> The second query in a week - sorry!
Are they going to get steadily harder?
> A concern has been the legal status of this service and the
>responses given. I'm not medically qualified (I have a biology
>degree) and therefore am I open to potential lawsuits if I miss an
>important paper/give bad advice? If a doctor asks me if aspirin is
>useful in the secondary prevention of MI. I report that the most
>recent SR stated that 'Aspirin has clearly been shown to reduce
>mortality in people who have suffered an MI' (or something like
>that). The patient is then advised by the doctor that they should
>take aspirin (as a result of the literature I forwarded) - the patient
>dies due to an allergic reaction.
My understanding is that ultimate responsibility rests with the
doctor who is examining, treating and managing the patient. So,
in your case, the GP would be negligent because if he had taken a
full history, including an adequate drug history, covering allergies
and other medications which might interact with the aspirin, he
would have known not to prescribe. The basic definition of EBM
recognises that it is the "judicious" application of the evidence,
related to the individual clinical picture.
If the provider of information is a clinician themselves, I don't think
they are so immune: for instance, if the GP ordered an x-ray and
the radiologist reported the films as "normal" and the GP re-
assured the patient but they came back nine months later with an
advanced and incurable cancer, there might well be case against
the radiographer, if independent experts felt there were changes on
the x-ray which a reasonalby competent radiologist should have
recognised as suspicious.
There have been cases where clinical practice has been reveresed
by later studies (e.g. when I was a house officer, we routinely used
lignocaine infusions after shocking CCU patients out of ventricular
fibrillation: now we know that this may have reduced survival). As
far as I am aware, the authors of a review or book have never
suffered legal action if later studies show their instructions were
clinically detrimental.(It would however make an "interesting" case
if someone could prove that they deliberatley manipulated the
conclusions for their own benefit!)
I think that it is the clinician, with the patient in front of them, who
is responsuble for what they do with the information. If you want
some more advice, you could ask the following organisations who
insure doctors against malpractice litigation :
Medical Defence Union:
http://www.the-mdu.com/
or the Medical Protection Society:
http://www.mps.org.uk/html/open_flash.html
Regards Alan O'Rourke
Alan O'Rourke
Information Officer
Wisdom Centre for Network Learning
http://www.wisdom.org.uk/
Institute of General Practice
Community Sciences Centre
Northern General Hospital Sheffield S5 7AU
Tel: 0114 271 5095 Fax: 0114 243 3762
E-mail: [log in to unmask]
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