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There is an art and a science in medicine and variation in biology and medicine is inherent. Chemical pathology and toxicology departments quality control and accredit all processes to limit variation and error as far as is sensible. Systematic multidisciplinary meetings (MDM) as case conferences are now standard practice in hospital medicine and continuous professional development points are earned by participants. The purpose is to gather specialists in many areas to examine, discuss and agree best diagnostic and treatment practice in each individual case. Pre-meetings where histopathology or imaging is discussed within disciplines to gain speciality consensus are best practice features of successful conferences. Structured interdisciplinary rounds have been shown to reduce the adverse event rate significantly. 1 Considerable variation regarding verdicts among coroners was demonstrated using responses to index cases in a formal survey of 64 coroners. 2 This may lead to serious distortions of national statistics leading to resource distortion. The impact on families may also be problematic when life assurance and other claims are involved. The new Medical Examiner system in the UK will result in the appointment of at least 500 Medical Examiners and the variations that this system will experience has been discussed in a recent address to the Medico-Legal Society. 3 This still leaves the issue of the quality of the interpretation of post-mortem results for coroners and for medical examiners. Nowhere in the Coroners and Justice Act of 2009 is there a specific requirement for MDMs prior to reporting the autopsy findings to the coroner. 4 The coroner is charged with determining the how, when and where the deceased came to his or her death. The Chief Coroner can determine the description of the practitioner who can make suitable examinations of material from post-mortems. 5 In Chapter 2, Section

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The attitudes and experiences of pathologists and coroners to the provision of biochemical forensic toxicology in the Republic of Ireland were determined using separate questionnaires to each group anonymously. Replies were received from 36/88 (41%) of pathologists and 19/71 (27%) of coroners. 37% of coroners considered that histopathologists give an adequate opinion in forensic toxicology yet 58% of pathologists reported that they did not have adequate access to expert medical interpretative toxicological opinion. For drug-drug interactions and metabolic diseases, 69% of pathologists were unhappy with the processes and 68% of coroner replies did not know if vitreous samples were used appropriately. There is a clear requirement for retraining of coroners and for the appointment of medical toxicology expertise to improve the quality of service for coroners.