26 July 2013

Hospital Doctors Botch Even Death Certificates

That is right! Doctors working for hospitals cannot even get the cause of death correct in about 54 percent of the cases. Granted this was in the hospitals in the City of New York, but still folks this is bad. The two studies of doctors in the New York City teaching hospitals are not painting a confidence builder. The studies were published in the May issue of the journal Preventing Chronic Disease.

The studies reported what researchers have suspected: that heart disease is over reported as the cause of death, while diseases like pneumonia and cancer tend to be under reported. The findings from one study reported that the health system is far too cavalier about the accuracy of death certificates.

This study surveyed resident doctors in specialty training in 26 hospitals where about 40 percent of the city's deaths occur. The respondents included 521 residents and 54 percent declared they had knowingly reported what they believed was an inaccurate cause of death. One-third of the respondents believed that health system accurately documents the cause of death.

I know from overhearing three doctors talking about what to put on death certificates is always the same – heart failure. One doctor said that is true, because as long as the heart is functioning they are not dead. The second doctor said that is the reason he only reports heart failure and the third doctor mumbled he would need to think about this. The other two asked what he meant. The doctor said that heart failure was often caused by other conditions, and while it may be the last organ to fail, it was not the cause of death. The other two doctors laughed and said why not take the easy way – the person is still dead so what difference did it make.

The second study followed doctors in the same program, but dealt directly with the issue of over reporting of heart disease as the cause of death. This happens often in older patients and while heart disease is considered the leading cause of death in the USA, doctors often list it by default without considering other possibilities. This lack of caring on the part of doctors tends to obscure the statistics of other serious diseases.

One problem I can see is our certificate of death. The form needs revision and needs to reflect secondary illness or disease and possibly more. The form needs to be uniform across all states and copies signed by the doctor sent to the CDC, local courthouse recorder, and given to the administrator or court appointed administrator. Then anyone requesting copies of a certificate of death would receive a copy of the original and the form used by the state or county of residence.

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