our pathologists from doing the full post mortem? I think we need to consider this aspect. We don’t want to end up being lazy, abandoning the methods that are the best we currently have. Paediatric pathologist 3
Will we get a decrease in traditional post mortems because the method is better or because we are getting lazy and when getting consent saying ‘ok, they will consent for a non-invasive, I don’t need to [get] consent for a full post mortem’. Paediatric Pathologist 3
We have trainees here that train to be APTs and NIA would kind of take that away from it. I don’t think it would take it completely but in years to come you just don’t know do. Will we be needed anymore? APT4
  • APT, anatomical pathology technologist.