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Modern medicine demands self audit. The process is rarely flattering, and glaring weaknesses become all too evident. A review of 12 interviews of recently bereaved parents is presented here as such an exercise. The paper will not focus on issues of the bereavement reaction itself, which are well covered elsewhere,' -3 but rather on the broader issues raised by contact with the families after their loss. MethodThis is a study of postmortem contact with families over an 18 month period at Booth Hall and the Royal Manchester Children's Hospitals. The families of all 13 children to die on the authors' service over this time were seen and notes made at the time of the interview. The parents involved were contacted by letter about six weeks after the death of their child inviting them to attend the hospital to discuss postmortem findings or any residual worries they might have over their child's last illness. At the time of the death of their child they would have been told to expect this invitation. The interviews were conducted in office surroundings divorced from outpatient or ward activities or, in one case, at the parent's home.Each interview was structured. The format was: an initial discussion of postmortem findings; relation of these to clinical observations and explanations given at the time followed by any questions; enquiry into current feelings and behaviour of parents and siblings; formal counselling/advice as necessary followed by a word on the future, including the introduction of genetic counselling; then a further question session, and closing with an invitation to make contact as required. The social worker concerned would usually make subsequent contact on at least one occasion, and the family doctor was informed of the essence of the interview content.A social worker, attached to the Department of Child Neurology and known to the parents, was present at seven of these interviews and made subsequent contact with four of the remaining six parents. ReportsCase 1. A boy with tuberous sclerosis had developed a glioma. After treatment he was left blind, intellectually handicapped, and with epilepsy. His tumour recurred, and there had been a steady downhill course over two to three months with an increase in frequency of fits and physical handicap to the extent that he became totally dependent. He finally lapsed into coma and was readmitted. His parents stayed by his side for five hours, but he died while they were away taking lunch.The follow up interview went as planned, and the family was coping well with its loss. The parents and teenage daughter got up to leave, and then the father asked to have a private word. His daughter and wife having left, he said that although the other two probably did not suspect he knew that we had hastened the demise of his son while they were at lunch. He was not apportioning blame but was obviously feeling angry. The women were recalled and the matter discussed openly, though it is not clear if we were believed.

ture in the future. While some of these potential problems have already been highlighted,8 the weakening economy is causing a sharp decline in living standards, mass unemployment, and continued dependence on heavily polluting industries. There is no sign that public health problems will decrease. In this environment the need for public health skills has never been greater. We thank Dr Theo Miltenburg of the Institute of Applied Social Sciences, Nijmegen, Netherlands; all the staff at Kaunas Medical Academy who helped us gather information and ideas; and in particular Dr Zilvinas Padaiga and Professor Grabauskas for organising the trip. We also thank Dr Caroline Collier of the Department of Health for sponsoring the visit, North West Thames Regional Health Authority for its support, and Drs M McKee and N Black for their comments on previous drafts of the paper.

This paper presents the results of a study into some specific aspects of the management of coronary heart disease within one district health authority. In particular, it is concerned with the appropriate balance of inpatient coronary care between the district general hospital and community hospitals in the light of current and potential changes in the clinical management of coronary cases. The study is an example of a multidisciplinary approach to local health planning which is beginning to emerge within the Exeter Health District, the methodology of which may be applicable to client groups within the medical specialties other than coronary cases, such as strokes or respiratory disorders. It also illustrates the use of spatial analysis and diagnosis-related groups in local planning.

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