Purpose: To gain insight into how general practitioners (GPs) determine the cause of death and record it on the death certificate for patients who die at home.
Method: During 1998 and 1999, the number of patient deaths, as well as the cause and place of death, were registered for 17 general practices.
Results: A total of 841 patients died during the two-year study period: an average of 25 patients per practice, per year. 53.8% at home, 34.6% in hospital, 8.7% in a nursing home, and 2.8% elsewhere. When compared with national figures, the number of deaths due to neoplasms were similar, whereas there were clear differences when causes for sudden death were compared with the information obtained from the National Central Bureau of Statistics (CBS). Heart disease (19%) was registered less often, and cerebrovascular accidents (45%) more frequently. There were 57 (6.7%) deaths due to unnatural causes, 23 (2.6%) of which were due to euthanasia, which were all reported according to the law, requiring no further action. Autopsies were obtained in 3% of all deaths.
Conclusion: Especially in cases of sudden death, determining the cause of death is guesswork. During medical school and continuing education, attention should be given to the completion of registration information. The Central Bureau of Statistics would be able to give more and better feedback to the physicians. A case is made for maintaining a death registry in each general practice. A death register is a means of reflection and for improving quality of care.