Nearly half of new doctors in New York City say they've knowingly reported a wrong cause of death for a patient, a study shows.

The report surveyed 521 resident physicians participating in 38 residency programs. It appears in the Centers for Disease Control and Prevention's (CDC) publication Preventing Chronic Disease. According to the authors, 76.8 percent of residents who admitted recording wrong causes of death did so because "the system would not accept the correct cause," while 40.5 percent said office personnel had so instructed them. Of those residents, 30.7 percent said a medical examiner had told them to list a wrong cause of death.

As a result, records reported a greater rate of deaths from heart disease while underreporting deaths from septic shock and acute respiratory distress syndrome, researchers said.

The report found that only a third of resident physicians in the city believe causes of death are reported accurately. Those who recorded more deaths were more likely to believe record-keeping to be erroneous.

"Residents need better training in proper completion of death certificates, including cause-of-death identification, when and why causes should be amended, and the implications of cause-of-death data for their community," researchers, from St. Luke's-Roosevelt Hospital Center and Columbia University College of Physicians and Surgeons, wrote in the report. "Historically, residents have not been well-educated as to what they can and cannot put on death certificates, and most have not undergone formal training in death certificate completion."

At least one reddit user agreed, writing that residents are often confused about whether an underlying illness is the cause of death. 

"The whole point of this research study is that residents are not often given enough direction on the proper labelling of a cause of death," the commentator wrote. "For instance, if a patient does [sic] from cardiac arrest, secondary to septic shock that is itself secondary to an underlying pneumonia, does that cause of death get itself listed as cardiac arrest, septic shock, or pneumonia[?]

"We are trained to put the underlying cause, but sometimes that may be unclear. What if the underlying infection causing the septic shock is unclear, and that is where there is the response by residents feeling unsure whether septic shock is an acceptable diagnosis."

The CDC said that aside from better training for residents the recording system should be improved to allow more options for cause of death.