Death Certificates

Jackson, Brian brian.jackson at ARUPLAB.COM
Thu May 5 19:20:14 UTC 2016


I think you're making a cultural argument more than a scientific one.  (Which doesn't make it wrong by the way).

Death certificates are supposed to list the immediate "cause" rather than the immediate physiologic mechanism.  For example MI and lung cancer are appropriate causes of death to list on a certificate.  Cardiac arrest and respiratory failure are not.  (Disclaimer:  I haven't done autopsies or death certificates for almost 20 years so my knowledge is a bit rusty here.)

--Brian

Sent from my iPhone

On May 5, 2016, at 12:12 PM, Geri Amori <gamori at COVERYS.COM<mailto:gamori at coverys.com>> wrote:

I am following this discussion with interest and curiosity.  Perhaps what I am going to say will not be popular, but it feels like it needs to be said.  I am not certain there would be any benefit to putting “error” on a death certificate.   Ultimately, it was NOT the error that caused the death, but the physical response to the possible error.   Putting “error” in the death certificate is like saying typing is the cause of erroneous information in the news.    My point is that labeling the cause of actual physical death as “error” feels and sounds punitive and indirect.  We MUST find out the cause of errors so they happen less frequently. (We are striving to make them happen not-at-all.)  Nevertheless, we will never stop death. The rate remains 100% globally.  I would NOT want my death certificate to label and blame another person for all eternity.  I prefer to go to my grave in a state of humane understanding.   Nonetheless, I would still want for those who remain to investigate what happened to ensure it doesn’t happen to another.

Geri Amori, PhD, ARM, CPHRM, DFASHRM
Vice President, Academic Affairs
P: 617.526.0360

C: 802.238.5652


COVERYS
One Financial Center
Boston, MA 02111
www.coverys.com<http://www.coverys.com/>
1.800.225.6168

From: Pete Dayton [mailto:pdayton at PTWFL.COM]
Sent: Thursday, May 05, 2016 12:44 PM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at list.improvediagnosis.org>
Subject: Re: [IMPROVEDX] Death Certificates

Hi folks, my first post…It probably won’t be used as a cause of death as this is sometimes subjective unless one performs a formal autopsy. Secondly malpractice risk, who would assign that liability willingly to themselves on a death certificate, it’s human nature ? Lastly people dying of multisystem disease sometimes die of multiple simultaneous issues all of which may not have been thoroughly investigated. Is that an error, slip or malfeasance? Calling a PE a rib bruise is one thing, but my experience is that it is seldom that clear. Hindsight is always 20:20 and yes I agree the Errors are happening at an alarming rate. Stop paying doctors for piece work and stop depending on the EMR to mention every possible drug interaction east of Eden , make the docs be Doctors! High volume , alarm fatigue and distractions all clearly recognized as potential opportunities for error in aviation and not in medicine. Docs need cockpit resource management , RCM , skills and need to slow down, study the drugs they prescribe well, see fewer patients , especially complex internal medicine patients, take better histories, listen to patients, become astute at physical diagnosis again and enjoy the practice of medicine! Yes they will make less money but pay them for outcomes not volume and this will improve. I don’t think we should rely on the ERM and the internet for everything. I have used an EMR for 10 + years and it is helpful but a double edge sword. I teach medical students and make them get their heads out of their phones and actually learn the stuff. The harder one  works to solve the problem the better the lesson. Make answers too easy and I think you lose a lot. Students come through their  general surgery rotations come to my GYN service and can’t write post op orders because of automated order sets. When I see them we pull a blank piece of paper out of the printer and they write the orders. It is amazing the deer in the headlight looks I get!

Just my 2 cents

Love your show Joe!

Peter M. Dayton MD
Medical Director of Patient Safety and Quality
Martin Health Systems
1815 Kanner Highway
Stuart, FL 34994
772-288-2992 Office
772-285-4020 Cell
772-288-2999 fax
pdayton at ptwfl.com<mailto:pdayton at ptwfl.com>
I Peter 3:15



From: Joe Graedon [mailto:jgraedon at GMAIL.COM]
Sent: Thursday, May 05, 2016 8:36 AM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>
Subject: Re: [IMPROVEDX] Death Certificates

This is a very interesting concept.

Just out of curiosity, has anyone ever asked the question or sought an answer to the question:

How many times does "Error in Diagnosis" show up on death certificates? If I were a betting person I would guess rare to never.

As to the second "Error in Medicine" I would guess never.

To change that one would need to change the culture of medicine.

Joe

Sent from my iPad

On May 4, 2016, at 11:11 PM, robert bell <0000000296e45ec4-dmarc-request at LIST.IMPROVEDIAGNOSIS.ORG<mailto:0000000296e45ec4-dmarc-request at LIST.IMPROVEDIAGNOSIS.ORG>> wrote:
It is not common practice to put either Error in Diagnosis, or Error in Medicine on a death certificate. They seem to require some kind of diagnosis even if it may be incorrect.

Could this Society change that with action and recommendations or would you have to first change litigation law to achieve that?

Are there any other solutions that would be acceptable?

This would seem to be part of that data lack that plagues the Error in Medicine discipline.

Robert M. Bell, M.D., Ph.C.



________________________________

Address messages to: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>

To unsubscribe from IMPROVEDX: click the following link:
http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?SUBED1=IMPROVEDX&A=1
or send email to: IMPROVEDX-SIGNOFF-REQUEST at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX-SIGNOFF-REQUEST at LIST.IMPROVEDIAGNOSIS.ORG>

Visit the searchable archives or adjust your subscription at: http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?INDEX

Moderator:David Meyers, Board Member, Society for Improving Diagnosis in Medicine

To learn more about SIDM visit:
http://www.improvediagnosis.org/

________________________________

Address messages to: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>

To unsubscribe from IMPROVEDX: click the following link:
http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?SUBED1=IMPROVEDX&A=1
or send email to: IMPROVEDX-SIGNOFF-REQUEST at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX-SIGNOFF-REQUEST at LIST.IMPROVEDIAGNOSIS.ORG>

Visit the searchable archives or adjust your subscription at: http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?INDEX

Moderator: David Meyers, Board Member, Society for Improving Diagnosis in Medicine

To learn more about SIDM visit:
http://www.improvediagnosis.org/

________________________________

Address messages to: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>

To unsubscribe from IMPROVEDX: click the following link:
http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?SUBED1=IMPROVEDX&A=1
or send email to: IMPROVEDX-SIGNOFF-REQUEST at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX-SIGNOFF-REQUEST at LIST.IMPROVEDIAGNOSIS.ORG>

Visit the searchable archives or adjust your subscription at: http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?INDEX

Moderator:David Meyers, Board Member, Society for Improving Diagnosis in Medicine

To learn more about SIDM visit:
http://www.improvediagnosis.org/

________________________________
This email and any files transmitted with it are intended only for the person or entity to which it is addressed and may contain confidential and/or privileged material. If you received this email in error, please contact the sender immediately and delete this email from your system. If you are not the named addressee, you should not disseminate, distribute, print, or copy the email, or take any action in reliance on its contents.

________________________________

Address messages to: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at list.improvediagnosis.org>

To unsubscribe from IMPROVEDX: click the following link:
http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?SUBED1=IMPROVEDX&A=1

or send email to: IMPROVEDX-SIGNOFF-REQUEST at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX-SIGNOFF-REQUEST at list.improvediagnosis.org>

Visit the searchable archives or adjust your subscription at: http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?INDEX

Moderator:David Meyers, Board Member, Society for Improving Diagnosis in Medicine

To learn more about SIDM visit:
http://www.improvediagnosis.org/

 -------------------------------------------------------------------
The information transmitted by this e-mail and any included
attachments are from ARUP Laboratories and are intended only for the
recipient. The information contained in this message is confidential
and may constitute inside or non-public information under
international, federal, or state securities laws, or protected health
information and is intended only for the use of the recipient.
Unauthorized forwarding, printing, copying, distributing, or use of
such information is strictly prohibited and may be unlawful. If you
are not the intended recipient, please promptly delete this e-mail
and notify the sender of the delivery error or you may call ARUP
Laboratories Compliance Hot Line in Salt Lake City, Utah USA at (+1
(800) 522-2787 ext. 2100






Moderator: David Meyers, Board Member, Society to Improve Diagnosis in Medicine




More information about the Test mailing list