État des lieux et des connaissances et des pratiques professionnelles sur l’obstacle médico-légal des médecins thésés et internes de quatre établissements hospitaliers du Maine-et-Loire

Introduction

The declaration of death is the responsibility of every clinician. In the case of a suspicious, unexpected or violent death, the “obstacle médico-légal” (OML) must be ticked off on the death certificate. Published French studies on the OML concern exclusively pre-hospital doctors. The main objective of our study was to evaluate the knowledge and current practices of in-hospital physicians regarding the OML.

Material and methods

We carried out a descriptive, quantitative, multicentre study comprising firstly a retrospective collection of the number of certificates with OML issued in four hospitals in Maine-et-Loire (Angers University Hospital, Cholet Hospital, Saumur Hospital, CESAME) between 2017 and 2020, and then an anonymous questionnaire addressed to the post-graduate doctors and interns of these same hospitals, asking them about their knowledge and experience on the subject and including eight fictitious clinical cases on the situations most frequently encountered in practice. The free answers to the clinical cases were classified into four categories with the possibility of answering “I don’t know”.

Results

From 2017 to 2020, 1.7% (131/7484) of deaths at Angers University Hospital were concerned by an OML. The questionnaire collected a total of 386 responses out of 1596 people contacted (24.2%). The main obstacle to the installation of an OML was a “general lack of knowledge about the OML” (80.1% of participants). Having previous training in forensic medicine had a significant influence on the placement of an OML. Almost 50% of the participants would not apply an OML if there was a suspicion of misconduct during care. In all clinical cases, the majority response was category 1 (37% of responses).

Discussion and conclusion

The results of our study are similar to the current publications in the French literature concerning only pre-hospital doctors. The knowledge of clinicians about OML should be reinforced and they should be encouraged to seek advice from the on-call coroner at Angers University Hospital. Our study also addressed the problem of suspected medical malpractice situations, which represent an additional difficulty for doctors because of the conflict of interest generated and for which the OML procedure does not seem to be very suitable.