Robert
Thank you for your reply,
I think you gave the almost perfect reply to my
request.
Regards
David Brown
--- Robert Forrest <[log in to unmask]> wrote:
> The framework for personal injury litigation in
> general and its subset
> medical negligence litigation in particular is
> somewhat different in The
> Republic than in the either England and Wales or
> Scotland. The Republic is
> in general a somewhat more litiginous society. Even
> so, the basic legal
> framework that in order to recover damages a
> claimant (what used to be
> called the plaintiff) has to show a duty of care on
> the part of the
> defendant, a negligent breach of the duty of care
> and harm resulting from
> that breach applies in all three jurisdictions. In
> the event of the highly
> probably event of a result or two being outwith the
> reference range in a pan
> (wo)man scan profile of tests, litigation will only
> result if the patient is
> harmed as a consequence of the practitioner who
> requested the tests ignoring
> the aberrant result. Even then the practitioner may
> not be liable if a
> responsible group of practitioners rightly believe
> that the practitioner
> concerned was negligent in ignoring those results.
>
> The converse may be true. Doc A orders a pan man
> scan. Gets back a positive
> fob and orders a colonoscopy. The colonoscopist
> pokes a hole in the large
> bowel and the patient dies or, worse becomes
> permanently disabled as a
> consequence... Was he negligent in ordering the
> colonoscopy? If you prefer a
> more biochemical scenario, the doc gets back
> elevated transaminases and
> orders a liver biopsy from which the patient bleeds
> out....
>
> The practice of some practitioners in responding at
> spinal level to
> statistical wobble in a large batch of largely
> irrelevant investigations
> shouldn't happen but it surely does. When was
> "Beyond Normality" published?
> How can we inculcate a bayesian approach to test
> interpretation in our
> customers who only see the asterisked results. I
> don't know. I can only
> agree with Andrew Raftery FRCS, the surgeon who
> raised the hare about
> inadequate scientific knowledge in the medical
> students doing the new fast
> track course, when he said "Young doctors today know
> all about the
> management of bereavement and the square root of
> ****** all about the causes
> of bereavement". What is needed is less touchy feely
> stercor in
> undergraduate medicine and more on the scientific
> basis of medical practice.
> That includes not only the basic clinical sciences,
> which include psychology
> and sociology, but also a sound statistical
> appreciation of the basics of
> laboratory medicine. At present, I fear the young
> vets who treat my cats
> when sick have a better scientific approach to their
> craft than some of the
> young (and not so young) doctors floating around.
>
> Robert Forrest
>
> > -----Original Message-----
> > From: Clinical biochemistry discussion list
> > [mailto:[log in to unmask]]On Behalf
> Of Grimes, Helen,
> > UCHG
> > Sent: 05 February 2003 17:29
> > To: [log in to unmask]
> > Subject: Re: Test requests
> >
> >
> > More people are being tested, as the emphasis on
> Health Promotion, annual
> > check ups etc means that "well" individuals are
> seeing their doctors. The
> > more people tested, the more one can guarantee
> "abnormal" results, defined
> > as any part of a unit above or below the "stated "
> ref range. A doctor has
> > to further investigate all "abnormal" results, due
> to medicolegal
> > implications, and so the "well" individual is now
> a patient. The
> > busier the
> > laboratory, the more we rely on profiles to enable
> us to process the work,
> > so this increases the ratio per sample. Some labs
> will insist on separate
> > samples for TFT, PSA etc, which can reduce the
> ratio per sample, in
> > comparison to the laboratory who tries to do all
> on one sample.
> > If you are a
> > teaching hospital, where patients are scattered
> throughout wards, and
> > "daily" requests are made by the interns, so that
> they have all the
> > information at the Consultnat's round, then that
> gives a high patient/test
> > ratio. Surely, currently the only meaningful
> comparison between
> > laboratories
> > is individual number of a specific test, and
> perhaps grouped according to
> > automated instruments. Does it also highlight how
> poor our computer
> > managment information is?
> >
> >
> >
>
____________________________________________________________
> >
> > Dr. Helen Grimes, Dept. of Clinical Biochemistry,
> UCH, Galway, Ireland
> >
> >
> > -----Original Message-----
> > From: David Brown [mailto:[log in to unmask]]
> > Sent: 05 February 2003 10:52
> > To: [log in to unmask]
> > Subject: Re: Test requests
> >
> >
> > Thanks to all who replied to my mail regarding
> patient
> > test request ratios.
> > The consensus seems to be people don't have time
> or
> > the computer resources/design to calculate them.
> Too
> > much emphasis is put on "depends what you mean". I
> am
> > aware there is more to just counting test numbers,
> due
> > to local factors, staffing levels, equipment used,
> > complexity of analysis etc. But a test is a single
> > analysis, a request is the piece of paper on which
> > they are written,and a patient is the person on
> whom
> > the request and the tests are performed.
> > This question arose from a previous debate on ever
> > increasing laboratory workloads, but it appears it
> > isn't important to identify whether this is due to
> > more tests per patient or more patients having
> tests
> > done (or a combination of both?).
> > Remember someone in the government has said the
> NHS
> > is under strain, not because of resources, but
> because
> > more patients are being treated than ever before.
> > Many labs fear they are becoming nothing but
> "number
> > crunchers", but it appears they won't even know
> what
> > numbers they are "crunching".
> >
> > Thanks
> > David Brown
> >
> > __________________________________________________
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=== message truncated ===
__________________________________________________
Do You Yahoo!?
Everything you'll ever need on one web page
from News and Sport to Email and Music Charts
http://uk.my.yahoo.com
------ACB discussion List Information--------
This is an open discussion list for the academic and clinical
community working in clinical biochemistry.
Please note, archived messages are public and can be viewed
via the internet. Views expressed are those of the individual and
they are responsible for all message content.
ACB Web Site
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