> ----------
>
>
> This is a very trickey subject and most physicians will agree that there
> never is a perfect evidence to a given clinical problem. The practice of
> medicine really entails a thorough history taking, sound clinical
> judgement which comes with years of experience and the best evidence.
> Either of these in isolation makes incomplete and probably liable cases
> for law suits in the event of adverse events.
> If you are only a reporter ( report on critical appraisal) only and donot
> advise the doctor what to do, you may still be responsible if you
> recommend a plan based on one study.
> This is a debatable issue as news reporter appraise articles in NEJM
> which are read by patients and lawyers alike.
> While it is easy to apply EBM to one problem in one patient, it is a
> challenge limited by imagination and time to treat a complex patient in
> the inpatient ward with several medical problems with lot of interacting
> medications/advise/relaibility on expert opinion and clearly the issue of
> uncertainity. I think you need to soften your stance when recommending
> treatment options.
Cheers
> Amit K. Ghosh, MD
> Division of General Internal Medicine
> Mayo Clinic
> 200 First Street SW
> Rochester, MN 55905
> Phone : 507-284-2511
> Fax: 507-284-5889
>
>
>
> ----------
> From: Jon Brassey[SMTP:[log in to unmask]]
> Reply To: Jon Brassey
> Sent: Wednesday, October 25, 2000 9:47 AM
> To: [log in to unmask]
> Subject: Legal issues around reviews
>
> Dear All,
>
> The second query in a week - sorry!
>
> Again related to reviews. I have run a service for the last three
> years that receives questions from primary care professionals. We then
> rapidly search, appraise and summarise the literature. This is then sent
> to the requestor within 6 hours. The rational behind it was not to do a
> systematic review for each question (clearly impossible) but to do better
> than, say, a GP with limited time would do. In Gwent the service is very
> popular and it is soon to expand outside of Gwent.
>
> 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. The doctor may
> say I only advised it because Jon Brassey told me to!
>
> I should point out we never advise on what is the best course of
> action. Likewise we are transparent about the process. I've been told
> that a disclaimer is not necessarily sufficient.
>
> Needless to say this is a bigger issue than just my service - what
> about other organisations that synthesise the literature?
>
> Any help?
>
> Jon
>
>
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