【Western medicine diagnotics question】CHP1: Ethics and communication

CHP1: Ethics and communication

1. Regarding medical ethics, if a man is discovered to be hepatitis B or C positive, is it advisable for the physician to inform the wife or sexual contact of the patient?

No. The doctor can only give confidential information to the patient. One would expect, however, that the doctor would counsel the patient, giving advice on his sexual behaviour and safe sex. The patient would hopefully discuss the results with his partner. (主动告诉患者，被动告诉患者亲属)

2. Is it unlawful in most countries to limit medical care, particularly by rationing the usage of drugs? Surely rationing must be against the oath we took as doctors to provide the best care available.

In all healthcare systems, rationing has become inevitable, partly because of the high costs of modern therapies. To be in line with good medical practice, doctors must acknowledge the obligation that, if rationing is unavoidable, it should be carried out in a responsible and justifiable way.

3. What is meant by QALYs? Is there a difference between quality and quantity of life?

QALYs are Quality Adjusted Life Years. These were developed to place a measurable value to the quality and quantity of life. 

The QALY can be calculated using the following formula which assumes a utility value (quality of life) between 1 = perfect health and 0 = dead: Years of Life x Utility Value = #QALYs

eg.

If a person lives in perfect health for one year, that person will have 1 QALY.

(1 Year of Life × 1 Utility Value = 1 QALY)

 

If a person lives in perfect health but only for half a year, that person will have 0.5 QALYs.

(0.5 Years of Life x 1 Utility Value = 0.5 QALYs)

In cost-effectiveness studies (or: health economic evaluations) the QALY is used to quantify the effectiveness of, for instance, a new medicine versus the current one. In other words, the current standard of care is taken as the baseline, and the QALYs gained from the new (improved) intervention are counted in addition.

4. Are ‘Do not resuscitate’ orders illegal in most countries?

A do-not-resuscitate order (DNR) is a legally binding physician's order stating that no steps will be taken to restart a patient's heart or restore breathing if the patient experiences cardiac arrest or respiratory arrest.

It is accepted in most countries that ‘futile’ treatment should not be offered. However, all decisions must be made by senior medical staff after discussion with a patient (if competent), other members of the team and family/carers (if the patient lacks mental capacity).

5. What is a living will?

A living will is a written, legal document that spells out medical treatments you would and would not want to be used to keep you alive, as well as your preferences for other medical decisions, such as pain management or organ donation.

6. What is Bolam principle?

Following the Bolam case (Bolam v. Friern Hospital Management Committee 1957), a doctor is not guilty of  negligence if he or she has acted in accordance with a practice that is accepted as proper by a responsible body of medical personnel skilled in that particular art. More recently, it was held that for a judge to rely on the opinion of a medical expert, the judge has to be satisfied that the expert’s opinion has a logical basis (Bolitho v. City and Hackney Health Authority 1997). This means that judges can now reach their own conclusions.

7.Why is counselling required before an HIV test can be done on a patient? 

Taking the HIV test is a very traumatic event. Furthermore, this trauma reaches an extreme condition when the test result (positive or negative) is disclosed. It is therefore essential that the process of HIV testing be accompanied by counselling.

8. As a junior doctor, I have to attend many multidisciplinary team meetings. I am concerned about the confidentiality of these meetings as they are attended by a diverse group of healthcare workers.

Related patients must always be informed about the meeting. It should be emphasized that modern medicine involves people from many disciplines. It must be made clear to patients that their confidentiality will be preserved within the team.

9. Is the role of the advocate in a medical interview to help the patient or the doctor?

Both. However, an advocate represents the values, interests and desires of patients and speaks on their behalf. She or he protects their rights, helps with consent, protects patients’ autonomy and ensures that they receive their fair share of resources. From a doctor’s point of view, it is nice to have someone who can interpret patients’ needs.