In article <000101bd9526$d1481560$0c5f7ec2@jeffg01>, Jeff Green
<[log in to unmask]> writes
>Professionally the best interest of the patient is the over-riding concern
Agreed
>Moral responsibility, even without the legal and professional
>responsibilities can never be escaped.
Agreed
>I am nowhere near convinced that
>knowingly putting a babies life at risk when there are alternatives that do
>not do so is in the best interest of the patient.
Whenever I prescribe I consider the alternatives - that is part of the
process of the consultation.
*knowingly putting a baby's life at risk* is an emotive criticism - of
course neither I, nor any other doctor I know, would do that; however
there are degrees of risk -
for example: a mother with severe depression, husband in Bosnia, none of
these aforementioned aunts/grandparents, no friends because they have
recently moved into the area, and a baby that *won't sleep* - a common
situation in our area, and one quite likely to lead to a *battered baby*
if not quickly relieved.
That baby is at risk in the first place.
I am not talking about a sick child, not even snuffles etc. but a child
who I have examined, found to be well, but possibly reacting to mother's
tension and so not settling at night.
Apart from taking the child home myself, there are very few
alternatives. Sleep clinic? - referrals take weeks to result in an
appointment (and usually use vallergan!) Leaving the child to cry? -
mother would rapidly become suicidal with the engendered emotions.
Behaviour modification ? - again the time scale.
> contradicting the doctor who
>>signed it in front of the patient. That would be both counterproductive
>>and unprofessional.
>
>Agreed, but that has to remain secondary to the overriding concern which is
>the best interests of the patient.
Undermining the patients confidence in the doctor is not in their best
interests.
There are also 2 (or more) *patients* in this situation -baby and
parent. They both have interests which may even conflict.
>I have never denied the efficacy of phenergan, only its safety.
The quoted studies are interesting and useful.
I would hesitate to make major decisions on speculative conclusions of
one group of researchers, no matter how good their papers.
I am open to further evidence and my behaviour is not written in stone.
KT
--
Katie Law
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