Good point Paul.
I need to look into that a bit further. Watch this space!

Simon Ødum

-----Original Message-----
From: Accident and Emergency Academic List
[mailto:[log in to unmask]]On Behalf Of Paul Bailey
Sent: 20 February 2003 08:39
To: [log in to unmask]
Subject: Re: Written consent

Simon,
you raise an interesting point - how about when your own personal view goes
against that of the 'accepted wisdom' - eg the uncomplicated (seemingly)
minor inferior infarct without reciprocal ST depression - in my mind a
relatively benign event, and not worth exposing patient to risk of
thrombolysis..... and yet most people would thrombolyse....

Just a thought... I never know what to do... patients are unable to make
their own decisions on this one I think - it relies on a thorough
understanding of relative risks when the patients are at their most
vulnerable - scared and in pain.

Best wishes
Paul M Bailey
Emergency Physician
Western Australia

----- Original Message -----
From: "Simon Odum" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Thursday, February 20, 2003 4:25 PM
Subject: Re: Written consent


> I'm with Robbie and Adrian here.
>
> If you think that "informed consent" can be gained from someone who has
just
> been told that they are having a heart attack, then I think you are
> mistaken.
>
> My practice is to tell them what is happening, why, what we can do, that
> there is a risk of complications which are bleeding and therefore stroke,
> but that the benefits are much greater then the risks.
> A patient once brought me up very sharply and said "So much the mumbo
jumbo
> doc. Just answer me one question. Would you have it?"
> "Yes" said I.
> "That's fine by me."
>
> I always now tell the patients that I would have this treatment if I were
in
> their position. It seems to be this statement that helps people make up
> their minds.
>
>
> Simon Odum
>
> -----Original Message-----
> From: Accident and Emergency Academic List
> [mailto:[log in to unmask]]On Behalf Of Robbie Coull
> Sent: 19 February 2003 22:49
> To: [log in to unmask]
> Subject: Re: Written consent
>
> I don't bother with consent before thrombolysis, but always insist on
> written consent from cardiac arrest patients before defibrillation.
>
> This has been such a successful policy, that I have been able to afford a
> pretty decent foreign holiday after selling my defibrillator.
>
> Seriously though, if you had crushing central chest pain, sweating,
nausea,
> had a sick bowl in one hand and someone setting up an iv on the other,
while
> a nurse finishes shaving your chest to get a better 12 lead, someone is
> telling you that half your cardiac muscle has just gone paws up, you can
see
> another person checking the defib in the background, the lady in the next
> cubicle is screaming in pain and security is wrestling a lunatic to the
> ground in the hallway, the iv diamorph is making everything go fuzzy which
> is good because you can't shake loose the dreadful feeling that these are
> your last moments, and to top it all off the head medic is telling you to
> listen carefully to the list of things that could go wrong if they give
you
> the clotshot (stroke, blindness, coma, convulsions and death) so if you
> could please make up your mind fast and sign the form as your shedding
> cardiac cells with each tick of the clock.
>
> No, I don't think so.  You want someone who knows what they are doing to
> help you, and help you fast.
>
> Similarly, I won't be taking signed consent forms to the next entrapment I
> attend either.
>
> --
> Robbie Coull
> email: [log in to unmask]             website: http://www.coull.net
>
> https://www.locum123.com contact locum doctors by SMS and email
>