Pressure to provide a death certificate

The scene

A GP called the MDU advice line after having a difficult conversation with the coroner's officer.

The coroner's officer had contacted the GP to ask him to provide a death certificate for an elderly patient who had been registered as a temporary patient at the practice and had died following an admission to hospital. The GP had seen her on one occasion six weeks ago, after which the patient was admitted to hospital for at least a month. The GP surgery did not receive a discharge summary from the hospital because the patient was discharged to a nursing home outside of the practice area, so was registered with another GP practice.

The coroner's officer put a great deal of pressure on the GP to provide a death certificate for the patient, saying they expected the GP to put 'old age' as the only Part 1 cause of death.

The GP explained to the coroner's officer that he did not feel that he was in a position to complete the death certificate as he had only seen the patient in one consultation before her substantive admission to hospital, and he had no information on what had taken place during that admission.

The GP suggested that the coroner's officer contact the GP with whom the patient was registered on discharge from hospital, or alternatively the clinician who cared for the patient in hospital if they were the last doctor to see the patient before she died. The coroner's officer made it very clear to the GP that they considered he was being obstructive to the coroner and threatened that he would be summonsed to appear before the coroner for refusing to provide the certificate.

The GP felt understandably shaken by the coroner officer's insistence to provide a death certificate, so called the MDU advice line for reassurance.

MDU advice

The MDU adviser explained that the GP had done exactly the correct thing. When a patient dies it is the statutory duty of the doctor who has attended in the last illness to issue the death certificate. While this is not legally defined, this is generally taken to be a doctor who cared for the patient during the last 14 days of their life.

In this case, not only had the GP not seen the patient within 14 days, the patient had also had a substantive hospital admission following the GP's last consultation with her.

It is also clearly set out in Guidance for doctors completing medical certificates on the cause of death that old age should only be given as the sole cause of death in very limited circumstances, where the doctor has personally cared for the deceased patient over a long period and had observed a gradual decline in the patient's condition.

The adviser also reminded the GP of the GMC guidance in Good medical practice that any documents he signed must not be false or misleading.

The outcome

The adviser reassured the GP that he had taken the correct course of action. She suggested that if the coroner's officer contacted him again, he should talk to the MDU for further advice, and that if necessary the MDU adviser would speak directly to the coroner's officer on the member's behalf.

Summary

It can be unsettling when an 'official' puts pressure on you to do something you do not believe is correct. Under these circumstances, whether it is the coroner's office asking for a medical certificate, the police asking for disclosure of the records or any other 'official', the MDU advice line is there to provide you with advice, support and reassurance.

This guidance was correct at publication 16/07/2018. It is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.

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