Death certification in Auckland.

AIMS

to investigate the reasons behind general practitioner referral of cases of natural death to the coroner, and also the understanding of general practitioners of the relevant legislation.

METHODS

as cases of natural death were referred to the coroner over a seven month period, the deceased's general practitioner was contacted by telephone and questioned regarding his/her knowledge of the death and willingness to sign a cause of death certificate. Based upon this interview, cases were divided according to whether their general practitioner could have signed the death certificate or not.

RESULTS

there were 314 cases where there was a contactable general practitioner. In 257 instances, the general practitioner would not have signed the death certificate: 183 found the death unexpected, and 74 had not seen the patient recently enough. In 57 instances the general practitioner would have signed the death certificate, but did not because: 23 were unaware of the death, 13 could not be contacted, 14 did sign a death certificate but this was rejected by the medical referee, and seven would have signed but did not for miscellaneous reasons.

CONCLUSION

a disturbing finding was the general lack of understanding of certification legislation in particular the concept that the patient must have been seen in their last illness to be able to sign the death certificate. When signing death certificates, doctors should be thinking in terms of last illness rather than a vague period of time between two weeks and three months.