Disagreement among general practitioners regarding cause of death

Death certificates are well known to state poorly the pathological processes leading to death. Hospital specialists using complex investigative equipment often fail to make accurate diagnoses before death, and thus not surprisingly general practitioners with fewer diagnostic aids at their disposal often disagree on the cause of death in a particular case. In addition, even when in agreement general practitioners often differ in the exact terminology they use when completing death certificates. Apparently minor differences in wording or ordering entries on the certificate may result in the assignment of entirely different diagnostic codes once the rules of the International Classification of Diseases (ICD) are applied.¹ In an attempt to quantify this real and apparent diversity of opinion we have surveyed a random sample of general practitioners practising in England and Wales.