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‘What is a myocardial infarction, Doctor?’

The receptionist told me a patient on the phone wished to speak to an independent doctor in our practice about an urgent problem. The distressed woman’s opening words were: ‘What is a myocardial infarction, Doctor? I simply have to speak to you about it; I’m too embarrassed to speak to the doctors there that I know’.

The story unfolded. Her husband, aged 56, had been treated by Dr A for hypertension. Her doctor was Dr B. Twelve months ago Dr C saw her husband at home early one morning because he had chest pain. Despite attempted resuscitation after a cardiac arrest in the ambulance, he was dead on arrival at the hospital.

Everything happened so suddenly that she did not have an opportunity to speak to a doctor at the time but assumed her husband died from a heart attack. However, a copy of the death certificate that stated death was caused by ‘myocardial infarction’ confused her. She had mulled over this for the past year. Her catharsis began: ‘How could he have died in this modern day of wonder medicine? Why didn’t Dr A warn us this could happen? If only I could have spoken to one of the doctors. If only I’d known exactly how he died. I have felt like killing myself, I’ve been so depressed. I feel so bad about the way I looked after him’.

An erroneous death certificate

A patient consulted me last year, distressed and angry about the death certificate issued after her husband’s death. She said, ‘This certificate is wrong. It’s an illegal document. It’s a lie—Ted did not die from septicaemia after bronchopneumonia—he had a heart attack.’

Ted, who had a history of ischaemic heart disease, was found semiconscious with a blood pressure of 80/40 and a temperature of 38 °C. When hospitalised, with a provisional diagnosis of septicaemia, he was treated with intravenous antibiotics. He developed heart failure and died 48 hours later; the resident doctor issued the death certificate. Later, a postmortem revealed an extensive myocardial infarction.

Her grief and hostility towards the doctors at the hospital were profound. ‘Doctor, the diagnosis is wrong. The treatment was wrong—you will have to change it.’

The unreal image of the great hospital

‘Doctor, would you please call on Mum? She is in a terrible state over Dad’s death, although it was four months ago.’

Dad was a 72-year-old farmer who developed pyloric stenosis after a long history of peptic ulceration. He was admitted to a major teaching hospital in the city, under the care of a surgeon. His postoperative course had been good until a tear developed in the lower oesophagus following ...

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