Steve Raymond FRANZCOG FRCOG
HOD Obstetrics & Gynaecology
Royal Hobart Hospital
Tasmania 7001
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Gregor
Sent: Monday, 26 May 2008 1:22 AM
To: Multiple recipients of list OB-GYN-L
Subject: Re: vbac on demand
Wow, Steve, your post shook me loose from my prior resolve not to
comment on this potentially never ending discussion. But your conjecture
that a bad outcome will not lead to litigation in the event of a bad
outcome if what the patient desired got done...whew!!...that just flies
totally in the face of a mountain of factual litigation history re
lawsuits over adverse VBAC outcomes. Those suits go to trial despite
informed consent processes having been observed....(I'll conjecture at
this point that cases done without documentation of informed consent get
settled before trial...will further conjecture that it would be
difficult to find VBAC's being done in today's USA medical-legal climate
without informed consent.) So, your sanguine view that doing what the
patient wants will insulate one from litigation seems a bit misguided,
IMHO, no flame intended, whatsoever.
Hank
Raymond Stephen <Stephen.Raymond@dhhs.tas.gov.au> wrote:
All of the concern about losing one's career and livelihood
really applies in a different way when you are faced with a patient who
doesn't want to accept your blanket policies. Is she more likely to sue
you and win, if you do what she wants and she has a bad outcome, or is
it more likely, if you don't do what she wants and has a different bad
(to her) outcome. I would have thought that, given that most litigation
arises out of a situation where a patient's expectations haven't been
met, it is likely that the bad outcome that you predicted will not lead
to litigation, if you do what she wants.
Steve
________________________________
________________________________
From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf
Of DoctorJoe@aol.com
Sent: Saturday, 24 May 2008 1:43 AM
To: Multiple recipients of list OB-GYN-L
Subject: Re: vbac on demand
In a message dated 5/23/08 9:54:06 AM, ajfields@pine-net.com
writes:
Would that be that the physician's right to do whatever he wants
trumps
the patient's right to informed consent? Or that the physician's
legal
and financial risk are more important than the patient's
physical risk?
Because I really can't see how the relative risks aren't
important to
this woman's decision about her body.
There are two "rights" here (if you ignore the baby's right):
1) The woman's right to take whatever risks with her body (after
being informed what the risks are).
2) The physician's right to practice what he feels is good
medicine (i.e. not be forced against his better judgment into a course
of action that he feels is unacceptable, given the standards, the
circumstances, etc.).
How you balance those two "rights" is the question.
We all talk of #1 a lot, as we should. But #1 does NOT
automatically overrule #2, by any means.
And sometimes, although I may be getting ahead of the argument
here, there is no easy solution to the problem and it ends up being
decided on policy grounds (e.g. you can't have patients willy-nilly
showing up at hospitals and demanding unacceptable procedures or
treatments when the doctors don't think they're warranted -- it would
make the "system" unworkable).
Joe P.
(http://food.aol.com/tyler-florence?video=4&?NCID=aolfod00030000000002)
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