Post-mortem Examination from the Living Room Door -- MEDICA - World Forum for Medicine

The physician had certified a natural death after the post-mortem examination. However, when the undertaker saw the old man he became suspicious. He discovered a brown liquid on the pyjamas. In the Institute of Forensic Medicine in Aachen it turned out to be blood. And the reason for this was quickly at hand: a bullet stuck in the lung. The pensioner who had allegedly died of a natural cause had actually shot himself. This has been just one of the cases PD Dr. Karl-Heinz Schiwy-Bochat, who in the meantime works at the Institute of Forensic Medicine in Cologne, has seen during his career.

“Intrinsically the physician has to undress the body and examine it from head to toe”, explains Schiwy-Bochat, “however, as the old man was still wearing his pyjamas when the undertaker arrived, this was supposedly rather a post-mortem examination taking place at the living room door.” If somebody dies at home often the family doctor is called. However, family doctors often feel inhibited to undress and thoroughly examine the body in front of the relatives. According to a study by the Institute of Forensic Medicine in Münster about 10,000 deaths are wrongly classified as natural. The suicide of the old man in Aachen very nearly would have been one of the 10,000.

Physicians also recoil from “bringing the police into the house”, as Schiwy-Bochat says. This is one of the reasons why they don´t tick “unnatural” or “not clear” on the death certificate. In both cases the police has to be informed in North Rhine-Westphalia. Mostly the cause of death cannot be detected from the outside, even if the body is thoroughly examined. An autopsy only takes place if it is ordered by the prosecution. If a natural cause of death is attested the body is immediately released to the undertaker.

“In the west of Germany about 40 percent of the diagnoses are false”, says Schiwy-Bochat. He describes a vicious circle: “As heart attack is presumed to be the most frequent cause of death, physicians often record this on the death certificate if no other cause of death can be seen. This falsifies the statistics which in turn influence the health care policy.”

During a post-mortem examination one often has to unify different interests. According to Schiwy-Bochat the police is only interested in deaths in which somebody has had a hand in. Family doctors do not want to burden the mourning family with a meticulous examination. In a seminar with the title “The post-mortem examination”, which takes place within the MEDICA congress and is given among others by Schiwy-Bochat, these conflicts will be a key topic. Apart from him a policeman and an emergency doctor will describe their point of view. Furthermore participants can expect practical hints for example on what is often missed during a post-mortem examination.