Obtaining full consent is not workable. By presenting themselves for blood
tests, the patient is putting their trust in the laboratory professionals as
much as they are trusting the physician whom they are consulting. It is
this trust which broke down at Alder Hey and which has resulted in much of
the furore.
Under the new human tissue regulations, will we need informed consent,
signed by the patient before assigning their specimen to the incinerator ?
Perhaps there should be an alternative clause which requires the laboratory
to return any unused specimen to the patient !
with best wishes
Richard
Richard Mainwaring-Burton
Consultant Biochemist
Queen Mary's Hospital
Sidcup, Kent
DA14 6LT
020-8308-3084
-----Original Message-----
From: Paul Masters [mailto:[log in to unmask]]
Sent: 21 April 2004 10:14
To: [log in to unmask]
Subject: Re: Assaulting patients with additional tests
Let's think this through a little further.
Say I find a raised globulin on an LFT and feel that electrophoresis is
indicated. I decide to discuss this with the clinician responsible. This not
always a trivial task, as those in the UK will know. There is no longer any
continuity of care, particularly in hospitals, but increasingly in primary
care. Finding the "clinician" (who might not even be a doctor) responsible
might itself take several phone calls. (Perhaps things are different in
Canada.) But say I do find the requesting doctor and (s)he gives permission,
but without further discussion with the patient. I do the EPP, find a band
and the patient ends up having a marrow and is told they have myeloma. The
patient, as in Andy's original example, now decides to sue for assault as he
never consented to the EPP, only the LFT, which itself was only done to
monitor his statin. Who has committed the assault? I put it to you that the
physician is unable to give consent on his patient's behalf and that they
and the lab consultant are now co-conspirators. Of course, the physician
could deny ever having given permission, and I doubt the lab would have
recorded this anywhere. So in order to be totally protected I would need a
written consent form for the EPP signed by the patient.
Alternatively, I could just do the EPP, on the grounds that it has always
been implicit in an LFT request that one may be generated by a high
globulin, and hope that the patient is reasonable (an increasingly risky
proposition). I await the test case with interest!
As an aside, I would suggest that the relative lack of legal action against
labs (excluding cytology) is a function of our oft-bemoaned invisibility.
The side-effect of increasing our profile may well be that we are seen as
someone else to blame by patients with grievances.
Dr Paul Masters FRCPath
Consultant Chemical Pathologist
Chesterfield Royal Hospital, S44 5BL
01246 512212
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