Duty to disclose material risks.
= a reasonable person (patient or doctor) would view a material risk as being
something of significance
Factors to consider are:
- more common and more serious risks must be disclosed
- the nature of the proposed procedure
- respond to patient's desire for more information.
- responsive to the temperament and health of that particular
- circumstances (elective may allow different level of information
- explain alternative treatment options
- blood transfusion
- systemic risks
- exacerbation of comorbid conditions
- who is doing the procedure
- pictures to be taken
- right to refuse
- training of surgeons
Must be documented
Booklets are helpful but do not replace discussion with a patient 2. Ethics
- do most good, benefiting others ii) Autonomy
- self governance, own choice and free will iii) Altruism
- selfless concern for welfare of others iv) Non-maleficence
- do no harm v) Justice
- equality of worth, equal rights.
- interntionally over-riding a person's decision making based on
own judgements and values
- goal to help the person who's will is over-ridden.
Not considering resource
allocation 3. Delivering Bad News
- privacy, family, mdt, free of distractions / pagers, phones off
Perception of patient
- assess knowledge, understanding of situation to date
- ascertain how much they want to know.
- give the news, discuss implications,
- observe, empathise
Strategy and Summary
- make plans and discuss options
- offer resources
- make a follow up plan. 4. Stages of Grief
Kubler Ross Model
v) Resigned acceptance 5. Sensitivity and Specificity
Sensitivity: proportion of people with the disease who test
Specificity: proportion of people without the disease who test
+ve predictive value: chance that people have the disease if
they've tested positive (a/a+b)
-ve predictive value: chance that people do not have the disease
if they've tested negative (c/c+d)
6. Exposure to Blood-Borne Pathogens in the Operating Room
1. Mainly HBV, HCV, HIV.
- >1% of general populations have these
2. 100% of surgical trainees will report being stuck by a needle
No documented case of OR transmission, although >50
seroconversions in other healthcare worker contexts.
- mainly hollow bore needles / punctures.
Transmission via mucous membranes is inefficient; 0.3% of exposures.
Diagnosis first established by ELISA, then confirmed by Western
When infected risk occurs:
- exposed undergoes baseline testing.
- then, 2 or 3 drug antiretrovial prophylaxis, depending on risk
- start within 72h; window period before onset of systemic
DNA virus, highly transmissible by needle stick.
- 30% risk with a hollow needle stick.
Most are vaccinated and no risk if titers sufficient.
- get a booster every 10 y or if titer low.
May show hepatitis with jaundice and fever.
- 5% of acute infected develop chronic disease.
Diagnosis from HBSAg.
PEP is with HBIg and revaccination if risk.
No vaccine, but inefficient transfer; 3% on exposure.
RNA virus, majority infected will get chronic disease but 75%
asymptomatic. but slow, predictable march to cirrhosis.
Detection of anti-HCV.
- may follow exposure by months.
Promptly test source and surgeon.
If source positive, test clinician at 3 and 6 months fro anti-HCV
and ALT levels.
No prophylaxis currently recommended
25% will clear it spontaneously; 90-98% clearance of rest with
interferon at 8 weeks post exposure.
Standard barrier precautions.
Wearing 2 gloves reduces risk of infection following needle-stick by
Pass sharps in metal trays
Surgeons should know status and "seek expert advice" for themselves
and patients in current guidelines.
Infection is not used in the assessment of suitability to practice.