A recent pilot scheme in England and Wales has identified that doctors are failing to give an accurate cause of death in one in four patients. The results of the scheme suggest that doctors may document the wrong disease as the cause of death in one in ten cases.
Dr Alan Fletcher, who led the pilot scheme in Sheffield where a quarter of more than 8,000 death certificates recorded over four years were found to be inaccurate, said that it was not a case of doctors deliberately making mistakes but was rather “a question of precision”. He added that problems had developed as a result of doctors not properly reading the full stories behind patients’ fatal illnesses.
The results of the pilot scheme also highlighted that doctors had not always understood when to refer deaths to the Coroner. Dr Fletcher commented that:
“Doctors receive little or no training in death certification or Coroner referral”.
The effects of these errors are significant, not only for the families of the deceased who may have been given the wrong cause of death, but also for the allocation of NHS services and health policy.
Following the success of the pilot scheme which introduced improved monitoring, checks and access to information, a team of approximately 1,000 medical examiners will start double-checking the causes of death recorded on all medical certificates in England and Wales, from April 2014. It is hoped that this move will increase the accuracy of data recorded on final death certificates and will ensure that relevant cases are always referred to a Coroner.
The new system is being introduced partly in response to the inquiry into how GP Harold Shipman managed to kill a suspected 260 people without suspicion being raised.
Dr Fletcher reported that feedback from doctors involved in the pilot scheme had been “almost universally positive”. Relatives of the deceased were grateful for the improved accuracy and explanation of medical terminology, as well as the fact that an independent doctor had considered the cause of death and then raised any concerns.
Comment
Reforms to the system of providing death certificates are to be welcomed. It is important for families and friends that they know and understand what caused their loved one to die. It is also crucial to help identify cases where there has been poor quality care which may have led to a person’s death.
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