General practitioner's knowledge of when to refer deaths to a coroner.

BACKGROUND: In 1992 about 179,000 deaths were reported to coroners in England and Wales and these represented 32% of the total number of registered deaths. Many of these cases were referred to coroners by general practitioners who certify the vast majority of deaths which occur outside hospitals. The safeguards to society which are provided by the coroner system in England and Wales are undermined if doctors fail to recognize those deaths which should be reported for further investigation. AIM: A study was undertaken to assess the ability of general practitioners to recognize deaths which require referral to a coroner. METHOD-A postal questionnaire consisting of 12 fictitious case histories was sent to all 323 general practitioners in Sheffield and the senior staff of the local coroner's office (two coroner's officers and two deputy coroners). Ten of the case histories contained a clear indication for referral to the coroner. RESULTS: A total fo 196 general practitioners (61%) and all the coroner's office staff returned the questionnaire. General practitioners correctly identified whether or not referral was indicated, with reasons, in a mean of 8.5 cases (range 4-12). Only six general practitioners (3%) were correct in all 12 cases. All of the coroner's staff were correct in all cases. CONCLUSION: General practitioners may be failing to bring certain categories of cases to the attention of coroners because of misconceptions of ignorance of their medico-legal responsibilities. General practitioner education in this area, and a closer working relationship between general practitioners and coroners may improve the situation.

Clinicians and the coronial system: ability of clinicians to recognise reportable deaths.

OBJECTIVE: To assess the ability of clinicians to recognise deaths which require referral to the coroner. DESIGN: Postal questionnaire consisting of 16 fictitious case histories, 14 of which contained a clear indication for referral to the coroner. SETTING: Large teaching hospital. Coroner's office. SUBJECTS: 200 clinicians from general medical and surgical firms and senior staff of the local coroner's office (two coroner's officers and the two deputy coroners). MAIN OUTCOME MEASURES: Number of correct assessments on questionnaire. RESULTS: The mean recognition score for the clinicians was 9.11 (range 3-14) with no difference between the clinical grades. All of the coroner's senior staff recorded maximum recognition scores of 16. CONCLUSIONS: The study highlights several features of the coronial system which are poorly understood by clinicians and provides the basis for an initiative to improve the medicolegal education of all clinicians.