What killed my dad?

R.I.P. - but do we know the cause of death?

There is a sad story reported by the BBC today of an elderly man who died of multiple medical complications after being admitted for a “routine” hip operation. Of course any “routine” operation for a man of 86 is not without risks but nonetheless with modern anaesthetics one would confidently expect the majority of such patients to walk out of hospital in a better condition then when they limped in.

The lawyers always say that “justice must not only be done but it must be seen to be done.” Dr Crippen believes that there is an even greater need for this to apply in medicine.

If there are complications or an unexpected death, patients and their relatives need to understand what has happened.

As discussed here, many death certificates are a work of fiction. If Dr Crippen has a 94 year old lady who suddenly stops eating, fades away and dies, it is easy to write words such as “bronchopneumonia” on the certificate. No one will ever challenge that diagnosis. Dr Crippen used to do that a lot. He never does it now unless he has first-hand clinical knowledge that the patient really did have “bronchopneumonia”. Nowadays, he puts “Old Age”. It is unimpeachably correct, though lacks the diagnostic precision that the gatherers of statistics prefer.

One does not have to talk of death certification for long before the dreaded word “Shipman” comes up. This is a red herring. Shipman could and should have been caught in a matter of weeks by a method that is so simple and so obvious (as described here) that Dr Crippen is still flabbergasted that it has even now not been introduced.

In general terms, the public have to decide if they really want diagnostic precision on all death certificates. If they do, there are going to have to be an awful lot of post-mortems. Do you really want to chop-up granny?

The BBC article reports:

A government report into death certification in 2003 showed that only 55% of death certificates are correct. This meant that 45% weren't. So nearly quarter of a million certificates are wrong.

Dr Crippen is surprised it is only 45% that are wrong.

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"TV producer Angie Mason secretly filmed her dying father in an NHS hospital. During her efforts to find out why he died, she makes a startling discovery about the accuracy of death certificates." (full report here)