Despite many workshops given to the Vital Statistics directors of the individual states on how to increase accuracy of death reporting on the Death Certificate. Despite these and the filter-down workshops held for physicians, there is a persistent error rate.
Many times patients in a nursing home are given the wrong diagnosis as the cause of death because the nursing home physician of record (he, not the primary care physician, is in charge of ALL the patients in the nursing home) will simply put in whatever the nurses tell him. If they don’t mention RA in a patient that had RA, there can be some interesting problems. For example, my mother’s death certificate listed dehydration as the primary cause of death, and malnutrition as the contributing cause of death. No mention of RA. But she actually died from complications of RA. RA should have been the contributing cause of death. RA wasn’t even listed as an “Other Significant Condition.” By the time I was given my copy of her Death Certificate, it was too late to emend it. This is all too often the case when RA patients die in a nursing home. How many RA patients reside in nursing homes at any one time? How many have died in nursing homes over the decades? And how could their death certificates be emended and corrected? There is no way to do this. So how many deaths of patients with RA aren’t documented as being related to RA? Scary, isn’t it?
Some doctors simply put down Cardiac Arrest and no chain of events, no contributing causes. Well – everyone dies from cardiac arrest when you come right down to it. What made the patient’s heart stop? What disease, what process? Without that information, we have no idea whether the patient died from sepsis, RA, atherosclerotic heart disease, or some other disease.
Death certificates are used for medical research – including determining the death rate from particular diseases. If the cause of death is inaccurate, then the results of research will also be inaccurate. Compilations of vital statistics use death certificates for the primary data. It is my suspicion (and that of many in the health care community) that the death certificate is only about 50% reliable for causes of deaths outside of acute facilities (hospitals). For those in Hospice or who die at home, a generalized diagnosis, rather than a specific one, may be recorded, and generalized rather than specific contributing causes.
I think it would be great if a study were undertaken to determine accuracy of reporting of deaths.It would be very expensive, however.