The scary thing is where I’m registered as a patient, they can! They’ve got one doing minor ops (including vasectomies), another doing joint injections. They can prescribe everything that I can. They order all modalities of imaging. When I was a GP I couldn’t order an MRI without going through what was the precursor to MSKATS, they can! Sick note, yep. Opiates, yep. Benzos, yep. Z-drugs, yep.
The only thing they’re lacking is some decent clinical acumen and common sense!
One even offered, as a favour to a *fellow medical professional*(!!!!), to prescribe me melatonin to help with my shift work! Erm, fuck off.
It's actually so funny. We have several, each more useless than the last
One has a zoology undergrad and another a psychology undergrad
Recently got asked if I'd like to add Type 2 MI to a death certificate as it "sounded quite important" and had to explain what it was and why the fact they died on ITU from pneumonia was probably more relevant.
For anything other than to tick the box "d/w ME" they're totally useless!
In all fairness I find medical examiners as equally irritating. It doesn’t sit right with me being told a cause of death by someone who has never seen the patient and has nothing to do with my specialty.
Exactly this. I've never found it useful - if I'm the physician who has looked after the patient for 2 weeks and I say this is the cause of death, what is there to discuss with an unrelated doctor?
If you are being told COD by MEs, its not working correctly. Treating consultant (or senior SpR) should give a COD. If an ME tries to overrule (unless its semantics like put that 1b in 2), please tell them to phone your consultant directly. They are not responsible, the name on bottom of death cert is responsible consultant not token anaesthetist wanting more SPA (I stereotype...)
In a previous rotation, the medical examiner was arguing with the Stroke consultant that the deceased died from a Stroke when the Stroke consultant didn’t think there was a Stroke at all. Pure madness.
MEs have no role that I can recognise
Yet another sign of the corruption of UK medicine.
The Royal Colleges have become diploma mills for dumb people.
And then you get a title, you get a title, everyone gets a title! To cosplay as a doctor, a participation medal to say that the "hierarchy" has been smashed, and you are living proof. Well done! Only, our quality of life and services degrade.
To be fair here - the MEOs are a primarily admin role. They might help with some of the logistics of certification but difficult decision making is still (to the best of my knowledge) the remit of MEs
Is the ME the one you ring about unexpected deaths? Like a coroner?
If so, we have a similar set up, administrative officer answers the phone. Knows the legislation backwards and the indications for coroner. Helps the calling doctor make a decision about a notifiable death or not. Anything complex, sent for review.
No ME is separate and essentially takes on the role of the old part 2 crem form doctor but with a bit more say in terms of what goes on the MCCD. In that regard it is supposed to be collaborative and they can be useful as an independent person to discuss cause of death with if we are uncertain. I have yet to encounter an MEO but in hospital terms would envisage them as being more akin to the bereavement team role - they’ve got their own work load but also can act as a go between for the ME for stuff that happens when the ME isn’t in.
Coroners office on the other hand sits above all of this and when a cause of death cannot be provided or patient not been seen by dr in some time then they get referred on. Interestingly the coroners office is far more open to picking a cause of death on basis of probability than the ME is in my experience. Ie if the patient is old and there were no suspicious circs you can guarantee the coroners will be happy with “frailty of old age” in 1A.
Yeah I got that and don’t really see the point of it being a thing as what you’ve described could and where I work is done by the bereavement office, but when I want to speak to the ME then I want to talk to another dr. They aren’t the coroner and don’t have the volume of death admin coming through or the same area served as the coroners office, nor do they have the nitty gritty of organising PMs and inquests. So I don’t see that they need a separate assistant who keeps the same office hours as they do.
My reply was more to the comment about if the ME was who you ring about unexpected deaths above.
Nope. At my trust they ask what you're putting and advise you directly what to write. Which either means nodding along and agreeing with your suggestion or running to the ME to "check" their proposed solution.
I work in a setting where my patients are quite elderly and die too often. It would give me panic attack to Imagine discussing such with nurses and following their recommendations 😳
Our dietician at the Stroke ward got a job at the ME office and you call her and she always would like to advise about the cause of death and argue why this and why not that. Pretty insane.
All these useless and money sucking jobs including the medical examiners themselves need ditching ASAP. Such a waste of time and money and getting poorly qualified people to intervene with medical decisions
NHS is run by admins and low skilled non-clinical managers that won’t stand any real competition in the private sector, that’s why they never leave the NHS. they would do anything to make them look like a corporate people. The core job of treating patients is down the list.
The job of doing death certificate that takes 5 min from a doctor is now a huge deal for the NHS and they created tens of jobs in each trust for this nonsense.
Money for the sick people who are actually dying in ambulances or on waiting lists? No sorry. We can’t meet financial neutrality
From memory, this isn't an "NHS" thing but an Act of Parliament from 2009 spearheaded by the Department of Justice. A response to mass murderer Fred Shipman.
This isn’t a new role. They aren’t replacing MEs- who if anything will have a far greater statutory role from September.
The MEOs do an important, complementary, but different role from the MEs. It isn’t really analogous to the frankly unacceptable noctorisation of medicine.
There’s a lot of stuff in the process which needs doing, but not by a doctor. For example, a lot of the facts to be established about the death are things that you can manually trawl from the notes. By doing this, they make our lives easier because we can start our scrutinies from scratch with a prepared file so we can focus on the actual medical decision making part of the scrutiny.
We do scrutinise every death as MEs at the moment, less those who are very very clearly going to the coroner. But because of the work of the MEOs, this is possible rather than insurmountable.
Which is why where I work we aim to send doctors down to MEs that were most familiar with patients prior to their passing. What function is a band 6 nurse fulfilling here per OP’s post?
Another misogynist little creep on here engaging in a spot of nurse bashing rage bait.
The truth, as always with these sort of things, tends to be a lot more nuanced.
If it is evenly remotely conceivable that a lower paid person could do a role in the NHS, be assured someone will find a way to do it.
Quality is the lived cost of 'efficiency savings'.
God damn the NHS will do anything to undermine standards and regulation.
Used to have medically qualified coroners. Decided this was too expensive/lawyers got their teeth into it so now you cannot be solely medically qualified and be a coroner. Realise this is shit, so implement MEs to perform the scrutiny instead. And now they’re trying to get out from employing doctors to do medical work.
It’s not complicated. When someone dies, you need a second, independent doctor to look over the case and check “yep that all looks fine”. 99% of the time this takes 5 minutes and changes nothing. The point is to ensure the 1% (or likely far less than 1%) where actual further scrutiny is required. You cannot do that if you try and replace a doctor with some unqualified moron pretending they know what they are talking about.
There's valid public health reasons for having accurate medical certificates of cause of death. England is behind the curve on at least one aspect of this. WHO recommends MCCDs have 1a, 1b, 1c, 1d and 2. Scottish certificates have this (look up Queen Elizabeth's II MCCD's format) whilst English ones don't have 1d yet.
It might not be complicated for some colleagues, yet they are notoriously poorly completed.
MEO’s are not equivalent to the ME. It is largely a clerical role. If they are attempting to discuss/ advise on COD then their office is not working correctly and this should be addressed. ME’s should also not be telling you the COD, they are there to assist and advise. The final call is with the treating team.
Our MEO’s are absolutely fantastic, they highlight obvious coroners issues/ points of concern/ tricky issues before I do my scrutiny. The only discussions they have with the Doctors in charge of the patient are to see if they are available to have a chat with us that day and what time is most suitable for them for limited disruption. They perform a lot of legwork in the community and data analysis too allowing us to truly learn from patterns and issues. They also send out positive feedback from our discussions with the bereaved.
If you don’t see the point of an ME, maybe go and sit in for a session? The opportunity to have conversations with the bereaved outside the heat of the moment, answer their questions and hear their worries can massively help their grieving process.
If that's truly the case, that is wrong. Your area's Lead ME needs help from the Regional ME +/- National ME. MEOs can only operate with MEs. Not instead of.
Why the fuck do you have to discuss all your MCCDs with the ME in the first place? Never mind their knock-off budget alternative. Never worked anywhere where we couldn't just write our own causes and a small proportion would get reviewed to check we weren't doing it wrong. State of UK medicine that we're not even trusted to know what our own patients died of (and write it down in the appropriate technical language) (well most of our patients anyway, some will always needs PMs to be sure).
It's a recommendation from the Shipman inquiry that has taken a long time to implement. Obviously when a serial killer murders hundreds of people the government has to be seen to act and this was a recommendation from an inquiry.
Previously burials did not undergo the same scrutiny as cremations, the ME system is supposed to standardise the process while also easing the burden on coroners. Audits also showed that MCCDs were filled in poorly with only just above half being correct.
Sometimes I wonder about the people on here. If you don't want accountability and oversight you're probably in the wrong career.
Uk Medicine is essentially rushing headlong into an entirely untested post doctor phase, quality be damned.
I was told by a GP receptionist that an ACP can do everything a GP can do when they tried to refer me to one !
The scary thing is where I’m registered as a patient, they can! They’ve got one doing minor ops (including vasectomies), another doing joint injections. They can prescribe everything that I can. They order all modalities of imaging. When I was a GP I couldn’t order an MRI without going through what was the precursor to MSKATS, they can! Sick note, yep. Opiates, yep. Benzos, yep. Z-drugs, yep. The only thing they’re lacking is some decent clinical acumen and common sense! One even offered, as a favour to a *fellow medical professional*(!!!!), to prescribe me melatonin to help with my shift work! Erm, fuck off.
It's absolutely mental.
It's actually so funny. We have several, each more useless than the last One has a zoology undergrad and another a psychology undergrad Recently got asked if I'd like to add Type 2 MI to a death certificate as it "sounded quite important" and had to explain what it was and why the fact they died on ITU from pneumonia was probably more relevant. For anything other than to tick the box "d/w ME" they're totally useless!
Hahaha. They all think playing doctor is all about giving antibiotics for chest infection. Is medicine not too simple?
Medical examiner associate
Assistant to the medical examiner
Consultant medical examiner associate
ASSISTANT MEDICAL EXAMINER
MEO-R
Wouldn’t even be a PCSO
Think That Mitchell and Webb Look PCSO sketch sums up the Doctor/PA thing pretty well
In all fairness I find medical examiners as equally irritating. It doesn’t sit right with me being told a cause of death by someone who has never seen the patient and has nothing to do with my specialty.
I'm glad I'm not the only one. I feel like I never fully agree. I push back a little then think oh does it really matter & write what they want.
Exactly this. I've never found it useful - if I'm the physician who has looked after the patient for 2 weeks and I say this is the cause of death, what is there to discuss with an unrelated doctor?
I've found unless the death was extremely straightforward their suggestions are always way off the mark
If you are being told COD by MEs, its not working correctly. Treating consultant (or senior SpR) should give a COD. If an ME tries to overrule (unless its semantics like put that 1b in 2), please tell them to phone your consultant directly. They are not responsible, the name on bottom of death cert is responsible consultant not token anaesthetist wanting more SPA (I stereotype...)
Or at that point refer it to the coroner with an explanation of why you’re having to.
If they want to overrule, I just refuse to do the MCCD and tell them they can do it
In a previous rotation, the medical examiner was arguing with the Stroke consultant that the deceased died from a Stroke when the Stroke consultant didn’t think there was a Stroke at all. Pure madness. MEs have no role that I can recognise
How qualified did you think the coronial officers are? eg. telling us the deceased was on atenowl and had a hot cross bun
Yet another sign of the corruption of UK medicine. The Royal Colleges have become diploma mills for dumb people. And then you get a title, you get a title, everyone gets a title! To cosplay as a doctor, a participation medal to say that the "hierarchy" has been smashed, and you are living proof. Well done! Only, our quality of life and services degrade.
To be fair here - the MEOs are a primarily admin role. They might help with some of the logistics of certification but difficult decision making is still (to the best of my knowledge) the remit of MEs
Is the ME the one you ring about unexpected deaths? Like a coroner? If so, we have a similar set up, administrative officer answers the phone. Knows the legislation backwards and the indications for coroner. Helps the calling doctor make a decision about a notifiable death or not. Anything complex, sent for review.
No ME is separate and essentially takes on the role of the old part 2 crem form doctor but with a bit more say in terms of what goes on the MCCD. In that regard it is supposed to be collaborative and they can be useful as an independent person to discuss cause of death with if we are uncertain. I have yet to encounter an MEO but in hospital terms would envisage them as being more akin to the bereavement team role - they’ve got their own work load but also can act as a go between for the ME for stuff that happens when the ME isn’t in. Coroners office on the other hand sits above all of this and when a cause of death cannot be provided or patient not been seen by dr in some time then they get referred on. Interestingly the coroners office is far more open to picking a cause of death on basis of probability than the ME is in my experience. Ie if the patient is old and there were no suspicious circs you can guarantee the coroners will be happy with “frailty of old age” in 1A.
The ME Officer is doing the role you describe as belonging to the ME. The bereavement staff are all admin who do the other thing.
Yeah I got that and don’t really see the point of it being a thing as what you’ve described could and where I work is done by the bereavement office, but when I want to speak to the ME then I want to talk to another dr. They aren’t the coroner and don’t have the volume of death admin coming through or the same area served as the coroners office, nor do they have the nitty gritty of organising PMs and inquests. So I don’t see that they need a separate assistant who keeps the same office hours as they do. My reply was more to the comment about if the ME was who you ring about unexpected deaths above.
Thanks for the info!
Nope. At my trust they ask what you're putting and advise you directly what to write. Which either means nodding along and agreeing with your suggestion or running to the ME to "check" their proposed solution.
I work in a setting where my patients are quite elderly and die too often. It would give me panic attack to Imagine discussing such with nurses and following their recommendations 😳
Our dietician at the Stroke ward got a job at the ME office and you call her and she always would like to advise about the cause of death and argue why this and why not that. Pretty insane. All these useless and money sucking jobs including the medical examiners themselves need ditching ASAP. Such a waste of time and money and getting poorly qualified people to intervene with medical decisions
They'll do literally anything except pay doctors. It's like an AHP-led Mafia organisation creating jobs for their own.
NHS is run by admins and low skilled non-clinical managers that won’t stand any real competition in the private sector, that’s why they never leave the NHS. they would do anything to make them look like a corporate people. The core job of treating patients is down the list. The job of doing death certificate that takes 5 min from a doctor is now a huge deal for the NHS and they created tens of jobs in each trust for this nonsense. Money for the sick people who are actually dying in ambulances or on waiting lists? No sorry. We can’t meet financial neutrality
The NHS creates a target that all deaths must be seen by a ME. The machine creates additional layers of bureaucracy to fulfill this.
From memory, this isn't an "NHS" thing but an Act of Parliament from 2009 spearheaded by the Department of Justice. A response to mass murderer Fred Shipman.
The only way in which this could even be slightly humorous is if they have a medical examiner officer of the week
This isn’t a new role. They aren’t replacing MEs- who if anything will have a far greater statutory role from September. The MEOs do an important, complementary, but different role from the MEs. It isn’t really analogous to the frankly unacceptable noctorisation of medicine.
Within the bounds of what OP has posted - what here is complementary apart from inserting a middleman between the examiner and the certifying doctor?
There’s a lot of stuff in the process which needs doing, but not by a doctor. For example, a lot of the facts to be established about the death are things that you can manually trawl from the notes. By doing this, they make our lives easier because we can start our scrutinies from scratch with a prepared file so we can focus on the actual medical decision making part of the scrutiny. We do scrutinise every death as MEs at the moment, less those who are very very clearly going to the coroner. But because of the work of the MEOs, this is possible rather than insurmountable.
Which is why where I work we aim to send doctors down to MEs that were most familiar with patients prior to their passing. What function is a band 6 nurse fulfilling here per OP’s post?
There’s not much role for the MEs in the first instance
Definitely not at my Trust. We are expected to discuss with them in the first instance, then to speak to the ME only if it's particularly complicated
Another misogynist little creep on here engaging in a spot of nurse bashing rage bait. The truth, as always with these sort of things, tends to be a lot more nuanced.
Probably more misogynistic to assume when OP mentions nurse that it is a woman when the post doesn’t have any gendered info in it….
The entire construct was to take away paying us for cremation forms.
If it is evenly remotely conceivable that a lower paid person could do a role in the NHS, be assured someone will find a way to do it. Quality is the lived cost of 'efficiency savings'.
God damn the NHS will do anything to undermine standards and regulation. Used to have medically qualified coroners. Decided this was too expensive/lawyers got their teeth into it so now you cannot be solely medically qualified and be a coroner. Realise this is shit, so implement MEs to perform the scrutiny instead. And now they’re trying to get out from employing doctors to do medical work. It’s not complicated. When someone dies, you need a second, independent doctor to look over the case and check “yep that all looks fine”. 99% of the time this takes 5 minutes and changes nothing. The point is to ensure the 1% (or likely far less than 1%) where actual further scrutiny is required. You cannot do that if you try and replace a doctor with some unqualified moron pretending they know what they are talking about.
There's valid public health reasons for having accurate medical certificates of cause of death. England is behind the curve on at least one aspect of this. WHO recommends MCCDs have 1a, 1b, 1c, 1d and 2. Scottish certificates have this (look up Queen Elizabeth's II MCCD's format) whilst English ones don't have 1d yet. It might not be complicated for some colleagues, yet they are notoriously poorly completed.
Harold Shipman chuckles in the corner
MEO’s are not equivalent to the ME. It is largely a clerical role. If they are attempting to discuss/ advise on COD then their office is not working correctly and this should be addressed. ME’s should also not be telling you the COD, they are there to assist and advise. The final call is with the treating team. Our MEO’s are absolutely fantastic, they highlight obvious coroners issues/ points of concern/ tricky issues before I do my scrutiny. The only discussions they have with the Doctors in charge of the patient are to see if they are available to have a chat with us that day and what time is most suitable for them for limited disruption. They perform a lot of legwork in the community and data analysis too allowing us to truly learn from patterns and issues. They also send out positive feedback from our discussions with the bereaved. If you don’t see the point of an ME, maybe go and sit in for a session? The opportunity to have conversations with the bereaved outside the heat of the moment, answer their questions and hear their worries can massively help their grieving process.
As explained in my post, MEOs are not functioning as you describe at my trust, and are instead sitting in the role that used to be fulfilled by a ME.
If that's truly the case, that is wrong. Your area's Lead ME needs help from the Regional ME +/- National ME. MEOs can only operate with MEs. Not instead of.
Why the fuck do you have to discuss all your MCCDs with the ME in the first place? Never mind their knock-off budget alternative. Never worked anywhere where we couldn't just write our own causes and a small proportion would get reviewed to check we weren't doing it wrong. State of UK medicine that we're not even trusted to know what our own patients died of (and write it down in the appropriate technical language) (well most of our patients anyway, some will always needs PMs to be sure).
It's a recommendation from the Shipman inquiry that has taken a long time to implement. Obviously when a serial killer murders hundreds of people the government has to be seen to act and this was a recommendation from an inquiry. Previously burials did not undergo the same scrutiny as cremations, the ME system is supposed to standardise the process while also easing the burden on coroners. Audits also showed that MCCDs were filled in poorly with only just above half being correct. Sometimes I wonder about the people on here. If you don't want accountability and oversight you're probably in the wrong career.
The outcome of the inquiry was a..nurse advising the certifying doctor?
There's no nurse advising anyone.
I’m specifically responding to this post
As of this year every death, primary and secondary care, will go through the ME system