Social representations of obstetricians and neonatologists about fetal and early neonatal death certificate in the city of São Paulo

Abstract

Introduction:The insatisfactory completeness of the variables in the Death Certificate (DC) makes it difficult to obtain specific perinatal mortality indicators. Objective: To assess the social representation of physicians about the perinatal DC. Methods: Twenty-five physicians were interviewed in 15 hospitals in the city of São Paulo, in 2009. Qualitative analysis was performed with the Collective Subject Discourse technique. Results: The DC is primarily considered according to its legal aspect. Physicians feel responsible for fulfilling the cause of death. The majority of them reported receiving help from other professionals to complete information on maternal characteristics and identification variables. There is lack of information on the mother's pre-natal conditions, which can make it difficult to identify the perinatal cause of death, mainly in the Unified Health System (SUS) hospitals. Some participants received specific DC training only when attending medical schools. Conclusions: The organization of medical work may affect the completion of the DC, especially in hospitals from SUS. Other professionals contributed to this task and their training can improve the quality of information.

Completitude e confiabilidade do Sistema de Informações sobre Mortalidade para óbitos perinatais no Brasil, 2011-2012: um estudo descritivo*

“…The filling out of socioeconomic information, for example, tends to be delegated to administrative staff. 13 A qualitative study conducted in the municipality of São Paulo in 2009 25 found that physicians are aware of the legal aspects of death certificates and aware of the importance this data for epidemiological and public health purposes, but give emphasis to the filling out of the cause of death to the detriment of other fields, in addition to reporting being helped by other professionals to fill out identification information and maternal characteristics.…”

Tendência da incompletude das estatísticas vitais no período neonatal, estado do Rio de Janeiro, 1999-2014*

“…18,19 Another aspect to be discussed, although it cannot be identified on the information systems, is the training of health professionals responsible for filling in LBC and DC. [28][29][30] Only doctors are authorized to issue Death Certificates, whereas other health professionals can issue Live Birth Certificates. Studies have demonstrated that doctors do not receive sufficient training and/ or do not keep up to date on adequate filling in of DCs.…”

“…Studies have demonstrated that doctors do not receive sufficient training and/ or do not keep up to date on adequate filling in of DCs. 28,30 Health professionals responsible for filling in LBCs, usually nursing or administrative staff, generally incorporate this routine into their daily work in a more consistent manner. 29 Collaboration between different health professionals working in the same service can improve the quality of these documents.…”

“…29 Collaboration between different health professionals working in the same service can improve the quality of these documents. 30 One study has also described a possible difficulty felt by health professionals in recording events of a negative nature. 30 Notwithstanding, problems were found both with the filling in of unfavorable variables, i.e.…”

“…30 One study has also described a possible difficulty felt by health professionals in recording events of a negative nature. 30 Notwithstanding, problems were found both with the filling in of unfavorable variables, i.e. stillborn children, and with the filling in of favorable variables, i.e.…”