Saturday, December 31, 2011
Sunday, December 25, 2011
Tuesday, December 20, 2011
Continuing on with the discussion regarding issues of physical modesty in the context of medical care, there continues to be debate throughout these Volumes as to who is responsible for the contested inequalities in attention to these issues and what is necessary for the resolution of these issues. Is there a conflict between the male and female gender, working apart, in attaining their own individual modesty goals or should both genders look to each other's physical modesty needs and desires and stand and work together to change the medical care system to meet all their goals? I suspect the latter is the wisest. Perhaps the best suggestion for both genders to become active to the same cause and to get together on a website to develop tools for advocacy. I would suggest checking in at Suzy's site where the goal is to do just that. Here is her description of the Mission Statement and Goals:
We believe that each patient is an individual and as such has specific preferences and needs including what accommodations they require to maximize comfort when their modesty must be compromised in the medical experience. Our mission it to act as a liaison between patients and providers in establishing, understanding, and executing the policies and procedures essential to that end. When appropriate we will act as advocates for patients to achieve that goal through interaction, education, and referrals to both patients and providers.
GOALS: Our goal is to help patients achieve dignified and respectful healthcare through education and information. Everyone has different needs and expectations of their healthcare providers, and we provide choices and options in obtaining those needs. We understand that modesty, privacy, and respect are primary needs when facing procedures and we promote educating providers in the sensitivity of those needs.
But not just writing this protocol list to our blogs.. the final consensus list should be sent to Dr. Atui Gawande who wrote the article "Naked" in the New England Journal of Medicine and which was the basis for our entire series of Volumes on patient modesty. As some of you may know, Dr.Gawande is now a very well respected individual for his analysis and writings about a host of important medical issues that need fixing or change. By this project on our part, this may be the most direct way, through Dr.Gawande, to get something moving rather than repeated moaning and yearning on our blogs. How is that for an idea? Again, thanks Belinda for a suggestion to get us all "off our butts" (so to speak).
Graphic: "Man and Woman Apart and Together"-Classic icons modified by me with ArtRage.
Monday, December 5, 2011
Should all patients be given online access to their medical records? The British healthcare system is currently considering such a possibility. With electronic medical records progressively becoming the norm throughout the medical world, this access would be feasible but would it be wise? Certainly, there would be advantages to the patient who would readily see the written result of the office visit and could then, if necessary, confront the physician with corrections, additions and questions and in a timely fashion. But what are the negatives to such an idea beyond potential loss of patient privacy due to inappropriate or illegal computer access? For example, would this mean that the medical record would have to be written in words understandable by any patient rather than in more concise and professionally understandable terminology and thus perhaps degrade professional communication? Would such access more easily give rise to patients starting malpractice actions due to misunderstandings of what was written to the record? Could patient's be pressured by others (insurance companies or employers as examples) into providing access to the electronic records since they would be more readily available? What do you think? ..Maurice.
Sunday, December 4, 2011
In on ongoing legal challenge to the patent law which allows isolated human genes to be patented and which was previously overturned, the Court of Appeals for the Federal Circuit of the United States returned a ruling earlier this year that these genes were not simply a product of nature, which would not be eligible for a patent, but indeed could be patented. So..who has the legal rights to that rare and valuable germ growing in your nose or that gene which was part of your body but the one that was recovered and used for, as an example, a genetic test for cancer? And beyond the law.. what are the ethics? What is the good vs bad, what is the right vs the wrong?
Friday, November 25, 2011
Privileged communication is "an exchange of information between two individuals in a confidential relationship."
I present now three scenarios and look toward some wise visitors to this blog to provide me with some answers from the legal point of view but also a view of the ethics. ..Maurice.
Suppose a patient admits to his physician that he is emotionally upset and is having gastro-intestinal symptoms because he killed his wife and buried her body in the back yard and told others that she was on a vacation. Suppose a client who is about to be questioned by the police, admits to his lawyer that he killed his wife and buried her body in the back yard. Would the professional standard in each case see the admission as privileged communication and allow the professional to withhold the information to the police or courts that the patient or client admitted? Suppose the patient with symptoms and that same story went to his physician who was both a physician and a lawyer licensed to practice and revealed the killing but desired the professional as a lawyer to provide professional legal advice and, if necessary, defend his case. Could privileged communication still be preserved?
Tuesday, November 8, 2011
Relative to the current discussions -- In past posts, I've referenced an articled called "Not Just Bodies" which is based upon a study of the strategies and/or defense mechanisms doctors use to deal with body issues == which include not just nakedness and modesty, but also horrible accidents and diseases. The profession knows well about these issues and addresses them. A major problem, as I see it, is this: Some of the strategies they use protect them psychologically but do little for or actually psychologically harm the patient. Some doctors never really "get over" this issue but just put up fences to protect themselves. There are also studies out there using medical students showing how they deal with this issue. There are some related studies about nurses. I think a myth within the profession is that these issues can easily be hidden from the patient by covering up using these strategies. I question that. I think many patients pick up on this and it may affect their healing and/or psychological health. Most of us, medical professional or not, are often unaware of the face we are actually "showing" to others. It takes quite a bit of self-reflection and knowledge to be aware of this. My other concern is what I've started to call the "deprofessionalization" of medical care in this country -- for cost saving reasons. I'm not so concerned with what are called mid-levels (PA's and NP's) But the use of all kinds of various initialed (cna, cma, pt's, ma, etc.) nurse assistants, some with little maturity and/or training, in this country is frightening. Some have no actual scope of practice, work under the doctor's license, and can do whatever the doctor is willing to risk. It's this trend that bothers me most and IF, and I emphasize the IF, there's a tendency for people with sexual perversions (or other psychological defects) to enter the medical field, it would be in this area. And these are the people these days doing most of the bedside care and, more and more, even some invasive procedures.By Doug Capra
Wednesday, October 26, 2011
Tuesday, October 25, 2011
By the time he was admitted, his rapid heart had stopped, and he was feeling better.
Patient has chest pain if she lies on her left side for over a year.
On the second day the knee was better and on the third day it had completely disappeared.
She has had no rigors or shaking chills, but her husband said she was very hot in bed last night.
The patient has been depressed ever since she began seeing me in 1986.
Patient was released to outpatient department without dressing.I have suggested that he loosen his pants before standing, and then when he stands with the help of his wife, they should fall to the floor.
The patient is tearful and crying constantly. She also appears to be depressed.
Discharge status: Alive but without permission.
The patient will need disposition, and therefore we will get Dr. Shapiro to dispose of him.
Healthy appearing decrepit 67 year old male, mentally alert, but forgetful.
The patient refused an autopsy.
The patient has no past history of suicides.
The patient expired on the floor uneventfully.
Patient has left his white blood cells at another hospital.
The patient's past medical history has been remarkably insignificant with only a 45 pound weight gain in the past three days.
She slipped on the ice and apparently her legs went in separate directions in early January.
The patient experienced sudden onset of severe shortness of breath with a picture of acute pulmonary edema at home while having sex which gradually deteriorated in the emergency room.
The patient had waffles for breakfast and anorexia for lunch.
Between you and me, we ought to be able to get this lady pregnant.
The patient was in his usual state of good health until his airplane ran out of gas and crashed.
Since she can't get pregnant with her husband, I thought you would like to work her up.
She is numb from her toes down.
While in the ER, she was examined, X-rated and sent home.
The skin was moist and dry.
Occasional, constant, infrequent headaches.
Coming from New York, this man has no children.
Patient was alert and unresponsive.
When she fainted, her eyes rolled around the room.
Thursday, October 13, 2011
The current legal case being tried in court regarding the death of Michael Jackson by the alleged acts of Dr. Conrad Murray as involuntary manslaughter in contrast to the death being an act of malpractice brings up the question: what is the difference in legal terms between medical malpractice and involuntary manslaughter. And, perhaps, what is the difference in ethical terms? If the physician is found guilty, the physician is punished financially in the first case but by prison time in the second. An excellent article written by Eisenberg and Berlin in the American Journal of Radiology in August 2002 gives case examples and may tend to answer to the question posed in the title of my thread. An excerpt from the article follows:
The circumstances under which a physician's error of medical judgment triggers criminal prosecution are not totally clear. An English court of appeals ruled that to justify a criminal conviction, it must be proven that a physician acted with “gross negligence,” which is characterized by any or all of the following elements: indifference to an obvious risk of injury to health; actual foresight of the risk coupled with the determination nevertheless to run it; an appreciation of the risk coupled with a high degree of negligence in the attempt to avoid it; and inattention or failure to avert a serious risk.
A person whose behavior is “grossly negligent” may be liable for involuntary manslaughter if his or her conduct results in the accidental death of another person. Most jurisdictions hold that something more than ordinary negligence must be proven before the defendant can be found guilty of involuntary manslaughter. This usually requires that there be a substantial danger not only of bodily harm, but also of “serious bodily harm or death.” The defendant must have acted “recklessly,” a term defined as a “gross deviation from the standard of conduct that a law-abiding person would observe” in the same situation The court must consider all the circumstances surrounding the incident, including the social utility of any objective the defendant is trying to fulfill.
What, in my opinion, seems to be missing in the accusation of a physician with a crime of involuntary manslaughter rather than a professional error of malpractice is whether the physician's intent in diagnosis and management was to ignore any attempt toward the professional goal of beneficence (doing a "good" ) to his or her patient. If one could prove that such was not the intent and goal, shouldn't that be the overriding criteria to define a death as professional malpractice and not a crime? On the other hand, I look forward toward what how others to my blog thread look at this distinction. ..Maurice.