The End Is Near! But That’s Just the Beginning: A view under the Retrospectroscope.

If hindsight were 20/20, there would be no need for Practice Pearls in 2020.

The Practice Pearls lessons of 2019 put clinician educators in the spotlight. They have the important responsibility of molding future physicians, especially those destined to practice in one of the Primary Care specialties, into not only diagnosticians and caregivers, but also stewards of public health in helping us live longer, smarter and healthier lives. 2019 saw another blow to the already floundering hospital autopsy rate with the handing down of a so-called burden reduction rule put forth by the Centers for Medicare and Medicaid Services (CMS) which in part called for the removal of the requirement for a hospital’s medical staff to attempt to secure autopsies in all cases of unusual deaths and of medical-legal and education interest (1). Not exactly a good thing for clinical resident education. Clinical educators must prepare these doctors-in-training to educate families about the benefits of the autopsy, to take advantage of the expertise of the pathologist in understanding disease processes, to know when and how to report a death to the Medical Examiner or Coroner, and to know how to properly complete a death certificate and why it makes a difference (2,3,4,5). Earlier exposure of these topics to medical students would further bolster the efforts of clinical educators.

Mortality trends in the United States have identified cardiovascular disease, accidental drug overdoses, suicidal injury in adolescents, fall-related injury in the elderly, birth defects, and pregnancy complications as top common causes of death based on cause-specific information listed by the Certifiers of death in the cause-of-death section of the death certificate (6). There is much room for improvement of mortality trends.

The following death certificate was not originally certified by the local Medical Examiner but by a clinician, not so auld lang syne, but in the not- so-distant past of the latter half of 2019:

There’s still work to be done….
Out with the old and in with more, so desperately needed, new pearls of clinical practice wisdom!

1. Omnibus Burden Reduction (Conditions of Participation) Final Rule CMS-3346-F. Available at:
2. “How Trained is the Trainer-Comprehensive Medical Education: The Keystone of Modern Medicine”. Practice Pearls In Death Reporting and Death Certification, March 2019.
3. “Throwing mud at the wall: Sometimes it just doesn’t stick!”. Practice Pearls in Death Reporting and Death Certification, April 2019.
4. “Sch-o-o-o-ol’s-Out-For-the Summer!(But not if you’re a PGY-1 doc.)”. Practice Pearls in Death Reporting and Death Certification, July 2019.
5. “What Say You? Say It Isn’t So! Practice Pearls in Death Reporting and Death Certification”. October2019.
6. “Oh Say I-C-D!”. Practice Pearls in Death Reporting and Death Certification, May 2019.


Clinicians, kick off your New Year’s resolution to stay out of the crosshairs of the Funeral Director and Vital Statistics with a NEW AND IMPROVED copy of:

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