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Archive for the ‘Medical Ethics’ Category

Duty of Care – Ethics of Neurology

Posted by medliorator on April 11, 2009

our attention was drawn to a colleague whose subtle neck and facial movements were accompanied by grunting noises while eating—phenomena indicative of complex motor tics… When he had left, the medical student attached to our team asked the obvious question: with the evidence staring us in the face, why did no one inform him of the diagnosis and proffer appropriate treatment? we launched into an animated discussion about a physician’s duty of care, asking whether the ethical imperative to treat exists only in a medical emergency or after the establishment of a formal doctor–patient relationship.

Putting Ethics on the Spot in Neurology [Medscape]

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How do Doctors Heal?

Posted by medliorator on September 7, 2008

One of my friends lost a patient some time ago… It was the kind of case every anesthesiologist hopes never to have to face.  Unfortunately, it’s also the kind of situation that comes to every anesthesiologist’s table sooner or later, regardless of his or her skill and experience. My anesthesiologist friend asked me a very thought-provoking question after he told me about his experience… “Are you willing to continue in a career knowing that this will happen to you someday, if it hasn’t already, and you’re going to have to deal with it and live with it and not give in to grief and self-doubt afterward? Do you love this work and believe in yourself enough to keep going? Because if you don’t, you need to get out now while you can.”

Doctors grieve. Doctors shed tears, seen and unseen, over patients, for many different reasons – at least, the ones who care do. I know this to be true. Seen it. Done it. But doctors also can’t be debilitated by grief or doubt or regret for too long. Other lives hang in the balance. The question is, how do doctors heal?

Losing Patients [Notes of an Anesthesioboist]

Posted in Medical Errors, Medical Ethics, Professionalism, Wellness & Health | Comments Off on How do Doctors Heal?

How to Make Clinical Decisions and Avoid Defensive Medicine

Posted by medliorator on August 29, 2008

I was asked to examine a patient who was scheduled for an emergency amputation of her leg because of gangrene. I went over her chart and discovered that one of the junior residents had seen her the night before and had requested two consults… I cancelled the consults because they were unnecessary.

The next day, I ran into the resident who requested the consults… I asked him why he asked for the consults. His reply made me see red. It is the reply of the imbecile, of the doctor who is afraid to think and make decisions, and it drives me to distraction: “To spread around the responsibility”. To be fair, it is not all his fault, he learned this “defensive medicine” posture from [the chief of anesthesiology].

I told him that even if he really believes in that philosophy, he should never actually say it out loud, it’s just plain embarrassing. I proceeded to impart two pearls of wisdom that I believe are universal:

  1. If you ask the consultant a stupid question, you will, invariably, get a stupid answer. Don’t just ask for a “cardiology consult”. One must ask the consult a specific (and hopefully intelligent) question. For example, “Does this patient need further workup and/or intervention for her chest pain?”
  2. You better have a damn good justification for delaying surgery if the delay endangers the patient. In this case, delaying the amputation exposed the patient to another day of infection that could have developed into full blown sepsis with septic shock… Had such a complication occurred, the first question the judge will ask is: “What did you gain from the consults that justified delaying surgery and endangering the patient”.

I believe in this guiding principle: Any investigation, whether a consultation or a blood test should be done only if the results will affect patient management. Not only is an unnecessary test a waste of money, it may even endanger the patient.

Unnecessary Tests [The Sandman]

Posted in Clinical Rotations, How-To, Medical Ethics, Professionalism, Residency | Comments Off on How to Make Clinical Decisions and Avoid Defensive Medicine

Cognitive Enhancement in Medical School

Posted by medliorator on July 7, 2008

by Alison Hayward, M.D., Sarah M. Lawrence, and Bill Johnson, D.D.S.

The first drug used to treat ADHD was methylphenidate (Ritalin), patented in the 1950s for depression, narcolepsy and fatigue. It then began to be used as a treatment for ‘minimal brain dysfunction,’ as ADHD was known at the time. Ritalin’s popularity exploded with the acceptance of ADHD as a clinical entity, and it is now the most commonly prescribed drug for ADHD in the USA. Methylphenidate is available in numerous preparations, including a transdermal patch and extended release formulations such as Concerta. Ritalin is a CNS stimulant, thought to activate the frontal lobes of the brain by binding to dopamine and norepinephrine receptors.

Other, similar drugs used to treat ADHD include mixed amphetamine salts (Adderall) and dextroamphetamine (Dexedrine), which is one of the components of Adderall. Like Ritalin, these medications all have typical amphetamine side effects like decreased appetite, insomnia, and dry mouth. Dexedrine, the oldest patented amphetamine drug, has been used for its weight loss properties in extreme cases of resistant obesity. All are Schedule II, the most restricted classification for a drug considered to have a legitimate medical use, due to the potential for abuse and addiction. They are close relatives of methamphetamine, an illegal substance that has spawned an epidemic of ‘meth labs’ across the country in recent years.

Widespread abuse of drugs like Adderall and Ritalin on college campuses, however, is well-documented in the literature. One annual government study on the use of Ritalin by college students in 2003 concluded that 5% had used Ritalin without a prescription in the previous year, and broader studies have shown up to 35% prevalence of stimulant abuse, misuse, or illicit sales on undergraduate campuses. Anecdotally, the use of stimulants as “academic steroids” amongst health professions students appears to be similarly frequent.

Stimulant Use Among Professional Students [Medscape]

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