Death certification: increased clinical confidence in diagnosis and lack of interest in confirmation by necropsy is not justified.

Comparison of 742 necropsies from 1975 with 833 from 1984 showed that the degree of certainty the clinicians attached to their diagnosis of the underlying cause of death had increased significantly in 1984. This was due almost exclusively to an increase in the certainty of the diagnosis of circulatory disease. Unfortunately, this was not justified as the numbers of false positive and false negative diagnoses were high in both years. With this increased certainty came a lack of interest in the necropsy. Similar lack of interest was also shown by surgeons in 1984, though in this instance it was accompanied by a high level of agreement between their diagnoses and necropsy findings.