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[Death certification and general practitioners: opinion about propositions of improvement. Qualitative survey conducted among 14 general practitioners in the Loire].

Death certificates are one of the sources of national mortality statistics and allow for an evaluation of public health. General practitioners regularly certify deaths but studies revealed that they had difficulties in doing it. Propositions were made to improve death certification. The objective of our study was to know family physicians opinion about death certification and about those propositions. A qualitative survey was conducted through the analysis of 14 general practitioners' interviews. Our study confirmed that family physicians had difficulties completing death certificates. It also revealed that some propositions were rejected: to go rapidly to the deceased (with a few exceptions), whole and systematic body examination, call of regular doctor, notification of violent or suspect deaths according to official texts. The reasons were practical, technical, ethical and personal, or related to an obviously natural death (especially for elderly people). Majority of general practitioners rejected electronic death certification because they found it unpractical. Other propositions were approved: a reminder, written on the death certificate, of all situations that need to be referred to a coroner, intervention of forensic pathologists for some complex cases. In our study, family physicians seem to refuse to investigate patients' death. Therefore, better collaboration between forensic pathologists and general practitioners is of prime importance: it could be organized through easier access to specialists when necessary or through an informative booklet, as suggested by some doctors in our study. The validity of these propositions needs to be confirmed.