Nobody is apathetic about avoiding a coroner’s referral form
Copperfield on the tug of war between coroners and MEs over confirming causes of death in the medical examiner system, and where that leaves GPs
If you think you’re living in a parallel universe, or between a rock and a hard place – or both – that’s because you are. This much was made clear to me yesterday at Pulse LIVE London, as I listened to a talk on the medical examiner system, which has now had 18 months to bed in.
But if it has bedded in, the bed it resembles is that belonging to Tracey Emin. It’s all over the place. The session described a system that sounds reasonable but which I just do not recognise. And it suggested we should avoid apathy over signing MCCDs while, at the same time, being cautious about grey areas.
Let’s tease that out. The issue I’m hearing about most is coroners putting pressure on GPs to complete death certificates for unanticipated deaths in the elderly. Some have even insisted on engagement with the medical examiner first – even if we think it is a coroner’s case.
The problem we have is that it is difficult completing the medical certificate of cause of death when you, er, don’t know the cause of death. That doesn’t seem to bother coroners, for whom ‘clinical frailty of old age’ is suddenly a de rigueur solution for those grey areas. But it does bother GPs who remember Shipman and recall a dramatic tightening up of the MCCD process which seems to run counter to what is happening now.
And as for apathy over completing death certificates? Are you kidding? That is so much easier than filling out an online coroner’s referral form – that takes so long that you’re significantly nearer your own death when it is finally done. Back in the day, this would have been a simple phone call, but now there isn’t even a phone to ring.
This seems to leave us GPs being tugged in different directions by medical examiners and coroners. Most MEs do genuinely seem to be trying to help – syntactical nitpicking our cause of death aside.
So what’s going on with the coroners? Pressure of work? Targets to hit? Lack of medical insight? Variable interpretation of the rules?
I’ve no idea. Maybe they could get in touch? They seem to be able to manage it when clinical frailty strikes.
Dr Tony Copperfield is a GP in Essex
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READERS' COMMENTS [5]
Please note, only GPs are permitted to add comments to articles
Dr A Pathy signs an MCCD for his 90 year old heartsink, Hugh Jarsole:
1a. Mortal Coil shuffled off
b. Kicking the Bucket
c. The Passage of Time
d. Einstein
2. Miserable Git, Practitioner of Tedium, Inspired Hatred in all who knew Him
The Coroner’s phone number is 999 – Police.
Apathy is it, I just write to the ME with 1a frailty and they tell me what to put on the form. Typically this is something inflammatory like “1A Anxiety 1B Morbid Obesity” designed to make the family hate us when they read it
Coroners no longer have any interest in the cause of death even in unexpected cases. They just want to know if you think it’s natural causes at which point they insist the GP completes the MCCD. The GP is expected to complete the certificate with a much lower level of certainty than balance of probability (which applies to civil law). It’s basically what’s your best guess!
Harold Shipman would have loved this. No second GP to worry about, and Coroners just begging him to fob off his murders as “Old Age” and “Fraiilty”