When the Death Certificate Fudges the Facts

When I was a police reporter in a small town in Texas, writing about a man's shooting death, I asked to see his death certificate. The cause of death was listed as cardiac arrest.

"He was shot. How could it be cardiac arrest?" I asked the local law-enforcement official.

"Apparently, his heart stopped when the bullet entered it," was the sardonic reply.

That was decades ago, but evidently an accurate cause of death on a death certificate is still a persistent problem, writes a physician in the New York Times. In fact, one new study of doctors in New York finds that half knowingly reported an inaccurate cause of death.

Lawrence Altman, M.D., writes that our health system "is far too cavalier" about the accuracy of death certificates.

Death certificates are not just some minor paperwork. What is filled out as cause of death can affect insurance and estate settlements, provide critical health information about inherited disease to descendants, indicate growing health problems to researchers, even reveal information about accidents or other troubling reasons for a patient's dying, he writes.

Unfortunately, two studies, published in May in the journal Preventing Chronic Disease, indicate that time-stressed doctors often opt for an easy explanation for a patient's death - frequently heart disease - and overlook other causes, including pneumonia, influenza and cancer.

In one  study, half of the resident doctors surveyed said they had knowingly written down an inaccurate cause of death, and only one-third thought the system accurately documents the cause of death.

Some of the reasons, Altman writes, have to do with record-keeping roadblocks - an electronic system that doesn't recognize a diagnosis of sepsis, for example - or restrictions in on-duty hours that result in paperwork being filled out by a doctor who doesn't know the patient.

Because heart disease is the nation's No. 1 killer, doctors often write that down by default, especially with older patients who often have more than one ailment. Sometimes families may also pressure doctors not to list suicide, AIDS or other health problems as the cause of death - either out of embarrassment or because of restrictions in life insurance policies.

To improve death certificate accuracy, the New York City Department of Health and Mental Hygiene has instituted a training program for doctors in eight hospitals. Interestingly, heart disease as a reported cause of death dropped 54 percent in those hospitals.

For those who think the death certificate is an unimportant piece of paper, study coauthor Barbara Wexelman, M.D., argues otherwise.

As she told the Times, "We owe it to our patients to be able to accurately record why they die" - and thus, she added, to "help the living."

Photo: flickr.com