Mind Your Manners. Avoid A Query.

“…but in this world nothing can be said to be certain, except death and taxes”-Benjamin Franklin, 1789.

It is also pretty certain, that a clinician practicing in a primary care specialty will on more than one occasion during his/her career encounter the death of a patient and be called upon to certify the death. Collectively, clinicians certify the majority (about 80 %) of deaths as compared to those certified by medical examiners and coroners (1,2). Those of you who follow the Practice Pearls site regularly know why getting it right matters and the consequences of getting it wrong.

Consider the cause of death statement below taken from an actual death certificate involving a death that  was certified in lieu of reporting to the local Medical Examiner. It was promptly flagged by an astute Vital Statistics professional. Can you identify the reasons why?

Part I.


A.                  Pneumonia-Aspiration poss.

Approximate interval: Onset to death

1 day

Due to (or as a consequence of):

B.                  Dysphagia


6 months

Due to (or as a consequence of):

C.                   Quadriplegia


3 years

Due to (or as a consequence of):


Part II. Other significant conditions contributing to death but not resulting in the underlying cause given in Part I
Manner of Death




  1. Cambridge B and Cina SJ. The accuracy of death certificate completion in a suburban community. Am J Forensic Med Pathol. 2010;31(3):232-35.

2. Armstrong E J. Chapter 8: The Clinician Certifier of Death. In: Essentials of Death Reporting and Death Certification: Practical Applications for the Clinical Practitioner. 2017. Available at: https://www.amazon.com/Essentials-Death-Reporting-Certification-Applications/dp/0998533408 .

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