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Re: CS on demandFrom: Efrain Ramirez MD (eramirez@icepr.com)Mon Oct 25 16:51:08 1999
They were in the uppermost shelf in one of the rooms in my office. Dust covered -- why not? - Copyright 1984-- they were more interesting things to read in those days, (like Frank Manning and BPP) than Obstetrics/Gynecology and the Law by Fineberg-Peters-Wilson and Kroll. It was a soft day at the office so, must admit, in between patients I began to leaf through he first volume. It is a fascinating subject nowadays, at least to me. The concepts have become clearer but the specifics have not. The questions about c/s on demand, c/s on an ancephalic fetus, the "concept" of consent to "plastic" surgery, the carpenter (or electrician Geff will find someone named Electric) doing a c/s, the Kervorkian method of pain relief, -- even Carlo's case of cutting off a hand in a patient -- (a clear-cut case of assault and battery according to him) they all became, at least to me, no so well-defined and as easy to understand as I thought. It is evident that the concepts of informed consent, assault and battery, malpractice, etc, they all, in many ways, rely on naturally evolving issues like "medically indicated" and "standard of care" among others (society's expectations, culture, ). Blood letting in the early stages of medicine was the standard of care-- in 20-30 years from now--what will be the standard of care in a pregnant patient? -- viability will be define as 18 weeks? -- will a belly dancer can sue an obstetrician because he did not perform a "timely C/S" at 26 weeks and "striae gravidarum" covered her abdomen ruining her profession and causing irreversible psychological damage and a divorce? (remember-in those days the KY2-XL-imodium-laser-will leave no scar tissue)--- she had given and informed consent and "psychological trauma and extreme phobia to vaginal delivery- " is an indication for a C/S? Laugh-- I am -- as my professor did when someone suggested back in 1977, that the c/s rate might go up as high as 15%!! This is what I'll do-- I have 1-2 good friends who happen to be lawyers (contradiction in terms? -- it's an endangered species but they are still a few around), I'll call my good friend Carlos and, while we prepare the best pumpkin soup (with apple and ginger) and the best risotto in town, they will teach us this whole subject in 4 easy steps---"but wait -- if you order in the next-----" Efrain
>I do not intend to answer for Bob, however you got it fairly right. You
-- Efrain Ramirez MD FACOG "The things you learn after you know everything are the important ones"
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