In our part of the world the Coroner is keen to avoid post mortem examinations where possible. There are good reasons for this: bereaved relatives don't like them (not least because they delay the funeral arrangements) and they cost the Coroner's department money. A post mortem can be avoided if the GP is happy to certify the cause of death, and the Coroner is usually delighted to waive the requirement that the GP should have seen the deceased in the two weeks prior to the death.
Today the Coroner's officer rang me about an elderly gentleman whom I had not seen for several months. Since then he had been admitted to hospital and discharged to a nursing home outside our practice area, and so was now registered with a different practice. This morning he had been taken to the Emergency Department of a local hospital, where he promptly suffered a cardiac and respiratory arrest and died. Did I feel able to issue a certificate?
I could see things both ways. The chap was getting on a bit, and hadn't been visited by any suspicious-looking GPs recently. He had more pathology than you could shake a stick at: ischaemic heart disease, heart failure, renal failure and an industrial lung disease, and had also had bowel cancer and a pulmonary embolism in the past for good measure. I had no doubt that he had died of natural causes, and there was a wide range of natural causes to choose from.
But therein lay the rub. Death certificates demand a single cause of death, though you can add as many subsidiary causes as you like in part two: "other conditions contributing to the death but not related to the main cause". I didn't have the foggiest idea which of his many diseases had killed him in the end, and by signing a certificate I should be saying that I did.
In the old days (just a few years ago) I would have plucked a condition at random and happily signed a certificate, thus saving the relatives some anguish and the Coroner some expense. But in these po-faced times, that approach is untenable. I can just imagine some self-confident supercilious QC smiling knowingly at the bench and saying "so now Dr Brown, you admit that you hadn't seen the patient for four months and that he had had a hospital admission since then. Do tell us exactly how you came to your conclusion about his cause of death."
In an age when doctors seem to be mistrusted by the authorities, we can't bend the system to help people out any more. It's more than my job's worth, squire.