admin
Morning Health Talk :
New Delhi, June 23, 2018 :
Informed Consent Should Involve the treating doctor: Medscape Excerpts: Shinal v Toms case: a 2017 decision from the Pennsylvania Supreme Court. In a 4-to-3 decision, the Supreme court ruled that a physician may not “fulfill through an intermediary the duty to provide sufficient information to obtain a patient’s informed consent.”
The court’s insistence that “the treating physician personally provide all consent-related disclosures is an anachronism in a team-based health care system writes Lynch and colleagues write in an article published online today in the New England Journal of Medicine.
“From the patient’s perspective, physicians’ time may be better spent on those specialized tasks that only they have the skill to perform, while other members of the team participate in the consent process as they do in other clinical tasks for which they are appropriately trained and supervised,” they continue.
The Pennsylvania court’s decision stemmed from a 2008 case handled by Steven Toms, MD. He perforated the carotid artery of Megan Shinal during a total resection of a recurrent craniopharyngioma, leading to permanent severe neurologic injury.
Toms testified at trial that he discussed with Shinal her goals and the risks and benefits of total vs subtotal resection, including the potential harm that ultimately occurred.
Shinal decided to undergo surgery, but the question of whether to proceed with total vs subtotal resection was unresolved at the time of the initial consultation with Toms.
Shinal subsequently spoke with the physician assistant about scarring, the craniotomy incision, potential radiation, and the date for surgery.
Shinal signed a consent form indicating that she had discussed the risks and benefits of alternative treatments. However, the form did not specifically address the differential risks of the two surgical options.
Shinal later sued, claiming that Toms failed to explain the surgery’s risks. Shinal maintained that had she known that a lower-risk subtotal resection was an option, she would have pursued that alternative instead.
Dirofilaria
A Russian woman had a moving swelling on the face. She took a selfie when the bump first appeared, just below her left eye. Five days later it was above the eye, before migrating to her upper lip. The doctor found she had been infected by Dirofilaria repens – a type of parasitic worm that doesn’t normally infect humans according to a new case report in the New England Journal of Medicine.
About Dirofilaria immitis (Dog heartworm)
Is a vascular parasite, with the adult worm residing in the pulmonary artery and right ventricle in dogs. Most dogs are asymptomatic. The organism is transmitted to humans by Aedes, Anopheles, Culex, or Myzorhynchus mosquitoes, which ingest blood-containing microfilaria from affected dogs. Two clinical syndromes of dirofilariasis occur in humans: pulmonary and cutaneous infection. Cutaneous infection occurs when the larva die after inoculation into the subcutaneous tissue and cause an urticarial eruption. If a larva survives (as in this case) and reaches the heart, it dies and forms an embolus, which travels to the lungs resulting in focal pneumonitis followed by granuloma formation.
Anti-inflammatory diet
The diet has four components, including three types of food to add and a group of foods to avoid.
Foods to add include pre-biotics, such as oat groats and most fruits and vegetables, which are believed to feed the beneficial bacteria in the gut; pro-biotic foods with live cultures, such as plain yogurt, miso and kefir, which provide a variety of bacteria; and other foods necessary to meet complete recommended daily allowances of nutrients.
Foods that would feed the harmful types of bacteria and therefore should be avoided include certain grains and sugars.
It only happens in India but spoils the image of the medical profession
The family members of a 50-year-old patient were horrified after a government hospital in Maharashtra informed them of his death and handed them the body. It was only after the body was brought to the home of the “deceased” Avinash Dadasaheb Bagwade that family members realised it wasn’t his. Avinash Bagwade was, in fact, very much alive and receiving treatment at the hospital.
The hospital also failed to identify the person whose body was handed over to the Bagwade family after conducting the post-mortem.
The incident took place at the Sangli civil hospital, where Bagwade was admitted for liver ailment. The relatives received a call from the hospital informing them that he was dead. Some relatives arrived at the hospital and accepted the body.
Dr Atul Gawande, has been chosen to head a yet-to-be-started health venture put together by Amazon, Berkshire Hathaway, and JPMorgan Chase. Gawande will begin his role as CEO of the venture — which will be based in Boston — on July 9. The entity, which was announced in January, does not yet have a name. It will be focused on employee healthcare and will operate independently of its three parent companies and of any profit motive, according to a joint statement. The new venture will initially focus on using data and technology to provide “simplified, high-quality and transparent healthcare at a reasonable cost” for their 500,000 American workers.
Dr KK Aggarwal
Padma Shri Awardee
Vice President CMAAO
President HCFI
