Death certification: a primer, Part IV--problems in death certification

Beyond errors in diagnosis, procedural errors in completing the cause of death statement for the death certificate can usually be placed into a few distinct categories. Physicians often forget, after struggling to deal with a litany of medical problems, that an external event, usually trauma, brought a patient into their care in the first place. In these instances, the death needs to be reported to the coroner and the coroner must certify the death (since it was the external event that actually started the chain of events leading to the death). Likewise, physicians also must recognize a death that was precipitated by seemingly simple and common trauma, such as a fall in an elderly individual (which may seem like a natural event), must be certified by the coroner. Another common error in death certification is listing the elements of the cause of death statement in the wrong order, i.e., an order where one listing is not directly caused by the process listed directly under it. While listing nonspecific processes, such as congestive heart failure, in the cause of death statement is perfectly acceptable, what caused these nonspecific processes must also be listed beneath them. If that cause is unknown, then that needs to be stated. Abbreviations, of any kind, should not be part of the cause of death statement. Physicians should certify deaths for those patients they are providing care for, and in whom death is the result of known medical conditions, regardless of whether they or other medical personnel were actually present (in attendance) to witness the death.