External examination of the corpse in practice

Background and Objective: The quality of the external examination of corpses has repeatedly been criticized. This study provides information on the performance of the external examination of bodies in practice which is necessary for improving the quality of the examination. Methods: 1000 randomly selected medical practitioners from the Arztekammer Westfalen-Lippe were sent a questionnaire concerning personal data, the performance of the external examination of bodies and possible influencing of the decision on the manner of death (i.e. natural, unnatural or uncertain) by a third person. In addition reports of four typical cases were presented and a classification of the manner of death was requested. Results: The return rate of the questionnaires was almost 30%, 289 questionnaires were evaluated. Although most doctors stated that the external examination took them 20 to 30 minutes, only 25% undressed the body completely. Almost 50% of the doctors had been influenced by a third person in the decision on the manner of death at least once, most often by the police. The four short cases were incomprehensibly often classified as natural death, especially by internists. Conclusions: Signs of an unnatural cause of death will only be detected by chance if the body is only briefly examined and not undressed completely. If such signs are absent the manner of death should be classified as uncertain in unclarified or doubtful cases, even against attempted influencing by third persons. In order to avoid conflicts of interests it would be desirable if only specialized medical practitioners would perform the external examination of corpses.