AN EXPLANATION OF DEATH CERTIFICATES
AN EXPLANATION OF DEATH CERTIFICATES The cause of death may vary, depending on each observer's viewpoint of the situation. The trauma surgeon who is unsuccessful in controlling bleeding from a laceration in an auto crash victim might perceive hemorrhage as the cause of death. To the pathologist who conducts the autopsy, the cause of that person's death might be blunt force trauma. To an epidemiologist who studies mortality patterns, automobile accident might constitute the cause of death. Such varied viewpoints made it necessary for me to acquire knowledge in this area. The Coroner would formulate and put into words a cause of death for a death certificate, an autopsy report, or other medical documents using a format similar to the cause of death section on the death certificate and I transferred this information to the certificate. To foster a viewpoint of the cause of death, the Coroner has to maintain concepts and certain terms in a manner that is clear to all readers. The emphasis on definitions seemed excessive, but it was important to provide clarity regarding causes of death. Causes of death, whether appearing on death certificates or else¬where, are collected and used by governmental, public health,
This was important in order that updated information may be carried to the state or national level. If a cause of death is not stated clearly, the person who codes the cause of death (a nosologist) uses a somewhat arbitrarily established system of rules to identify a cause of death for official classification. If it is unclear whether the death is reportable to the ME/C, it is wise to report it. Each state has laws that require certain deaths to be reported to the Coroner (C) for official medicolegal investigation. The death certificate used in the 50 states usually contains space for demographic information about the decedent, as well as information about the decedent's parents, the informant, bodily disposition, the pronouncing physician, the certifier, and the cause and circumstances of death. The certifier may or may not be the same person who was responsible for the care of the patient (the attending physician) or who pronounced the person dead (the pronouncing physician). An attempt should be made to identify and contact the attending physician or personal physician who may be better able to accurately certify the cause of death. When the certifier indicates a cause of death and signs the death certificate, the certifier bases the cause of death on available information and des¬ignates that the cause of death was due to the stated causes to the best of the certifier's knowledge. Such factors might result in the death being coded to a cause that does not adequately reflect the real cause or circumstances of death. Therefore, it is impor¬tant that the cause of death information be as accurate and complete as possible. In general, notification of the C is required for deaths that an sudden, unexpected, and unexplained (lacking reasonable medical certainty); that occur when a person is in apparent good health; or if injury or poisoning is suspected or known as having! caused or contributed to death. Such hesitancy is usually unwarranted. When a physician who is not acting in the capacity of the Coroner is faced with certifying a death, the following procedures should be followed:1) Evaluate whether the death is reportable to the Coroner. Every effort should be made to base the cause of death on all information that is available from medical records, the attending and pronouncing physicians (if other than the certifier), and other sources (such as an autopsy report), if necessary.
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