When doctors don't have the right answers

GPs have admitted making educated guesses on death certificates, writes BRIDGET CARTER.


Nearly a quarter of death certificates are inaccurate because GPs are making an "educated guess" at how people have died, according to the author of a survey.

Dr Carol McAllum said GPs completed one-third of all death certificates, often inaccurately because they were unsure of the reason for death.

Her research was sparked by problems she had encountered with death certificates as a Northland GP.

"It was a personal difficulty I had writing down in about two words someone's cause of death. It is a difficult thing to do ... I thought it could be helped by raising the issues."

As part of her study: Death Certificates in General Practice: Uncertainty Is the Norm?, she questioned 220 GPs. Results showed nearly three-quarters of the respondents had experienced doubt about diagnosing cause of death.



Dr McAllum said GPs were not allowed to state "natural causes" on a death certificate. Legislation required the cause to be defined.

But the GPs sometimes found using a coroner to find out the actual cause of death was unjustified or could take a long time.

A GP might then make an intelligent guess, but it might be recorded that someone died of a heart attack when they had died of a stroke.

A concern was that the information could be used inappropriately.

The statistics helped to decide where money would go for health research, so money could be spent on research into heart attacks when people were dying of something else.

Dr McAllum said there were two possible solutions - being allowed to put "natural causes" on a death certificate or for more care to be taken over how the information was used.

The results of her study follow the discovery by a Timaru family that the death certificate of their relative was peppered with mistakes.

The family of Elaine Woolf, who died on May 26, said the error-ridden certificate was hurtful and useless as a family record. The mistakes included:

* The date of her death, listed as May 28.

* It was stated she had lived in New Zealand for 18 years. She was 18 when she arrived in New Zealand, but had lived here for 72 years.

* The certificate stated her place of marriage was not recorded. It is. She was married at St Mary's Church in Timaru in 1928.

* The certificate omitted one of her sons.

* Her home address was wrong.

* Congestive heart failure was listed as one of the causes of death.

The family said she had never had a heart problem.

Dr McAllum said the cause of death shown on the Woolf certificate was a typical example of an inaccuracy.

The chief analyst for the New Zealand Health Information Service, Jim Fraser, said mortality rates played only a very small part in funding decisions, and there was inaccuracy worldwide in recording cause of death. The service tried to make sure the information was as accurate as possible.

"We frequently ... get back to the person responsible for filling it in and ask for further details," he said.

But the chairman of the Medical Association's GPs council, Dr Philip Rushmer, questioned how important it was for the state to know the exact facts.

He said the need for accuracy should be balanced with the needs of the family, who often did not want a post-mortem on an elderly relative.

"They feel in many cases it is an unnecessary procedure for a family member who had suffered long enough, especially if they are all reasonably certain of what that person suffered from."

Murray Chiles, an underwriter with insurers Royal and Sun Alliance, said information for life insurance purposes was taken from death certificates.

If there was suspicion that there could be some non-disclosure, the company would investigate further.