Emedinews:Insights on Medicolegal Issues:Standard of medical care The Nebraska Supreme Court

Standard of medical care The Nebraska Supreme Court

A physician is not responsible for the consequences of an honest mistake or error in judgment in his diagnosis.

• A patient is entitled to an ordinary, careful, and thorough examination…and, while he does not insure the correctness of his diagnosis, a physician or surgeon is required to use reasonable skill and care…If he omits to inform himself, by proper examination, as to the facts and circumstances and injury results, he is not relieved of liability of errors in judgment…It is the duty of a physician or surgeon in diagnosing a case to use due diligence in ascertaining all available facts and collecting data essential to a proper diagnosis.
• The Minnesota Supreme Court in 1976 published its perspective Negligence cannot be found when the facts show no more than an error in diagnosis which…may be the result of an error in judgment rather than negligence…A physician is not responsible for the consequences of an honest mistake or error in judgment in his diagnosis.
• Five years later, an Illinois appellate court issued this commentary the plaintiff must demonstrate what the average reasonable physician in good standing…would have done in a similar case.
• Proof of a bad result or a mishap is not evidence of lack of skill or negligence. If a doctor has given a plaintiff the benefit of his best judgment, assuming that judgment to be equal to that ordinarily used by reasonably well–qualified doctors in similar cases, he is not liable for negligence, even if that judgment is erroneous…Plaintiff has established that other physicians may have handled her case differently, but we find that a reasonably well–qualified doctor might well have proceeded in the same manner as defendant.

Emedinews:Makesure:A patient on 10 units of insulin developed hypoglycemia after taking light breakfast.

Situation: A patient on 10 units of insulin developed hypoglycemia after taking light breakfast.
Reaction: Oh my God! Why was insulin dose not reduced?
Lesson: Make sure that insulin dose is correct. The formula is 500/total daily dose. The value will be the amount of sugar fluctuation with 10 grams of carbohydrates.

Emedinews:Inspiration:Learn from mistakes

Thomas Edison tried two thousand different materials in search of a filament for the light bulb. When none worked satisfactorily, his assistant complained, “All our work is in vain. We have learned nothing.”

Edison replied very confidently, “Oh, we have come a long way and we have learned a lot. We know that there are two thousand elements which we cannot use to make a good light bulb.”

Emedinews:Insights on Medicolegal Issues:What was counter affidavit of Dean, KEM Hospital in Aruna Shaunbag case?

Aruna is clearly not in coma

• Aruna accepts the food in normal course and responds by facial expressions. She responds to commands intermittently by making sounds. She makes sounds when she has to pass stool and urine which the nursing staff identifies and attends to by leading her to the toilet.
• Thus, there was some variance between the allegations in the writ petition and the counter affidavit of KEM Hospital. Supreme Court, by order dated 24 January, 2011 appointed a team of three very distinguished doctors of Mumbai to examine Aruna thoroughly and submit a report about her physical and mental condition.
• The committee after thorough examination given the opinion that she has evidence of intact auditory, visual, somatic and motor primary neural pathways. However no definitive evidence for awareness of auditory, visual, somatic and motor stimuli was observed during our examinations.
• On perusal of the report of the committee of three doctors the honorable SC noted that there are many technical terms which have been used therein which a non–medical man would find it difficult to understand. We, therefore, request the doctors to submit a supplementary report by the next date of hearing in which the meaning of these technical terms in the report is also explained.

Emedinews:Makesure:A patient on dialysis and on oral antacid developed aluminium toxicity.

Situation: A patient on dialysis and on oral antacid developed aluminium toxicity.
Reaction: Oh my God! You should have put him on magaldrate preparations?
Lesson: Make sure to remember that magaldrate preparations do not cause aluminium toxicity in patients undergoing dialysis.

Emedinews:Inspiration:Temper Control

There once was a little boy who had a bad temper. His father gave him a bag of nails and told him that every time he lost his temper, he must hammer a nail into the fence.

The first day the boy had driven 37 nails into the fence. Over the next few weeks as he learned to control his anger, the number of nails hammered daily, gradually dwindled down. He discovered it was easier to hold his temper than to drive those nails into the fence. Finally the day came when the boy didn’t lose his temper at all. He told his father about it and the father suggested that the boy now pull out one nail for each day that he was able to hold his temper.

The days passed and the young boy was finally able to tell his father that all the nails were gone. The father took his son by the hand and led him to the fence. He said “you have done well, my son, but look at the holes in the fence. The fence will never be the same. When you say things in anger, they leave a scar just like this one.”

You can put a knife in a man and draw it out. It won’t matter how many times you say I’m sorry, the wound is still there.

Make sure you control your temper the next time you are tempted to say something you will regret later.

EmedinewsInsights on Medicolegal Issues:What is embalming?

Embalming is the process of chemically treating a dead body developed by the ancient Egyptians of preserving a person’s body after death to delay the decomposition of the body, restore it to an acceptable physical appearance and reduce the presence and growth of bacteria to prevent foul smell as well as perfume or add fragrance to corpse. Embalming certificate is required by law in certain circumstances like air/rail transportation.

·         The process of embalming has a very long history, dating back to the Egyptian process of mummification. Though their techniques were quite different from those used today, the effect was the same — to preserve an individual’s body after death. The ancient Egyptians believed that the spirit would return to the body after death, so it must remain in good condition. To preserve the corpses, they covered bodies in a drying chemical called natron, and then wrapped them in linen sheets.

·         Today, embalming is done by injecting chemicals directly into the bloodstream to preserve the corpse’s appearance. The most commonly used chemicals for embalming are formaldehyde and ethanol. A combination of these two chemicals is sufficient to preserve the body for a short time i.e. up to a week.

·         To keep the corpse in a good condition for a longer period i.e. up to a month, a solution made up almost entirely of formaldehyde is used.

·         There are several steps involved in modern embalming. First, the embalming fluid is injected directly into the deceased’s blood vessels, and pushed through the body with a mechanical pump. Next, the internal organs are hollowed of their contents and filled with embalming fluid. The chemicals are then injected beneath the skin wherever necessary, followed by a final surface embalming on injured areas of the body.

·         One of the most famous embalmed corpses today is that of Russian communist leader Vladimir Lenin, whose embalmed corpse is on display at the Red Square mausoleum in Moscow. The corpse is very well-preserved, and should last for at least another hundred years.

Emedinews:Makesure:A patient on 10 units of insulin developed hypoglycemia after taking a light breakfast.

Situation: A patient on 10 units of insulin developed hypoglycemia after taking a light breakfast.

Reaction: Oh my God! Why was the insulin dose not reduced?
Lesson: Make sure that insulin dose is correct. The formula is 500/total daily dose. The value will be the amount of sugar fluctuation with ten grams of carbohydrates.

Emedinews:Inspiration:What goes around comes around

One day a man saw an old lady, stranded on the side of the road, but even in the dim light of day, he could see she needed help. So he pulled up in front of her Mercedes and got out. His Pontiac was still sputtering when he approached her.

Even with the smile on his face, she was worried. No one had stopped to help for the last hour or so. Was he going to hurt her? He didn’t look safe; he looked poor and hungry. He could see that she was frightened, standing out there in the cold. He knew how she felt. It was those chills which only fear can put in you. He said, “I’m here to help you, ma’am. Why don’t you wait in the car where it’s warm? By the way, my name is Bryan Anderson.”

Well, all she had was a flat tire, but for an old lady, that was bad enough. Bryan crawled under the car looking for a place to put the jack, skinning his knuckles a time or two. Soon he was able to change the tire. But he had to get dirty and his hands hurt. As he was tightening up the lug nuts, she rolled down the window and began to talk to him. She told him that she was from St. Louis and was only just passing through. She couldn’t thank him enough for coming to her aid.

Bryan just smiled as he closed her trunk. The lady asked how much she owed him. Any amount would have been all right with her. She already imagined all the awful things that could have happened had he not stopped. Bryan never thought twice about being paid. This was not a job to him. This was helping someone in need, and God knows there were plenty, who had given him a hand in the past. He had lived his whole life that way, and it never occurred to him to act any other way. He told her that if she really wanted to pay him back, the next time she saw someone who needed help, she could give that person the assistance they needed, and Bryan added, “And think of me.”

He waited until she started her car and drove off. It had been a cold and depressing day, but he felt good as he headed for home, disappearing into the twilight. A few miles down the road the lady saw a small cafe. She went in to grab a bite to eat, and take the chill off before she made the last leg of her trip home. It was a dingy looking restaurant. Outside were two old gas pumps. The whole scene was unfamiliar to her. The waitress came over and brought a clean towel to wipe her wet hair. She had a sweet smile, one that even being on her feet for the whole day couldn’t erase. The lady noticed the waitress was nearly eight months pregnant, but she never let the strain and aches change her attitude. The old lady wondered how someone who had so little could be so giving to a stranger. Then she remembered Bryan.

After the lady finished her meal, she paid with a hundred dollar bill. The waitress quickly went to get change for her hundred dollar bill, but the old lady had slipped right out the door. She was gone by the time the waitress came back. The waitress wondered where the lady could be. Then she noticed something written on the napkin.

There were tears in her eyes when she read what the lady wrote: “You don’t owe me anything. I have been there too. Somebody once helped me out, the way I’m helping you. If you really want to pay me back, here is what you do: Do not let this chain of love end with you.” Under the napkin were four more $100 bills.

Well, there were tables to clear, sugar bowls to fill, and people to serve, but the waitress made it through another day. That night when she got home from work and climbed into bed, she was thinking about the money and what the lady had written. How could the lady have known how much she and her husband needed it? With the baby due next month, it was going to be hard…. She knew how worried her husband was, and as he lay sleeping next to her, she gave him a soft kiss and whispered soft and low, “Everything’s going to be all right. I love you, Bryan Anderson.”

There is an old saying “What goes around comes around.”

Emedinews:Insights on Medicolegal Issues:Doctor must record dying declaration in terminally injured patient

Under section S.32 of Indian Evidence Act a written or oral statement of an injured/sick dying person is called dying declaration, it must be recorded by the doctor attending an injured/sick person/patient who is dying/under medical expectation of death as a result of some unlawful act, relating to the material facts of cause of his death or bearing on the circumstances The dying declaration/statement carries legal importance to identify the offender or to clear innocent persons

• If there is time, the doctor should call the area Magistrate to record the statement/declaration. The doctor should certify that the person is conscious and his mental faculties are normal at the time of recording the statement. If the victim is very serious, and there is no time to call a Magistrate, the doctor should take the declaration in the presence of two witnesses particularly any attendant of other admitted patient. As far as possible, choosing nurses and paramedics as witness should be avoided to maintain the legal credibility of declaration. While recording the dying declaration, oath is not administered, because of the belief that the dying person will tell the truth. The statement should be recorded in the man’s own words, without any alteration of terms or phrases. Leading questions should not be put.
• The declarant should be permitted to give his statement without any undue influence, outside prompting or assistance. If a point is not clear, question may be asked to make it clear, but the actual question and the answer received should be recorded. It should then be read over to the declarant, and his signature or thumb impression is taken.
• The statement made must be of fact and not opinion. If the declaration is made in the form of an opinion or conclusion, questions should be asked by the recorder to bring out the facts that are the basis for the conclusion. While recording the statement, if the declarant becomes unconscious, the doctor recording it must record as much information as he has obtained and sign it. If the dying person is unable to speak, but is able to make signs in answer to questions put to him his can be recorded and it is considered as a "verbal statement".
• The doctor and the witness should also sign the declaration. If the statement is written by the declarant himself, it should be signed by him, the doctor and the witnesses. The declaration is admissible not only against an accused that killed the declarant, but also against all other persons involved in the same incident which resulted in his death.
• The declaration is sent to the Magistrate in a sealed cover. It is produced at the trial and accepted as evidence in case of death of the victim in all criminal and civil cases, where the cause of death is under enquiry. The person recording the declaration will have to give evidence in the Court of law under oath to prove it. If the declarant survives, the declaration is not admitted but has corroborative value, and the person is called to give oral evidence under oath.
• In India, if the declarant is in a sound state of mind at the time of making the declaration, it is admissible in Court as evidence, even if the declarant was not under expectation of death at that time.

Emedinews:Makesure:A patient with cough of more than 4 weeks duration came with blood in his sputum.

Situation: A patient with cough of more than 4 weeks duration came with blood in his sputum.
Reaction: Oh my God! Why was TB not suspected earlier?
Lesson: Make sure that all patients with cough of more than 3 weeks duration are investigated for TB.

Emedinews:Inspiration:Face difficulties positively

An Inspirational Story
(Ms Ritu Sinha)

This parable is told of a farmer who owned an old mule. The mule fell into the farmer’s well. The farmer heard the mule praying or whatever mules do when they fall into wells. After carefully assessing the situation, the farmer sympathized with the mule, but decided that neither the mule nor the well was worth the trouble of saving. Instead, he called his neighbors together, told them what had happened, and enlisted them to help haul dirt to bury the old mule in the well and put him out of his misery.

Initially the old mule was hysterical! But as the farmer and his neighbors continued shoveling and the dirt hit his back, a thought struck him. It suddenly dawned on him that every time a shovel load of dirt landed on his back, HE WOULD SHAKE IT OFF AND STEP UP!

This he did, blow after blow. “Shake it off and step up…shake it off and step up…shake it off and step up!” He repeated to encourage himself. No matter how painful the blows, or how distressing the situation seemed, the old mule fought panic and just kept right on SHAKING IT OFF AND STEPPING UP!

It wasn’t long before the old mule, battered and exhausted, stepped triumphantly over the wall of that well! What seemed like it would bury him actually helped him . . . all because of the manner in which he handled his adversity.

That’s life! If we face our problems and respond to them positively, and refuse to give in to panic, bitterness, or self-pity... the adversities that come along to bury us usually have within them the potential to benefit and bless us!

(http://academictips.org/blogs/face-difficulties-positively/)

Emedinews:Insights on Medicolegal Issues:Medical Testimony of Doctor in the Court of Law

Do not misrepresent documents/medical literature in the Court of Law

When evidence is read into the record of a trial, only that portion of the document, which validates the information being discussed needs to be read aloud. One paragraph or even one part of a paragraph may be all that is necessary to substantiate the point you are making. Documents must be presented in the words of the author. When you paraphrase evidence, you argue in a circle. Reading the remainder of the document, even if it establishes a context for the evidence, is unnecessary and time–consuming. When a document is cut in a manner, which lends the quoted passage a meaning other than what would be derived from a more complete reading, you are misrepresenting the document. This does not mean, however, that you are responsible for drawing the same conclusions from information as the author of the document.

Drawing a contrary conclusion from passages accurately interpreted does not constitute misrepresentation. The fact that the author of the document reached a different conclusion from the information argues perhaps persuasively against your conclusion. However, you have not misused the evidence.

Emedinews:Makesure:A patient with severe obstructive sleep apnea (OSA) developed acute coronary syndrome (ACS)

Situation: A patient with severe obstructive sleep apnea (OSA) developed acute coronary syndrome (ACS).
Reaction: Oh my God! Why was CAD not ruled out in this case?
Lesson: Make sure that all patients with OSA are investigated for underlying CAD.

Emedinews:Inspiration:For the always busy

An elderly man in Mumbai calls his son in New York and says, “I hate to ruin your day son, but I have to tell you that your mother and I are getting a divorce; 35 years of marriage... and that much misery is enough!”

“Dad, what are you talking about?” the son screams. “We can't stand the sight of each other any longer,” the old man says.

“We're sick of each other, and I'm sick of talking about this, so you call your sister in Hong Kong and tell her!”

Frantic, the son calls his sister, who explodes on the phone. “Like heck they're getting divorced,” she shouts, “I'll take care of this.”

She calls Mumbai immediately, and screams at the old man, “You are not getting divorced. Don't do a single thing until I get there. I'm calling my brother back, and we'll both be there tomorrow. Until then, don't do a thing, DO YOU HEAR??” and she hangs up.

The old man hangs up his phone and turns to his wife. “Okay”, he says, “It's all set. They're both coming for our anniversary and paying their own airfare!!”

Moral: No man / woman is busy in this world all 365 days.
The sky is not going to fall down if you take few days LEAVE and meet your dear ones.

Office work is not everything in life and money making is not everything in life.

Emedinews:Insights on Medicolegal Issues:UK Clinical negligence law –Bolam – v – Friern Hospital Management Committee 1957

UK Clinical negligence law –Bolam – v – Friern Hospital Management Committee 1957

Sir Liam Donaldson – "Patients deserve to receive quality healthcare"

• UK Clinical negligence law defines negligence as any act or omission which falls short of a standard to be expected of "the reasonable man."
• It is necessary to show that whatever the Doctor did or did not do fell below the standard of a reasonably competent Doctor in that field of medicine.
• In the leading case of "Bolam – v – Friern Hospital Management Committee 1957" it was stated that a doctor must act in accordance with a practice which is accepted as proper by a responsible body of men
• There are several acceptable ways of doing something and this may mean that there is no negligence if an alternative method is chosen.
• The fact that another person would not have done things in the same way does not automatically mean that there was clinical negligence.
• The Doctor will be able to defend the compensation claim successfully, if it can shown that a responsible body of reputable Doctors in the relevant field would have acted in a similar manner.
• This means that a judge will hear evidence from experts and decide whether the actions taken were appropriate.

Emedinews:Makesure:A patient on 10 units of insulin developed hypoglycemia with 11 units of insulin.

Situation: A patient on 10 units of insulin developed hypoglycemia with 11 units of insulin.
Reaction: Oh my God! Why was additional insulin given?
Lesson: Make sure that insulin dose is calculated correctly. The formula is 1500/total daily dose. The value will be the amount of sugar fluctuation with one unit of insulin.

Emedinews: Inspiration:The horse that wanted more beauty

An Inspirational Story (Ms Ritu Sinha)


A cosmic god had a horse. The horse was beautiful and also it had many good qualities. But it wanted to be more perfect in every way. It especially wanted to become beauty unparalleled. One day the horse said to the cosmic God, “O Lord, you have given me beauty. You have given me other good qualities. I am so grateful to you. But how I wish you could make me more beautiful. I would be extremely, extremely grateful if you could make me more beautiful.” The cosmic God said, “I am more than ready to make you more beautiful. Tell me in what way you want to be changed.” The horse said, “It seems to me that I am not well proportioned. My neck is too short. If you can make my neck a little longer, my upper body will be infinitely more beautiful. And if you can make my legs much longer and thinner, then I will look infinitely more beautiful in my lower body.” The cosmic God said, “Amen!” Then immediately he made a camel appear in place of the horse. The horse was so disheartened that it started to cry, “O Lord, I wanted to become more beautiful. In what way is this kind of outer form more beautiful?” The cosmic God said, “This is exactly what you asked for. You have become a camel.” The horse cried, “Oh no, I do not want to become a camel I wish to remain a horse. As a horse, everybody appreciated my good qualities. Nobody will appreciate me as a camel.” The cosmic God said, “Never try to achieve or receive more than I have given you. If you want to lead a desire-life, then at every moment you will want more and more. But you have no idea what the outcome will be. If you cry for a longer neck and legs, this is what will happen. Each thing in my creation has its own good qualities. The camel is not as beautiful as you are, but it carries heavy loads and has a tremendous sense of responsibility. (Source: http://academictips.org/blogs/the-horse-that-wanted-more-beauty/)

Emedinews:Insights on Medicolegal Issues: Investigation and medical negligence

The investigating police officer and the private/patient complainant cannot always be supposed to have knowledge of medical science so as to determine whether the act of the alleged medical professional/doctor/ hospital amounts to rash or negligent act within the domain of criminal law under Section 304-A of IPC said the Supreme Court of India. The SC says: • As we have noticed hereinabove that the cases of doctors being subjected to criminal prosecution are on an increase. Sometimes such prosecutions are filed by private complainants and sometimes by police on an FIR being lodged and cognizance taken. • The criminal process once initiated subjects the medical professional to serious embarrassment and sometimes harassment. He has to seek bail to escape arrest, which may or may not be granted to him. At the end he may be exonerated by acquittal or discharge but the loss which he has suffered in his reputation cannot be compensated by any standards. • We may not be understood as holding that doctors can never be prosecuted for an offence of which rashness or negligence is an essential ingredient. • All that we are doing is to emphasize the need for care and caution in the interest of society; for, the service which the medical profession renders to human beings is probably the noblest of all, and hence there is a need for protecting doctors from frivolous or unjust prosecutions. • Many a complainant prefers recourse to criminal process as a tool for pressurizing the medical professional for extracting uncalled for or unjust compensation. Such malicious proceedings have to be guarded against.

Emedinews:Makesure:In an STD clinic, a 23-year-old heterosexual male presenting with dysuria, and uretheral discharge was prescribed azithromycin to cover a suspected Chlamydia trachomatis infection.

Situation: In an STD clinic, a 23-year-old heterosexual male presenting with dysuria, and uretheral discharge was prescribed azithromycin to cover a suspected Chlamydia trachomatis infection. Reaction: Oh my God! Why didn’t you advise the same treatment for his partner also? Lesson: Make sure to remember that in such cases, it is essential that both the partners are treated.

Emedinews: Inspiration:Temper control

There once was a little boy who had a bad temper. His father gave him a bag of nails and told him that every time he lost his temper, he must hammer a nail into the fence. The first day the boy had driven 37 nails into the fence. Over the next few weeks as he learned to control his anger, the number of nails hammered daily, gradually dwindled down. He discovered it was easier to hold his temper than to drive those nails into the fence. Finally the day came when the boy didn’t lose his temper at all. He told his father about it and the father suggested that the boy now pull out one nail for each day that he was able to hold his temper. The days passed and the young boy was finally able to tell his father that all the nails were gone. The father took his son by the hand and led him to the fence. He said “you have done well, my son, but look at the holes in the fence. The fence will never be the same. When you say things in anger, they leave a scar just like this one.” You can put a knife in a man and draw it out. It won’t matter how many times you say I’m sorry, the wound is still there. Make sure you control your temper the next time you are tempted to say something you will regret later. (Source: http://academictips.org/blogs/temper-control/)

Emedinews:Makesure:What is impulse and its medicolegal importance?

What is impulse and its medicolegal importance? Impulse is sudden and irresistible desire or force in a person, compelling him to the conscious performance of some act for which there is no motive; for example, kleptomania means an irresistible desire to steal articles which may be of small value and even, may be of no use to the person stealing the article. A sane person who has self–control and judgment capacity may not finally give shape to his impulsive or compulsive desire. But an insane person, who lacks in self–control and judgment capacity, cannot resist the impulse and may commit any offence. Thus, in connection with commission of an unlawful act, impulse is a good defense for an insane person which is not so for a sane person. Some types of impulses are: • Dipsomania: This is found in alcoholics who have an irresistible desire to take alcoholic drinks. • Pyromania: Here, there is an irresistible desire to set fire to things, which may be important and valuable. The person is not conscious or careful, at least temporarily, to the possible dangers of his act. • Mutilomania: This is an irresistible desire to injure and mutilate animals, commonly the domestic pets. • Sexual impulse: The person may feel compulsive urge to perform sexual intercourse, often in a perverted way. There may be some psychic problem concerning the sexual behavior; or the person may be a victim of mental sub normality.

Emedinews:Makesure:A patient after receiving 40 units of insulin developed severe hypoglycemia.

Situation: A patient after receiving 40 units of insulin developed severe hypoglycemia. Reaction: Oh my God! The order was 4 units. Lesson: Make sure that 4 unit is not written as 4.0 units as it may be read incorrectly as 40.

Emedinews:Inspiration:Treasures To Be Thankful For

-- Author unknown
A man was exploring caves by the seashore. In one of the caves he found a canvas bag with a bunch of hardened clay balls. It was like someone had rolled clay balls and left them out in the sun to bake.
They didn't look like much, but they intrigued the man, so he took the bag out of the cave with him. As he strolled along the beach, he would throw the clay balls one at a time out into the ocean as far as he could.
He thought little about it, until he dropped one of the clay balls and it cracked open on a rock. Inside was a beautiful, precious stone!
Excited, the man started breaking open the remaining clay balls. Each contained a similar treasure. He found thousands of dollars worth of jewels in the 20 or so clay balls he had left. Then it struck him.
He had been on the beach a long time. He had thrown maybe 50 or 60 of the clay balls with their hidden treasure into the ocean waves. Instead of thousands of dollars in treasure, he could have taken home tens of thousands, but he had just thrown it away!
It's like that with people. We look at someone, maybe even ourselves, and we see the external clay vessel. It doesn't look like much from the outside. It isn't always beautiful or sparkling, so we discount it. We see that person as less important than someone more beautiful or stylish or well known or wealthy. But we have not taken the time to find the treasure hidden inside that person.
There is a treasure in each and every one of us. If we take the time to get to know that person, and if we ask God to show us that person the way He sees them, then the clay begins to peel away and the brilliant gem begins to shine forth.
May we not come to the end of our lives and find out that we have thrown away a fortune in friendships because the gems were hidden in bits of clay. May we see the people in our world as God sees them. 

 (Source: http://www.inspire21.com/stories/generalstories)

Emedinews:Insights on Medicolegal Issues:Can a doctor disclose the medical condition of the patient?

• The conclusive summary of the Principle of "duty of care", as applicable to persons in medical profession, includes the duty to maintain confidentiality.
• From ancient age in India the medical ethics has viewed the duty of confidentiality as a relatively non–negotiable tenet of medical practice.
• The Hippocratic Oath express about patient confidentiality as Whatever, in connection with my professional service, or not in connection with it, I see or hear, in the life of men, which ought not to be spoken of abroad, I will not divulge, as reckoning that all such should be kept secret.
• Patient Confidentiality is mandated in America by laws known as Health Insurance Portability and Accountability Act (HIPAA) of 1996, specifically the Privacy Rule, and various state laws, some more rigorous than HIPAA. However, numerous exceptions to the rules have been carved out over the years in view of medico–legal cases.
• Many American states require physicians to report gunshot wounds to the police and impaired drivers to the Department of Motor Vehicles.
• Confidentiality is also challenged in cases involving the diagnosis of a sexually transmitted disease in a patient who refuses to reveal the diagnosis to a spouse, and in the termination of a pregnancy in an underage patient, without the knowledge of the patient’s parents.
• In India a law like HIPAA is required or should be incorporated in code of medical ethics by MCI

eMedinewS:Makesure:: A patient who had multiple blunt injuries on his abdomen is admitted for management.

Situation: A patient who had multiple blunt injuries on his abdomen is admitted for management.
Reaction: Oh my God! Why did you not do a peritoneal lavage?
Lesson: Make sure to perform a peritoneal lavage in patients of multiple blunt injuries to exclude peritoneal hemorrhage from ruptured abdominal organs as the peritoneal reaction is often mild and a thorough clinical examination is not possible.

Emedinews:Inspiration:Who I Am Makes a Difference

A True Story by Author Unknown

A teacher in New York decided to honor each of her seniors in high school by telling them the difference they each made. She called each student to the front of the class, one at a time.

First she told each of them how they had made a difference to her and the class. Then she presented each of them with a blue ribbon imprinted with gold letters, which read, "Who I Am Makes a Difference."

Afterwards the teacher decided to do a class project to see what kind of impact recognition would have on a community. She gave each of the students three more ribbons and instructed them to go out and spread this acknowledgment ceremony. Then they were to follow up on the results, see who honored whom and report back to the class in about a week.

One of the boys in the class went to a junior executive in a nearby company and honored him for helping him with his career planning. He gave him a blue ribbon and put it on his shirt. Then he gave him two extra ribbons and said, "We're doing a class project on recognition, and we'd like you to go out, find somebody to honor, give them a blue ribbon, then give them the extra blue ribbon so they can acknowledge a third person to keep this acknowledgment ceremony going. Then please report back to me and tell me what happened."

Later that day the junior executive went in to see his boss, who had been noted, by the way, as being kind of a grouchy fellow. He sat his boss down and he told him that he deeply admired him for being a creative genius. The boss seemed very surprised. The junior executive asked him if he would accept the gift of the blue ribbon and would he give him permission to put it on him.

His surprised boss said, "Well, sure." The junior executive took the blue ribbon and placed it right on his boss's jacket above his heart. As he gave him the last extra ribbon, he asked, "Would you do me a favor? Would you take this extra ribbon and pass it on by honoring somebody else? The young boy who first gave me the ribbons is doing a project in school and we want to keep this recognition ceremony going and find out how it affects people."

That night the boss came home to his 14-year-old son and sat him down. He said, "The most incredible thing happened to me today. I was in my office and one of the junior executives came in and told me he admired me and gave me a blue ribbon for being a creative genius. Imagine. He thinks I'm a creative genius. Then he put this blue ribbon that says "Who I Am Makes a Difference," on my jacket above my heart. He gave me an extra ribbon and asked me to find somebody else to honor. As I was driving home tonight, I started thinking about whom I would honor with this ribbon and I thought about you. I want to honor you. My days are really hectic and when I come home I don't pay a lot of attention to you. Sometimes I scream at you for not getting good enough grades in school and for your bedroom being a mess, but somehow tonight, I just wanted to sit here and, well, just let you know that you do make a difference to me. Besides your mother, you are the most important person in my life. You're a great kid and I love you!"

The startled boy started to sob and sob, and he couldn't stop crying. His whole body shook. He looked up at his father and said through his tears, "Dad, earlier tonight I sat in my room and wrote a letter to you and Mom explaining why I had killed myself and asking you to forgive me. I was going to commit suicide tonight after you were asleep. I just didn't think that you cared at all. The letter is upstairs. I don't think I need it after all."

His father walked upstairs and found a heartfelt letter full of anguish and pain. The envelope was addressed, "Mom and Dad."

The boss went back to work a changed man. He was no longer a grouch, but made sure to let all his employees know that they made a difference. The junior executive helped several other young people with career planning and never forgot to let them know that they made a difference in his life... one being the boss's son.

And the young boy and his classmates learned a valuable lesson.

WHO YOU ARE DOES MAKE A DIFFERENCE. (Source: http://www.inspire21.com/stories/educationstories)

Emedinews:Insights on Medicolegal Issues:What is embalming?

Embalming is the process of chemically treating a dead body, developed by the ancient Egyptians, and preserving a person’s body after death to delay the decomposition, restore it to an acceptable physical appearance and reduce the presence and growth of bacteria to prevent foul smell as well as perfume or add fragrance to corpse. Embalming certificate is required by law in certain circumstances like air/rail transportation.

• The process of embalming has a very long history, dating back to the Egyptian process of mummification. Though their techniques were quite different from those used today, the effect was the same — to preserve an individual’s body after death. The ancient Egyptians believed that the spirit would return to the body after death, so it must remain in good condition. To preserve the corpses, they covered bodies in a drying chemical called natron, and then wrapped them in linen sheets.
• Today, embalming is done by injecting chemicals directly into the bloodstream to preserve the corpse’s appearance. The most commonly used chemicals for embalming are formaldehyde and ethanol. A combination of these two chemicals is sufficient to preserve the body for a short time i.e. up to a week.
• To keep the corpse in a good condition for a longer period i.e. up to a month, a solution made up almost entirely of formaldehyde is used.
• There are several steps involved in modern embalming. First, the embalming fluid is injected directly into the deceased’s blood vessels, and pushed through the body with a mechanical pump. Next, the internal organs are hollowed of their contents and filled with embalming fluid. The chemicals are then injected beneath the skin wherever necessary, followed by a final surface embalming on injured areas of the body.
• One of the most famous embalmed corpses today is that of Russian communist leader Vladimir Lenin, whose embalmed corpse is on display at the Red Square mausoleum in Moscow. The corpse is very well-preserved, and should last for at least another hundred years.

Emedinews:Makesure: A patient on 10 units of insulin developed hypoglycemia after taking a light breakfast.

Situation: A patient on 10 units of insulin developed hypoglycemia after taking a light breakfast.
Reaction: Oh my God! Why was the insulin dose not reduced?
Lesson: Make sure that insulin dose is correct. The formula is 500/total daily dose. The value will be the amount of sugar fluctuation with ten grams of carbohydrates.

Emedinews:Inspiration:Keep Your Dream

Author Unknown

I have a friend named Monty Roberts who owns a horse ranch in San Ysidro. He has let me use his house to put on fund-raising events to raise money for youth at risk programs.

The last time I was there he introduced me by saying, “I want to tell you why I let Jack use my horse. It all goes back to a story about a young man who was the son of an itinerant horse trainer who would go from stable to stable, race track to race track, farm to farm and ranch to ranch, training horses. As a result, the boy’s high school career was continually interrupted. When he was a senior, he was asked to write a paper about what he wanted to be and do when he grew up. “That night he wrote a seven-page paper describing his goal of someday owning a horse ranch. He wrote about his dream in great detail and he even drew a diagram of a 200-acre ranch, showing the location of all the buildings, the stables and the track. Then he drew a detailed floor plan for a 4,000-square-foot house that would sit on a 200-acre dream ranch. “He put a great deal of his heart into the project and the next day he handed it in to his teacher. Two days later he received his paper back. On the front page was a large red F with a note that read, “See me after class.”

The boy with the dream went to see the teacher after class and asked, “Why did I receive an F?”

The teacher said, “This is an unrealistic dream for a young boy like you. You have no money. You come from an itinerant family. You have no resources. Owning a horse ranch requires a lot of money. You have to buy the land. You have to pay for the original breeding stock and later you’ll have to pay large stud fees. There’s no way you could ever do it.” Then the teacher added, “If you will rewrite this paper with a more realistic goal, I will reconsider your grade.”

The boy went home and thought about it long and hard. He asked his father what he should do. His father said, “Look, son, you have to make up your own mind on this. However, I think it is a very important decision for you.” Finally, after sitting with it for a week, the boy turned in the same paper, making no changes at all.

He stated, “You can keep the F and I’ll keep my dream.” Monty then turned to the assembled group and said, “I tell you this story because you are sitting in my 4,000-square-foot house in the middle of my 200-acre horse ranch. I still have that school paper framed over the fireplace.” He added, “The best part of the story is that two summers ago that same schoolteacher brought 30 kids to camp out on my ranch for a week.” When the teacher was leaving, he said, “Look, Monty, I can tell you this now. When I was your teacher, I was something of a dream stealer. During those years I stole a lot of kids’ dreams. Fortunately you had enough gumption not to give up on yours.”

Don’t let anyone steal your dreams. Follow your heart, no matter what. (Source: http://www.inspire21.com/stories/educationstories)

Emedinews:Insights on Medicolegal Issues:Doctor & law

Doctor is neither a detective nor a curtain between injured/sick alleged criminal and police or judiciary.

• The primary and absolutely transparent duty of a doctor/hospital is to provide medical services to sick and injured patient may be an alleged criminal, to save his health/limb and life without any discrimination.
• When the medical care records are required for judicial/police investigation, the records becomes medicolegal in nature and the same may be required to be testified under oath in the court of law by the treating doctor.
• The doctor should acquire the habit of making a careful note of all the facts observed by him with exact time and date.
• The doctor should examine the facts which come to his knowledge in his special capacity as a medical man, draw his conclusions logically and correctly after a detailed consideration of the pros and cons of the case, and elaborate in the Court that interpretation, along with the medical grounds on which it is based.
• Presumption is not proof, and conjecture is not evidence. The Court has no special medical knowledge. It relies on medical witness for an opinion and expects him to assist it with his special knowledge and experience in perusal of truth.
• Presumption, assumption hypothesis, and mere conclusion on self defined interpretation are not a proof, and conjecture is not evidence.

Emedinews:Makesure:An asthmatic with respiratory rate of 37 developed respiratory arrest.

Situation: An asthmatic with respiratory rate of 37 developed respiratory arrest.
Reaction: Oh my God!! Why was the patient not put on the ventilator in time?
Lesson: Make sure to remember that a respiratory rate of > 35 is a warning signal to start ventilation therapy.

Emedinews:Inspiration:Dirt Roads

By Paul Harvey

What's mainly wrong with society today is that too many Dirt Roads have been paved.

There's not a problem in America today, crime, drugs, education, divorce, delinquency that wouldn't be remedied, if we just had more Dirt Roads, because Dirt Roads give character. People that live at the end of Dirt Roads learn early on that life is a bumpy ride.

That it can jar you right down to your teeth sometimes, but it's worth it, if at the end is home...a loving spouse, happy kids and a dog. We wouldn't have near the trouble with our educational system if our kids got their exercise walking a Dirt Road with other kids, from whom they learn how to get along. There was less crime in our streets before they were paved.

Criminals didn't walk two dusty miles to rob or rape, if they knew they'd be welcomed by 5 barking dogs and a double barrel shotgun. And there were no drive by shootings.

Our values were better when our roads were worse!

People did not worship their cars more than their kids, and motorists were more courteous, they didn't tailgate by riding the bumper or the guy in front would choke you with dust & bust your windshield with rocks.

Dirt Roads taught patience. Dirt Roads were environmentally friendly, you didn't hop in your car for a quart of milk you walked to the barn for your milk. For your mail, you walked to the mail box.

What if it rained and the Dirt Road got washed out? That was the best part, then you stayed home and had some family time, roasted marshmallows and popped popcorn and pony rode on Daddy's shoulders and learned how to make prettier quilts than anybody. At the end of Dirt Roads, you soon learned that bad words tasted like soap. Most paved roads lead to trouble, Dirt Roads more likely lead to a fishing creek or a swimming hole.

At the end of a Dirt Road, the only time we even locked our car was in August, because if we didn't some neighbor would fill it with too much zucchini.

At the end of a Dirt Road, there was always extra springtime income, from when city dudes would get stuck, you'd have to hitch up a team and pull them out.

Usually you got a dollar...always you got a new friend...at the end of a Dirt Road!

 (Source: http://www.inspire21.com/stories/educationstories)

Emedinews:Insights on Medicolegal Issues:UK Clinical negligence law –Bolam – v – Friern Hospital Management Committee 1957

Sir Liam Donaldson – "Patients deserve to receive quality healthcare"

• UK Clinical negligence law defines negligence as any act or omission which falls short of a standard to be expected of "the reasonable man."
• It is necessary to show that whatever the Doctor did or did not do fell below the standard of a reasonably competent Doctor in that field of medicine.
• In the leading case of "Bolam – v – Friern Hospital Management Committee 1957" it was stated that a doctor must act in accordance with a practice which is accepted as proper by a responsible body of men
• There are several acceptable ways of doing something and this may mean that there is no negligence if an alternative method is chosen.
• The fact that another person would not have done things in the same way does not automatically mean that there was clinical negligence.
• The Doctor will be able to defend the compensation claim successfully, if it can be shown that a responsible body of reputable Doctors in the relevant field would have acted in a similar manner.
• This means that a judge will hear evidence from experts and decide whether the actions taken were appropriate.

Emedinews:Makesure:A patient on 10 units of insulin developed hypoglycemia with 11 units of insulin.

Situation: A patient on 10 units of insulin developed hypoglycemia with 11 units of insulin.
Reaction: Oh my God! Why was additional insulin given?
Lesson: Make sure that insulin dose is calculated correctly. The formula is 1500/total daily dose. The value will be the amount of sugar fluctuation with one unit of insulin.

Emedinews:Inspiration:God Created The Teacher

An Inspirational Story
God Created The Teacher

-- Author Unknown

On the 6th day, God created men and women. On the 7th day, he rested. Not so much to recuperate, but rather to prepare himself for the work he was going to do on the next day. For it was on that day - the 8th day - that God created the FIRST TEACHER.

This TEACHER, though taken from among men and women, had several significant modifications. In general, God made the TEACHER more durable than other men and women. The TEACHER was made to arise at a very early hour and to go to bed no earlier than 11 PM, with no rest in between.

The TEACHER had to be able to withstand being locked up in an air-tight classroom for six hours with thirty-five "monsters" on a rainy Monday. And the TEACHER had to be fit to correct 103 papers over Easter vacation. Yes, God made the TEACHER tough...but gentle, too. The TEACHER was equipped with soft hands to wipe away the tears of the neglected and lonely student... those of the sixteen-year old girl who was not asked to the prom.

And into the TEACHER God poured a generous amount of patience. Patience when a student asks to repeat the directions the TEACHER has just repeated for someone else. Patience when the kids forget their lunch money for the fourth day in a row. Patience when one-third of the class fails the test…patience when the text books haven't arrived yet, and the semester starts tomorrow.

And God gave the TEACHER a heart slightly bigger than the average human heart. For the Teacher's heart had to be big enough to love the kid who screams, "I hate this class - it's boring!" and to love the kid who runs out of the classroom at the end of the period without so much as a "goodbye," let alone a "thank you."

And lastly, God gave the TEACHER an abundant supply of HOPE. For God knew that the TEACHER would always be hoping. Hoping that the kids would someday learn how to spell... hoping not to have lunchroom duty... hoping that Friday would come... hoping for a free day... hoping for deliverance.

When God finished creating the TEACHER, he stepped back and admired the work of His hands. And God saw that the TEACHER was good. Very Good! And God smiled, for when he looked at the TEACHER, he saw into the future.

He knew that the future is in the hands of the TEACHERS. And because God loves TEACHERS so much... on the 9th day God created... SNOW DAYS!

(Source: http://www.inspire21.com/stories/educationstories)

Emedinews:Insights on Medicolegal Issues:What is the vegetative state?

What is the vegetative state?

Complete absence of behavioral evidence for self or environmental awareness

• There is preserved capacity for spontaneous or stimulus–induced arousal, evidenced by sleep–wake cycles i.e. patients are awake, but have no awareness. This means that the patients appear awake.
• They have normal heart beat and breathing, and do not require advanced life support to preserve life and cannot produce a purposeful, co–coordinated, voluntary response in a sustained manner, although they may have primitive reflexive responses to light, sound, touch or pain.
• They cannot understand, communicate, speak, or have emotions and are unaware of self and environment and have no interaction with voluntary passage of urine or stools. They sleep and awaken. As the centers in the brain controlling the heart and breathing are intact, there is no threat to life, and patients can survive for many years with expert nursing care.
• The following behaviors may be seen in the vegetative state:
• Sleep–wake cycles with eyes closed, then opened. Patient breathes on her own; spontaneous blinking and roving eye movements; produce sounds but no words; visual pursuit following an object with her eyes; grimacing to pain; changing facial expression; yawning; chewing jaw movements swallowing of her own spit no purposeful limb movements; arching of back; reflex withdrawal from painful stimuli; brief movements of head or eyes toward sound or movement without apparent localization or fixation; startles with a loud sound.

Almost all of these features consistent with the diagnosis of permanent vegetative state were present during the medical examination of Aruna Shaunbag. Behavior suggestive of a minimally conscious not vegetative state observed during the examination.

Emedines:Makesure:A patient with dengue fever developed shock.

Situation: A patient with dengue fever developed shock.
Reaction: Oh my God! Why was the blood pressure 90/80 ignored?
Lesson: Make sure that a pulse pressure of less than 20 is not ignored, it is an impending sign that the patient is going into shock.

Emedinews:Inspiration:Seven Wonders of the World

An Inspirational Story
(Dr GM Singh)

A group of Geography students were asked to list what they considered to be the Seven Wonders of the World.

Though there was some disagreement, the following got the most votes:

1. Egypt's Great Pyramids
2. Taj Mahal
3. Grand Canyon
4. Panama Canal
5. Empire State Building
6. St. Peter's Basilica
7. China's Great Wall

While gathering the votes, the teacher noticed one student, a quiet girl, hadn't turned in her paper. So she asked the girl if she was having trouble with her list.

The quiet girl replied, "Yes, a little. I couldn't quite make up my mind because there were so many."

The teacher said, "Well, tell us what you have, and maybe we can help."

The girl hesitated, then read, "I think the Seven Wonders of the World are:

1. to touch
2. to taste
3. to see
4. to hear
5. to run
6. to laugh
7. and to love

Sometimes we forget what really matters. May you be reminded today of those things which are truly wondrous.

(Source: http://www.fropki.com/seven-wonders-the-world-vt49411.html#p527627) 

Emedinews:Insights on Medicolegal Issues:What is rape trauma syndrome?

• Rape trauma syndrome describes that rape survivors go through fear experienced during a sexual assault particularly violent sexual assault. Each victim has their own experience; but there are common characteristics the victims possess. These characteristics are the direct result of the fear inherent in sexual assault.
• The acute phase lasts from a few days to a few weeks after an assault. It is a response to a complete disruption of one’s life and the humiliating experience of being sexually assaulted. The acute phase produces as many responses as there are survivors. Some survivors may cry, others may laugh, and still others may be completely silent. It is important that there is no "wrong" way to cope with the immediate after effects of sexual trauma. During the acute phase, survivors may feel disbelief or in some way frozen. It has also been described as if survivors "left their body," forever being unable to reconnect with the woman or man who was raped. Survivors may feel humiliated, confused, dirty, ashamed, or in some way at fault for the assault; especially in the case where the assailant was an acquaintance. Physical concerns may arise during the acute phase as well. These concerns may be the direct result of the assault or fear of the possible physical ramifications of the assault i.e. pregnancy or STDs.
• Following the acute phase is the Reorganization Phase where the survivor attempts to reorganize her life. This phase invites a myriad of emotions such as fear, anxiety, denial, and most of all the loss of security. The shattering of security as well as trust is inherent in sexual assault. This loss of the fundamental need for security wreaks havoc on the survivor’s life. The feeling of being unsafe looms over the survivor causing a heightened state of anxiety, difficulty with intimate relationships, and overcautious such as constantly checking one’s surroundings.
• Chronic reactions to sexual assault include the inability to find peace at the level of soul. Sexual assault can change the individual forever as well as the world as they know it. The end result is a constant state of turmoil in thought process. At times, the survivor may not even recognize what is happening within. Sexual assault causes the body to be an unfriendly environment leading the survivor to at times feel dirty and ashamed. These feelings cause the individual to disconnect from their body entirely. Without a connection to their body, the survivor is unable to listen to internal states which assist her in navigating through the world. This contributes to a feeling inherent in many survivors, the feeling of being "lost." The patient needs close monitoring/treatment by doctor and counselors.

Emedinews:Makesure:An asthmatic with respiratory rate of 37 developed respiratory arrest.

Situation: An asthmatic with respiratory rate of 37 developed respiratory arrest.
Reaction: Oh my God! Why was the patient not put on the ventilator in time?
Lesson: Make sure to remember that a respiratory rate of > 35 is a warning signal to start ventilation therapy.

Emedinews:Inspiration:"God Bless You" Speech

They walked in tandem, each of the ninety-three students filing into the already crowded auditorium. With rich maroon gowns flowing and the traditional caps, they looked almost as grown up as they felt. Dads swallowed hard behind broad smiles, and moms freely brushed away tears.

This class would not pray during the commencements; not by choice, but because of a recent court ruling prohibiting it. The principal and several students were careful to stay within the guidelines allowed by the ruling. They gave inspirational and challenging speeches, but no one mentioned divine guidance and no one asked for blessings on the graduates or their families.

The speeches were nice, but they were routine; until the final speech received a standing ovation. A solitary student walked proudly to the microphone. He stood still and silent for just a moment, and then he delivered his speech -- a resounding sneeze! The rest of the students rose immediately to their feet, and in unison they said, "God bless you." The audience exploded into applause. The graduating class found a unique way to invoke God's blessing on their future -- with or without the court's approval.

(Source: http://www.inspire21.com/stories/educationstories)

Emedinews:Insights on Medicolegal Issues:Supreme Court of Georgia echoed the Illinois decision, albeit with somewhat different wording

Malpractice

• Every person who enters into a learned profession undertakes to bring to the exercise of his profession a reasonable degree of care and skill. He does not undertake to use the highest possible degree of skill, for there may be persons who, for having enjoyed a better education and greater advantages, are possessed of greater skill in their profession; but he undertakes that he will bring a fair, reasonable, and competent degree of skill…He is not responsible for an error in judgment…if such error arises from the peculiar circumstance of the case, and not from the want of proper care or competent skill on his part.
• Nearly a half–century later, a state of New York appeals court issued an opinion as to what constitutes the standard of care of a medical physician. Although the lawsuit did not involve radiology, the court decision could have well applied to radiologic interpretation
• The law requires a physician to possess the skill and learning which is possessed by the average member of the medical profession…and to apply that skill and learning with ordinary reasonable care. He is not liable for a mere error in judgment, provided he does what he thinks is best after a careful examination. He does not guarantee a good result.

Emedinews:Makesure:An HIV patient died after sulfa prophylaxis.

Situation: An HIV patient died after sulfa prophylaxis.
Reaction: Oh my God! You should have known that he was sulfa sensitive.
Lesson: Make sure that patients with a history consistent with Stevens Johnson syndrome and toxic epidermal necrolysis or an exfoliative dermatitis due to a sulfonamide medication should strictly avoid the culprit drug and other agents in the same sulfonamide group. Re–exposure to the same agent may be fatal.

Emedinews:Inspiration:Socrates' Triple Filter Test

An Inspirational Story
(Ms Ritu Sinha)

In ancient Greece, (469 - 399 BC), Socrates was reputed to hold knowledge in high esteem. One day an acquaintance met the great philosopher and said, “Do you know what I just heard about your friend?” “Hold on a minute,” Socrates replied. “Before telling me anything, I’d like you to pass a little test. It’s called the Triple Filter Test.”

“Triple filter?”

“That’s right,” Socrates continued. “Before you talk to me about my friend, it might be a good idea to take a moment and filter what you’re going to say. That’s why I call it the triple filter test.”

“The first filter is TRUTH. Have you made absolutely sure that what you are about to tell me is true?”

“No,” the man said, “actually I just heard about it and...”

“All right,” said Socrates. “So you don’t really know if it’s true or not. Now let’s try the second filter, the filter of GOODNESS. Is what you are about to tell me about my friend something good?”

“No, on the contrary...”

“So,” Socrates continued, “you want to tell me something bad about him, but you’re not certain it’s true. You may still pass the test though, because there’s one filter left: the filter of USEFULNESS. Is what you want to tell me about my friend going to be useful to me?”

“No, not really.”

“Well,” concluded Socrates, “if what you want to tell me is neither true nor good nor even useful, why tell it to me at all?”

This is why Socrates was a great philosopher & held in such high esteem. We should all use this triple filter each time we hear loose talk about any of our friends, family and other associates.

(Source: http://www.inspire21.com/stories/friendshipstories/SocratesTripleFilterTest)

Emedinews:Insights on Medicolegal Issues:Postmortem in case of medical negligence

In India, for the Autopsy surgeons, the strict test to be applied should be: ‘would death could have occurred, if the operation had not taken place?’

• Information is needed before beginning the medicolegal autopsy. The patient’s notes are essential along with some other relevant information. Equally important is the attendance of clinicians at the autopsy, more indeed, in deaths associated with anesthesia.
• Discussion among autopsy surgeon and the anesthetist may arrive at an amicable conclusion of opinion to offer the investigating authority.
• The hospital lab may be requested to retain any antemortem blood or fluid samples sent to them so that they remain available for analytical checks, such as blood grouping in transfusion mishaps, or creatine phosphokinase activity in malignant hyperthermia
• If death is due to a disease or disability, other than that for which the operation was performed, a distinction has to be drawn between those conditions that were known before the operation was performed
• A distinction has to be drawn between those conditions that were known before the operations and those which were unexpected. Naturally, operative and anesthetic techniques may have to be modified to take account of the known adverse conditions
• Death may occur due to failure of a surgical technique. This may be inadvertent, from a true ‘accident’ sometimes caused by unusually difficult operative circumstances, to anatomical abnormalities or even failure of equipment.
• When it is one result of error of incompetence, then a legal action for negligence may ensue and the autopsy surgeon must be even more meticulous than usual in producing a detailed and impartial report.
• When a failure of equipment may be responsible, then expert examination and advice is required. Anesthetic machines, gas supply, compatibility of connections and all the sophisticated hardware of Operation Theater must be subjected to the most rigorous inspection if a malfunction is suspected. This becomes important part of the autopsy surgeon concern, because he is responsible for the eventual decision about the cause of death.
• The risk of death from all causes cardiac arrest was the most common single mode of death, being seen on average once or twice a year in most busy operating suites even under the most careful surgical and anesthetic regimens. Most cardiac arrest occurs at either the start or finish of the surgical procedure.