Station 80

Robert Jones

Age: 56 years old male

Examiner

Station List
Doctor
Patient
Full Case

Marking Scheme

Data Gathering and Diagnosis 

  • Start by exploring the patient’s immediate concern: “I understand you’re worried about your HIV status being included on your death certificate. Could you tell me more about why this is important to you?”
  • Ask what his specific concerns are about how his family might perceive his HIV status if it were disclosed
  • Ask if he has any other wishes or concerns aside from keeping his HIV status confidential
  • Ask if he has any current symptoms, including pain, constipation, nausea, breathlessness, or anxiety
  • Ask about his appetite
  • Ask about his mood and emotional wellbeing
  • Ask about his current home situation and what support is available there
  • Ask if he has any close friends or family who could provide care or support at home
  • Ask about the level of involvement and support provided by the hospice or palliative care team
  • Ask if he knows what is involved in writing a death certificate, and whether he would like you to explain the process. 

Example of explanation to patient​

Thank you for sharing that with me, Robert. I can hear how important your privacy is, especially in relation to your HIV status and your concerns about how your family might respond. I want to reassure you that I take this very seriously.

Let me first explain a little about how death certificates work here in the UK. These are medical and legal documents that must accurately reflect the cause of death and any conditions that contributed to it. If HIV is considered a contributing factor, it may have to be included. I know that might be distressing to hear, but it is part of the legal requirement for how we complete these documents.

You should also be aware that death certificates are public records in the UK. This means that, unfortunately, anyone with some basic details such as your name and date of death can request a copy. That said, your broader medical records remain strictly confidential and cannot be accessed by anyone without legal permission. Are you following me so far?

If you would like, we can talk about ways to prepare your family or discuss your wishes in terms of how this information is shared. We can also involve the palliative care team or a counsellor to help with this conversation. How does this sound? 

That aside, I want to focus on supporting your wishes as best we can. I understand you would like to die at home, and that is entirely valid. When you are discharged from the hospice, I can arrange a home visit. We will involve the district nurses to support with any medical needs, and I will also ask an occupational therapist to visit. They can help assess your home and ensure any necessary equipment or care is in place to keep you comfortable.

We can also submit a form called the SR1 form, which may help fast-track access to benefits and carers if needed. I will update your records with your wish to have a home death, and we can involve the local palliative team and Macmillan nurses to provide additional emotional and medical support.

Management

Management

  • Sensitively explain that in the UK, the cause of death recorded on a death certificate must reflect the medical facts that contributed directly to the person’s death. As HIV played a role in the progression of the terminal illness, it may need to be included.
  • Inform him that the death certificate is a legal and medical document used for official purposes, including registration of death, and must be completed accurately.
  • Inform the patient that in the UK, death certificates are public records. This means that anyone with basic details such as full name and date of death can request a copy, so there is a possibility that his family may still become aware of the information recorded. 
  • Acknowledge the emotional impact of this and provide reassurance that although the death certificate is not private, the rest of the patient’s health records remain confidential under the NHS and cannot be accessed by others without appropriate consent or legal basis.
  • Offer to support the patient in preparing how to communicate their wishes or diagnosis to their family, if they choose to. The palliative care team or a counsellor can also be involved to help facilitate these conversations sensitively, if the patient wishes.
  • Inform the patient that once he is discharged from the hospice, a home visit can be arranged to review his needs in person.
  • Explain that we will involve the district nurse to support his medical needs and symptom control at home, and that an occupational therapist may also assess his home environment to recommend adaptations, equipment, and arrange help with personal care if needed.
  • A form called the SR1 (formerly DS1500) can be completed to assess eligibility for fast-tracked benefits related to terminal illness.
  • Confirm that his wish to die at home will be documented in his clinical records and shared appropriately with the multidisciplinary team.
  • Provide information about the special palliative care phone line (e.g. the Daffodil Line), which offers direct access to a GP or district nursing team for patients receiving end-of-life care at home, ensuring rapid support for urgent medical or symptom needs.



Learning point from this station: ​

The Medical Certificate of Cause of Death (MCCD) is a legal document completed by a registered doctor to confirm the cause of an individual’s death. It is required for the official registration of the death with local authorities and forms a crucial part of the legal process. If HIV directly contributed to the death, for example, through AIDS-related illness or complications from opportunistic infections, it must be recorded on the MCCD in line with national guidance.

Under UK law, death certificates are considered public records. This means that any individual can request a copy of a death certificate, provided they know key identifying details (such as the full name, date of death, and place of death). The certificate includes the cause of death, which is completed by the certifying doctor.

This station highlights the importance of sensitive communication in end-of-life care, especially around confidentiality, stigma, and advance care planning. GPs must balance legal duties (e.g. accuracy of death certificates) with compassion and respect for the patient’s personal wishes.

Further reading