Lecture Notes
The Fear of Death (Certificates)

Have you written “Pneumonia”, “Cardiopulmonary arrest” or “STEMI” on a death certificate lately? Dr Lee Simes hauled us all over the coals about the standards for death certification at the October medical update.

The coronial system is groaning under a deluge of reported deaths, including many cases that really need not be investigated. Additionally, some certificates have to be sent back to practitioners for amendment because they contain insufficient or inaccurate detail.

General tips for completing certificates include double checking that details of names and dates are correct. Any error of spelling or birth / death date will cause an ‘awful fuss’. Please make sure that your own contact details are included and correct (especially contact phone number) as cases may be unnecessarily referred to the coroner and funerals delayed or postponed if you as the certifying doctor cannot be contacted. It is an ongoing frustration if locum / trainee doctors omit their contact details and list the address as ‘Shoalhaven Hospital’. In general, if you have the slightest suspicion that relatives are unhappy about the circumstances or management, ask them if they want the coroner to be involved and the matter investigated.

Cases that genuinely require Coronial investigation are covered by the checklist included on each certificate. In general there is too much reluctance to complete a certificate. You are NOT required to give evidential proof of your Cause of Death. You are being asked for a clinical opinion only, you do not have to have seen the patient before death. Writing ‘probable’ and ‘presumed’ is acceptable, and time intervals can be vague, e.g. ‘weeks’, ‘months’, ‘years’, ‘unknown’. Some common pitfalls include:

  • Do not write cardiopulmonary arrest, old age, senescence, multiorgan / system failure. Be specific.
  • Don’t use abbreviations, e.g. VF, STEMI, IHD, COPD, IDDM, HT, CCF
  • If cancer, be specific.
  • If lung cancer, be sure to list whether it was caused by tobacco smoking
  • If intracerebral haemorrhage, you must be more specific as it is important to exclude trauma (else it should be a Coronial matter)
  • If writing Dementia, be very specific (and certain) about the duration, as wills can be contested on the basis of this date
  • Being a ward of the state does get overlooked, i.e. a person with Down Syndrome living in a group home who dies a normal expected death is still reportable.
  • Violent and unnatural causes are still reportable if traceable back to an injury even if it was decades earlier, e.g. an MVA causing paraplegia that eventually leads to recurrent urosepsis and death.
  • The coroner is not interested in accidental trauma (e.g. falls) in the elderly. The cutoff is age 72 or older.
  • You CAN be a locum and complete the certificate
  • ‘Unknown Natural Causes’ is acceptable.

For more information, see the Coroner’s Court website.

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