Dr Phil Hammond, GP, lecturer and presenter of the BBC2 programme Trust me, I'm a Doctor

In this consumerist era where doctors are supposed to get it right first time every time, it's perhaps worth revisiting the misdiagnosis of death.

Statistically, people are found to be unexpectedly alive in a British mortuary every 2 years or so (that's not including the pathologists). But what amazes me is that when 'a twitcher' is discovered, the finder manages to summon help.

Picture the scene. You're the junior doctor on call, sipping a pink gin in the doctor's mess, and the crash bleep goes off. 'Cardiac arrest, the mortuary cardiac arrest, the mortuary…' Would you interrupt your snooker for that?

In the glory days of medicine, our cock-ups remained hush-hush, but now every farmer's wife who survives a pronouncement of death goes straight to the tabloids, swiftly followed by the policeman and the undertaker who were there when she started snoring. And all three then sue for post-traumatic stress.

It can be difficult for the layman to understand how doctors can misdiagnose death with such accuracy, but it's an easy mistake to make – patients who are very cold or in some sort of coma can do a very passable impression of death in the living room.

Then there's the problem of hearing the heart. With thin people, the heart is separated from your stethoscope by a couple of ribs and a thin sheet of muscle, so it's not too difficult. But in people who really enjoy their food (or eat like sparrows but have a glandular problem), it goes heart, muscle, ribs yard of lard. No chance of hearing anything save the odd tummy rumble.

Of course, there are more sophisticated ways of spotting death. You pour freezing water in the ear. This is called 'testing for the vestibulo-ocular reflexes', and in a living person should elicit an eye movement.

The only time I've tried it, it elicited a 'What the frig are you doing?!!' and a head butt, so I tend not to do it any more.

Other death-determining tortures include poking something in the eye ('testing the corneal reflex'), poking something down the throat ('testing the gag reflex'), grinding the knuckles into the sternum ('testing the pain reflex') and squeezing the testicles (ditto).

I know very few junior doctors who actually do all this. Most just poke their head round the curtains and grunt. Indeed, the only reason they have curtains at all is not out of respect for the dead, but so that the houseman can raid the fruit bowl without anybody noticing.

But what should a doctor do if he or she misdiagnoses death?

My friend Tom did it on a coronary care unit in Wessex. The patient was lying very still and had very big bones, and he couldn't hear her heart. So he certified her dead and told the nurses to inform the relatives.

He was then bleeped back to the unit 5 minutes later to find her sitting up in bed and reading The Sun (so technically she was still dead). However, when the grieving relatives arrived to find her humming along to Radio Bedside, they demanded an explanation.

The sensible option in these cases is to blame the nurses, but Tom is too honest for that. So he looked the relatives in the eye and said: "Well, you see there are different stages of death…"

In days of yore, it'd be a miracle. They'd be dancing in the streets and framing the death certificate for the lavy. In this modern age of whinging and scape-goating, however, you aren't allowed to make an honest mistake and Tom is waiting for the obligatory solicitor's letter. He says that if he's sued he'll give up medicine and retrain as a counsellor. "Less responsibility and more opportunity," says Tom.

Apparently, there are 30 000 junior doctors in the UK and 90 000 counsellors. That's one to kill the patients and three to ask the relatives how they feel. And if the patient isn't dead after all, she can have therapy too.

Step this way for CRUD counselling for the recently un-dead.

Guidelines in Practice, January 2001, Volume 4(1)
© 2001 MGP Ltd
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