All of us as medical practitioners have a statutory duty to issue death certificates when we have been in attendance in the last illness, but there are occasions when the coroner should be notified. This applies to any death where the certifying doctor has not personally seen the patient professionally within the preceding 14 days, where the cause of death is unknown, after surgery or when the cause of death may not be natural: this last includes any case where the deceased's employment may have been implicated in the causation of the death (this can have important financial implications for the family).

In order to be able to give a cause of death on a death certificate, I suggest that the doctor must:

a) have made diagnosis previous to death of the fatal condition

b) have expected the death to occur at about the time that it did and

c) be satisfied that the mode and circumstances of the death are compatible with the diagnosis.

So that if John Smith:

a) suffered from angina of effort and

b) was found dead

it is not logically inescapable that he died from some form of ischaemic heart disease although he may well have done so: a CVA or a knife in the back are other possible reasons for his demise. One has also become uncomfortably aware that deaths in residential and nursing homes are not invariably what they seem: do report any unusual bruising or other injuries on bodies if there is not a totally satisfactory explanation or if they have not been previously reported to a doctor and as required under the regulations.

When a death is reported to a coroner there may be some delay - usually slight - before the funeral can go ahead, so that it is necessary that relatives and undertakers should know of the coroner's involvement in order to avoid the possibility of having to cancel funeral arrangements. The greatest disruption occurs when the registrar of births & deaths has to refer a case to the coroner because the doctor has forgotten, perhaps, that a pneumoconiosis death requires an inquest and the funeral arrangements have already been made. Coroners are as concerned as you to avoid any unnecessary addtional distress to the bereaved and it is important that we work together to avoid this.

If there are any suspicious circumstances in relation to a death, then it is vital that the scene be preserved as near intact as possible. You must be sure that the person is beyond any medical help, but touch as little as possible as possible; make careful notes at the time of everything you have observed.

Please do not authorise the removal of a body by a funeral director unless you are in a position to issue a valid death certificate or have sound reason to believe that another GP can do so; if there is a doubt, then it should normally be possible to leave the body on the premises until enquiries can be made - usually in the morning. If in difficulty, telephone the coroner or his or her officer (out of workiing hours, the police usually act as coroner's officers).

All of us at times have problems with patients' deaths - do not hesitate to telephone the coroner at his office to ask advice: he may wear a crown on his note-paper, but it isn't on his head.

Dr David Bruce - East Cornwall Coroner (retired)