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.

News Media Is Schooling Doctors

I don't know whether to laugh or cry about this blog by Dr. Wes. What Dr. Wes is saying is true. It is in almost every daily newscast and in the printed media. I must wonder at the same time if this is not part of our current administration's goal to keep doctors off balance while changing so much of their lives with the roll out of the current healthcare law. As a patient, I feel like answering some of the points Dr. Wes says the media is trying to school him.

At the same time, what Dr. Wes is saying about the way he thinks (I hope tongue-in-cheek) is that all doctors should turn their head away from the computer screen (not a bad idea). His next suggestion will make patients wonder where he is coming from when he says hold the patient's hands and look into their eyes. If any of my doctors were to do this, I would probably be out the door very fast. Next, he says doctors are to listen to their concerns, which many doctors do not do. They have their cookbook medicine to follow and finish before their time with us out runs out.

The next two items he lists are over the top and I would complain if he put himself in my place and do a thorough physical exam at every appointment. Most of the time, patients just want communication and an exam maybe once a year, unless it is necessary because of what the symptoms are or may indicate. Having constant empathy and insight is over the top and a little sincere communication here would go a long way. The doctor's assistant, sometimes a nurse but often a certified nurse's aid, normally handles reading back medications.

Some patients do need written instructions in fifth grade English, but even then, some patients will not understand. These patients should be encouraged to repeat back what they have been told. A doctor should consider escorting the patient to the checkout area where normally the next appointment is set up and instructions for lab work at the next appointment are spelled out on the appointment card. The following area I have seen in some media news stories and I wondered why every doctor needed highly skilled and educated assistants. Now I know that some doctors do need their services because to the requirements of the appointment and in some outpatient services. Most other doctors will not need them.

Rather than quote Dr. Wes, I would say his blog is excellent and he does need support for the position he takes. I poked a little fun at him above, but in reality, the media and even some of his colleagues are not supporting him. They want more monies for not doing some important aspects of their profession. See my blog here. I will quote this and it is about the requirements put on doctors by the electronic health records. Dr. Wes says, “We move as fast as we can to remain productive, because that's what's REALLY valued in healthcare these days. So is patient loyalty because that's what keeps them coming back. But in the process of growing loyalty, we increasingly have to document everything or other payers think it doesn't happen. So we type. And click. And type. And click. And print. To get paid. Talk about a communication and empathy buzz-kill!”

Please take time to read the blog by Dr. Wes. I am surprised that it received few comments and some as anonymous.