In my limited experience, patients do not refuse thrombolysis when the risks
are explained. The few who want to know more about the complications, or
discuss things with the spouse, or otherwise make a more considered decision
end up saying yes.
How often have people on the list experienced patients refusing
thrombolysis? If no patients are refusing it, then you could argue that
consenting offers no benefit to the patient as they will all say yes anyway,
and only worsens their prognosis by delaying things.
However, if they ARE refusing it, there is a strong argument that we should
be continuing to allow them the opportunity. This would be especially true
if patients who refused thrombolysis still believed they had made the right
decision once the acute episode was over.
Chris Kirke
-----Original Message-----
From: Accident and Emergency Academic List
[mailto:[log in to unmask]]On Behalf Of Henry Morriss
Sent: 19 February 2003 23:14
To: [log in to unmask]
Subject: Re: Written consent
I feel stongly that an intervention with such severe and devastating
possible side effects needs to be discussed with the punters. I don't think
the "I'm the doctor knows best routine" is the right approach. I do think
the risk of stroke should be specifically discussed ( I think catecholamine
levels are already fairly high) even if you miss the holy 20 minute grail.If
after hearing the risks/benefits explained the reply "Do what you think is
best doc" then obviously crack on with no written consent.
Henry Morriss.
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