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Refusal of care.pptx
- 1. Refusal of care and conflicts of interest DR. KEERTHANA, DNB GENERAL MEDICINE
- 2. Refusal of care 65 year female with severe anemia (Hb – 4g/dl) has presented with signs of cardiac failure. You have started treatment with diuretics and have advised blood transfusion. Patient and her relatives are not willing for blood transfusion as it is against their religious principles. Without transfusion, there is a chance that patient may die of cardiac failure. What will you do???
- 3. Continued.. After 3 days patient died despite diuretic therapy and other supportive measures. Now the relatives are arguing that you have not explained it clearly and that’s the reason they have refused transfusion. How will you argue?
- 4. Should act in the best interest of the patient. Patient has the right to decide. Informed consent before performing any procedure Documentation in case of refusal of care. Documentation should include, 1. Negative consent by the family member in their native language. 2. Name and relationship of the person who is giving negative consent. 3. Date and time
- 7. Successful outcomes of resuscitation mean restoration of patient’s health to their pre- arrest state. Resuscitation must be instituted in only when there is a reasonable chance of restoring cardiopulmonary functions, optimal mental capacity and length and quality of life that would be in the best interests of patients to sustain.
- 12. Medical Negligence Common errors by medical professionals: 1. Failure to communicate 2. Failure to diagnose 3. Failure to identify a complication 4. Inadequate follow up 5. Prescribing errors
- 13. Legal aspects Victim can seek any of the following actions against a negligent medical professional. 1. Compensatory action - monetary compensation 2. Punitive action – can lodge criminal complaint. 3. Disciplinary action – through Medical council 4. Recomendatory action – through Human Rights Commission
- 14. Prevention of medical negligence Always do the best for the patient Informed consent Adherence to clinical guidelines and hospital policies Documentation Keeping updated Contributory negligence Consider every patient as a Potential litigant.
- 15. Conflict of interest Acting in patients’ best interests may sometimes conflict with a physician’s self- interest or the interests of third parties such as insurers or hospitals.
- 16. Financial incentives: 1. Will result in ordering more interventions or ordering investigations which are not indicated. 2. Health care providers may avoid sick patients with terminal illness in order to get good outcomes and financial incentives
- 17. Pharmaceutical companies: 1. Providing gifts and meals for doctors. 2. Will create a burden on the doctors to prescribe the brand name of the drugs instead of generic one. Occupational risks : 1. Fear about risk of having occupational infections 2. Institutions should provide adequate training, protective equipment and supervision
- 18. Conflicts of interest Financial incentives Relationships with pharmaceutical companies Occupational risks Learning clinical skills Response to Medical errors Physician impairment