Death certificate process and issues

March 25, 2011

The author reflects on his role as patient advocate even when it comes to death certificate forms.

Some of us have been naughty. Some of us have been dragging our feet when filling out death certificates.

At first, it bothered me to see "death certificate" in lower case. I always think "Death Certificate." But then I was comforted. Lower case "death certificate" made it sound like just another form.

She's not talking to me, I rationalized. I'm not afraid of forms. Actually, I'm good at forms. My office staff will back me up on that. As Larry the Cable Guy would advise, I "git 'er done." I'll write just about anything on a preauthorization form, a Family Medical Leave Act (FMLA) form, or disability form as long as I'm confirming what the patient has told me.

Sure, some patients lie. If I know lying is involved, I don't just go along to help someone get a non-formulary drug or avoid accumulating those mysterious absenteeism "points" at the workplace. Assuming no obvious deception, fraud, or other breach of the physician-patient relationship takes place, however, I am the patient's advocate. As such, I do what I have to do to keep my patients from becoming sick, fired, or deprived of cigarette money. Er, I mean grocery money. What I'm trying to say is that my role as the patient's advocate is important to me, but, frankly, forms are not.

DEATH CERTIFICATE NOT JUST A FORM

Maybe I don't take forms seriously enough. If the commissioner scolds me for not thinking critically about a patient's diarrhea and whether it prevented him from working for 3 consecutive days, thus protecting his job under FMLA, I'll put my head down on my desk and think about it. My conscience, however, tells me the death certificate is not just a form.

Even the commissioner says: "This permanent legal record of vital information including demographics and the cause and manner of death is required for the survivors to be able to bury or cremate their loved one, move their loved one's body out of state for final disposition, access and close bank accounts, probate a will, settle an estate and obtain proceeds from life insurance policies."

Point taken. But establishing a permanent legal record of vital information and the cause and manner of death is what makes completing a death certificate important, isn't it? I'm not signing it so that cremation can take place expeditiously or so relatives can have access to the decedent's insurance money.

Although the subject not something we spend much, if any, time on in medical school, death certificates are a reality of practicing medicine. Completing them is another service we provide without receiving compensation. As philosopher Soren Kirkegaard might have put it, the death certificate is an end in itself. Forgive the pun and my throwing around the name Kirkegaard. How about this: completing a death certificate is important because completing a death certificate is important.

"Aw, come on. You worry too much," whispers the still, small voice of government. "Just fill it out. You won't get in trouble."

All right, I'm paraphrasing again. Guilty as charged. Here is what the commissioner actually wrote: "Virginia law clearly states that physicians are to determine and list the cause of death to the best of their ability. There has never been an instance in Virginia where a physician has been sued for the information listed in a death certificate."

Whew. Getting sued for doing the right thing would stink. I will verify that I never have been sued for what I've written on a death certificate. Maybe she's right.