Consistent acting, legal knowledge and competence of external postmortem examination in Dutch hospital settings

A crucial role in the external postmortem examination system of the Netherlands is that of the attending physicians, who are either general practitioners or physicians in hospitals. They perform 85% of all external postmortem examinations and must immediately report to forensic physicians all unnatural deaths and deaths that they are not convinced to be natural. These attending physicians need therefore to be properly qualified and need to be competent, by acting consistently and by having knowledge of the appropriate laws surrounding external postmortem examination. The aim of this study is to analyse the competence of the attending physicians in hospital settings. This research studied whether they regard themselves as competent, whether they had knowledge of and acted according to the appropriate laws, and whether they acted consistently in following the procedures around external postmortem examinations. A survey was conducted among clinicians. After discarding 23 questionnaires for various reasons, 326 datasets remained on which the research was based. There was no significant difference between the medical specialists (79%) and the residents and fellows (86%) in their feeling of being competent in undertaking external postmortem examinations. The answers of the respondents showed at least one inconsistency in 54%. Of the respondents 34% were considered as to have knowledge of relevant laws. Of the respondents 21% felt competent, was consistent in all their answers and scored a 100% on legal knowledge. The study showed that though a physician might feel competent, this does not mean he actually is competent in performing an external postmortem examination. Furthermore, the extent of a respondents' ignorance of the appropriate laws and the inconsistency in acts and thoughts is undermining the system of postmortem examination.