Economic rationalism is the cause. We are now running a production line with doctors tightening screws and welding on the new bits on compliant production model people while nurse managers with clip boards and  bed pressures (the modern version of the pressure sore) and bean counters in their counting houses upstairs overlook the factory. Government runs the bean counters as they take count of the macro bean counting model and send in beans only once they have all been accounted for.

In Oz when I was a young doc, medical superintendents who were clinicians (usually senior surgeons or physicians in the Masons) once ran hospitals along with matron who knew how to keep bed pans shiny and linen presses neat. Local hospital boards were made up of local men and women who knew how to run a garage or a dry cleaning shop and had common sense but not Harvard BMA's or Masters in  Health Economics. Post-mortems were ordered by doctor as doctors knew best and people were less squeamish about death and boys had sling shots and played in creeks after school.

Death certificates were dreamt up by a medical bureaucrat with dyslexia. No one yet has mastered the art of answering the questions with the facts as we know them without playing medical Twister. Few of us had a decent tutorial in how to write one and logical replies are not allowed. Dare anyone who puts "smoking" or "asbestos"  "gluttony" " sex maniac" as the cause of death.

Pathology registrars are not so keen on getting their nose into a deep rough-edged thorax full of pus or struggling through 30 metres of small intestines looking for a perforation or using their Black and Decker on an aged cranium with a man with no teeth and looking like one of Leonardo's drawings.

We are all fully reliant on CT scans and MRI for the truth now. Anyhow, what does it matter to the hospital funding for DRG-based medicine where $ come from the quick and not the dead. What happens at the end of the conveyor belt in the big blue bins outside is just too much. We'd rather not know. We'll have a monthly D & C meeting and argue the toss there and this will be recorded to show the bean counters and hoop manufacturers in Canberra that we have jumped through their hoops and God's in his heaven and all's well with the world as Pippa passes.

P.S. Should we be using general anaesthesia when we do post-mortems?