Death keeps Irish doctors guessingBMJ 2000; 321 doi: https://doi.org/10.1136/bmj.321.7259.468/a (Published 19 August 2000) Cite this as: BMJ 2000;321:468
Death, like taxes, may be certain—but the causes less so, said a recent survey of Irish GPs. As many as half the causes of death given on death certificates could be based on guesswork, the GP trainer conducting the study has concluded. Dr Sean Bourke surveyed family doctors in the North Western Health Board region of the Republic of Ireland and found a high level of dissatisfaction among his colleagues with the restrictions placed on them by the current certificates.
Although GPs were required to specify a cause of death on the forms, they often had to guess what to write in the absence of a postmortem examination as the forms did not include a “not known” option. One respondent commented: “There's no room for honesty in the certificates.”
“It annoyed me,” Dr Bourke told the BMJ. “National statistics are based on what we put down on death certificates, but half the time we're just guessing as to a cause of death. Everyone has a favourite cause, but really we don't know. After all, sometimes even the pathologists have trouble agreeing a cause.”
Nearly half the GPs who replied were not satisfied with the current certificates, especially in cases where the deceased person is elderly and there is no cause for a postmortem examination to be ordered. “The cause of death therefore often ends up being based on history and guesswork. Social factors can play a part as well,” Dr Bourke said. But, he warned, such skewing of statistical data may also have implications for surviving family members: “If we put down ‘myocardial infarction,’ for instance, we could be affecting the rest of the family's insurance cover in the future.” Many respondents suggested several new categories of cause of death including “multiple organ failure,” “unknown,” and even simply “old age”—a cause which the County Leitrim GP reported would be accepted by 56% of the respondents.
The survey also showed that 94% of the GPs responding said they had no written protocol or policy for dealing with the death of a patient. A similar number confirmed that they had received no training on how to complete a death certificate, either during undergraduate or during postgraduate training.
About 120 GPs in Sligo, Leitrim, and Donegal were sent questionnaires, and about 80% responded. The survey was part of an initiative in the North Western Health Board area to improve trainers' research and training capabilities.