The family doctor received a call from the police asking if she could write a death certificate for a patient who had gone to the office. The 83-year-old man was found dead in his bed that morning by his wife. One of the family doctor`s colleagues had been caring for the patient for about 10 years, but the colleague was abroad and unreachable. When reviewing the medical records, the GP found that the patient had a history of ischemic heart disease after suffering a myocardial infarction eight years earlier. The patient had undergone a coronary stent three years ago. Medical records showed that the family doctor`s colleague had last seen the patient about two months before his death. At this point, the patient was doing well and had received repeated prescriptions for his heart medications. According to the police officer, the patient`s wife indicated that her husband had been doing well since his visit to the family doctor and that he had not seen any other doctor or visited a hospital in the meantime. The night before his death, the patient said he was not feeling well and had chest pain for which he had taken anginine. The family doctor was unsure whether he could write a death certificate for the patient in this situation and turned to his medical advocacy organization for advice.
The forensic advisor told the GP that if she was “comfortably satisfied” with the probable cause of the patient`s death, she had the right to present a death certificate on the grounds that she was responsible for treating her colleague`s patients in her absence. If the family doctor wanted to discuss the situation further, she could also get advice over the phone from the coroner`s office about whether she should write the death certificate. Dr Sara Bird, head of Medico`s legal and advisory services at MDA National, told NewsGP that the most common reason GPs contact their medical advocacy organisation about the death certificate is when they receive a request from the police for a full death certificate after their patient has been found dead at home. Dr. Bird said that completing a death certificate by a doctor is an essential part of the process of notifying the registrar for births, deaths and marriages in the state or territory where the death occurred and allows the undertaker to arrange the disposition of the body. How does the family physician determine if he or she can issue a death certificate? The general practitioner must determine whether the death should be reported to the coroner before issuing a death certificate. “The most common reason primary care physicians are unable to complete a death certificate is when the cause of death is unknown,” said Dr. Bird. “To be able to write a death certificate, by definition, you have to be able to write on the certificate what the cause of death was. Family physicians should therefore consider whether they can write a death certificate or not. “If they cannot draw up a death certificate, the death must be referred to the coroner. It is important to know that writing a death certificate and declaring a patient`s death to a coroner are mutually exclusive.
“When is a death referred to a coroner? Police will refer a death to the coroner for review if they believe a death occurred under suspicious, violent, unusual or unnatural circumstances. For example, a death by suicide. “In cases where the primary care physician receives a call from the police, it is usually when the police have already considered the nature of the death,” Dr. Bird said. “If they haven`t taken the view – that the cause of death is unnatural or violent or suspicious or unusual – then the next step is usually to contact the primary care doctor or the last doctor the patient saw. Sometimes the police found a box of medicine in the patient`s apartment and they contact this GP and say, “This person was found dead at home. Are you able to issue a death certificate for this patient? Dr. Bird stated that other circumstances in which a death is referred to a coroner are when the person has been detained by police or other lawful place of detention or if the person has been taken into custody; for example, in a psychiatric institution or inpatient service. A death must also be reported if it is directly or indirectly due to an accident or injury. However, in New South Wales, this is only if the person was under 72 years of age. “For example, the patient had a broken hip and had just returned home from a rehabilitation center and died the next day, so it`s likely that the death was a direct or indirect result of that injury,” Dr.
Bird said. “Or if the death occurred within 24 hours – in the ACT within 72 hours – after an invasive surgery or medical or diagnostic procedure, or under or following anesthesia.” In New South Wales, Queensland and Victoria, a death is referred to a coroner if it is not a reasonably expected outcome of a medical or health intervention or if health care caused or contributed to the death and an independent person did not expect the death to be expected. “Only in ACT and NSW, if the person has not been treated by a doctor within three months [ACT] or six months [NSW] immediately before death, they must be referred to the coroner,” Dr. Bird said. Threshold for determining cause of death “This is an interesting discussion about the threshold for determining the cause of death,” Dr. Bird said. “You don`t need to know with absolute certainty what the cause of death was; However, the general practitioner must be able to determine the probable cause of death or be satisfied with the cause of death. “Has the death certificate ever been questioned? While unusual, Dr.
Bird said the cause of death is sometimes questioned and referred to a coroner after a death certificate is issued. What happens if the family doctor has doubts? If the primary care physician is unsure whether to write a death certificate, Dr. Bird said he can contact the coroner`s office directly. “You can certainly call your medical advocacy organization and in some circumstances we encourage GPs to contact the coroner`s office and discuss with them whether the coroner`s office deems it appropriate based on the information they know the primary care doctor is filling out a death certificate,” she said. Why is an accurate death certificate important? Information from death certificates is incorporated into many political decisions. “Cause of death statistics are used to make decisions as a community about where resources should be spent,” said Dr. Bird. “But the most direct thing is that this is an important legal document and there are specific reasons why accurate death certificates can be very important. “For example, it may be important to test the validity of a person`s will, especially if someone has dementia.” In completing the death certificate, Dr. Bird said primary care physicians must specify the approximate interval between the onset of an illness and the patient`s death.
If the GP does not have this information, he should write “unknown” instead of leaving it blank.