[HSF] (no subject)

[Nasser F. Abou'Seada]

hmmmm
I quiet agree to the logic ... yet would rather not be opinionated
about which category the patient is in. would rather leave that to the
judgement of the patient, and his doctor. of course what is good for
one patient is not for the other ..... again ... an 86 might be
terminal. and might have another 16 years to live ..... or even more
.... depends on individual patient condition and circumstances .....
Hal
I still think you are the one who can make the balance and the
argument as you are the one seeing this INDIVIDUAL patient.

NFA





On 5/12/07, Ani Anyanwu <anianyanwu at hotmail.com> wrote:
> Well if he wants surgery, we are ethically obliged to screen him for surgery. I was at a meeting few weeks ago where Frazier said (regarding VADs) that he had been sued twice for not putting them in (because he turned patient down) but has never been sued for putting one in. If patient is screened for surgery two scenarios can emerge whereby the surgeon advises against surgery.
>
> 1) Presence of an absolute contraindication to surgery - then the patient can be told condition is inoperable (provided most surgeons would accept same).
>
> 2) Risk of surgery is thought to be either prohibitive or thought not to justify the benefit (or benefit thought not to warrant the risk). In this case patient should be offered a second opinion as another surgeons assessment of risk and benefit may be different. Otherwise we may condemn a patient where a colleague might be able to give them another chance to life. There are countless patients who have been informed that they are not candidates for surgery who weeks to years later undergo successful surgery, presumably there were other such 'rejected' patients who were not fortunate to survive to see another surgeon. Asking for a second opinion protects patients from opinionated, ill-informed or skill mis-matched physicians, and helps ensure the physician cannot 'play God'.
>
> I suspect your patient falls into the latter category and most will accept the benefit is questionable and does not justify the excessive risk.
>
> Regardless of the scenario though, the reason for rejecting surgery must be clearly documented and must be one that one's peers would accept and defend.
>
> Ani
>  ----- Original Message -----
>  From: Hgrmd at aol.com<mailto:Hgrmd at aol.com>
>  To: OpenHeart-L at lists.hsforum.com<mailto:OpenHeart-L at lists.hsforum.com>
>  Sent: Saturday, May 12, 2007 11:51 AM
>  Subject: Re: [HSF] (no subject)
>
>
>  Prasanna,
>    His family isn't pressuring him to have surgery.  He wants it,  if we will
>  offer it to him.  I'm inclined not to do it.
>  Hal
>
>
>
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-- 
Nasser  F.  Abou'Seada,
MB,ChB,MD,FRCSEd,ChM,ChD C/Th,
FICS,FISCVS,FSSRCTS,FHMS,MESC