[HSF] (no subject)

[murtaza chishti]

ani,

how would one (roughly) "calculate" risk benefit ratio in this given case?

murtaza


>From: "Ani Anyanwu" <anianyanwu at hotmail.com>
>Reply-To: OpenHeart-L at lists.hsforum.com
>To: <OpenHeart-L at lists.hsforum.com>
>Subject: Re: [HSF] (no subject)
>Date: Sat, 12 May 2007 14:41:43 -0400
>
>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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