[Cause of death: from primary disease to direct cause of death]. / Doodsoorzaak: van primair grondlijden tot directe doodsoorzaak.

Following the death of a patient, the treating physician in the Netherlands is required to fill out two forms. Form A, which is the certificate of death and Form B, which is used by the Statistics Netherlands to compile data on causes ofdeath. The latter form often poses difficulty for the physician with respect to the primary cause of death. This applies particularly to cases of sudden death, which account for one third of all deaths in the Netherlands. As a result, the statistical analyses appear to lead to an incorrect representation of the distribution of causes of death. A more thorough investigation into the primary cause of death is desirable, if necessary, supported by a request for an autopsy. The primary cause of death is to be regarded as the basic disease from which the cascade of changes ultimately leading to death originated.

[Issues involved in Dutch general practitioners' failure to request autopsy: report from three focus groups]. / Overwegingen van huisartsen bij het niet aanvragen van obductie; een verslag van drie focusgroepen.

OBJECTIVE: To investigate which reservations to autopsy general practitioners (GPs) experience in themselves and in relatives of the deceased. DESIGN: Focus-group discussions. METHOD: Three focus-group discussions were organised (24 GPs in total), comprising the following three types of GP: those involved in the training of new GPs, those who were able to request autopsies without encountering practical obstacles, and those who did have to overcome these obstacles when requesting an autopsy. RESULTS: Neither training nor day-to-day functioning as a GP equips Dutch physicians in regarding autopsy as a research tool. The reservations experienced by the GPs were based on emotional issues, organisational obstacles, and financial considerations.

Family members' experiences of autopsy.

BACKGROUND: The experiences of family members will teach us how to handle an autopsy, the ultimate quality assessment tool. OBJECTIVE: The aim of this study was to determine surviving family members' experience of autopsy. METHOD: Seven GPs were asked to approach surviving family members of autopsied patients to ask for their co-operation with an interview about their experiences. The interview took place at the residences of the individual families, 6 months to a year after the autopsy. A partially structured set of interview questions was used by the interviewer (not a GP) who had experience with the grieving process and with grief counselling. RESULTS: Twelve family members of autopsied patients were interviewed: six partners, three mothers, one offspring and two sisters. In the case of one 35-year-old man, the autopsy was performed as a judicially required post-mortem. The GP initiated the autopsy request in eight cases. It appears that there is definite room for improvement in how the GP handles the topic of autopsy. The best way to explain it is to compare an autopsy with an operation. Several family members had specific concerns about the appearance of their relative after the autopsy. Several of the family members indicated that they were reassured by the autopsy results. Clarity about the cause of death was important, and reassurance that they had not overlooked important symptomatology helped the family members in their grieving process. CONCLUSION: A request for autopsy is one of the most difficult questions which has to be asked at a very difficult time. Three main considerations were important for the relatives: they wanted an answer to the questions "Is there something I overlooked", "How could this have happened" and "Are there hereditary factors which could have consequences for the rest of the family?" The GP is the optimal professional to discuss the autopsy report with the surviving family members. The best approach for the GP includes an open attitude, paying attention to informing the family and supporting their grieving process.