Adrenaline or salt water. Changes to the way heart attack patients are treated.

[Darkesteyes]

Just seen a report on Newsnight. Instead of injecting with adrenaline some patients (but we wont know which ones until afterwards) will be injected with saltwater as a placebo. It is to see if adrenaline causes more harm than good.
DH has heart disease. He called this an experiment. And i certainly see his point. He says its obviously to "kill some people off" He got quite upset. What do MNers think of this?

What makes you think I am ignorant? If have reasons for my views. It would seem to be you who are ignorant, as you claim in your latest post that ethics committees are trying to find an outcome for the greater good - surely they should be protecting the individual? It is the researchers who are acting for the greater good. I would love to be on an ethics committee, but unfortunately I would not have the time. Besides, they would not like my unmovable stance.

What makes you think I am ignorant?

You are slating ethics committees while showing very little knowledge of how they work.

By ignorant I mean you are ignorant of the workings of these committees. It was not intended as a generalised insult.

surely they should be protecting the individual?

The survivors of cardiac arrest who may be caused unnecessary brain damage are individuals they are trying to protect.

By individual, I mean the participants of the study. It is those the ethics committees are trying to protect.

Yes, I am slating ethics committees, because they are failing to take into account my views.

What if your views are so wide of the mark that they couldnt be taken into account?

There are some fundamental issues here which you don't seem to understand.

bangs head against the nearest wall

Ethics committees ARE trying to protect the individuals in this study.

There is NO EVIDENCE that adrenaline is helpful in cardiac arrest. It may cause HARM.

If someone does not want to take part in this study in the very unlikely event that they are one of the first 8000 eligible people to have an out of hospital cardiac arrest, they can register that.

Here's another study, which a number of us on MN will have been involved in even though we didn't realise this at the time. The Place of Birth study looked at outcomes for women starting labour at home, at a midwife led unit or in an obstetric unit. Data, as others have explained to you before, was anonymised on collection. www.bmj.com/content/343/bmj.d7400

Don't know why I am trying to be helpful when you have declared your "immovable stance" and inability to take any other (more experienced) view into even consideration, but try thinking about it this way:

(We actually already collect this data. Any arrest I run in hospital as a senior doctor has a huge form to be completed afterwards with what shocks I did, what drugs I gave, patient's blood sugar, patient outcome etc on it.)

The trial happens.

Patient A is given adrenaline or saline.

They are metabolised by the body within about 20 minutes.

The intervention is over within 60 minutes of the initial arrest.

Patient A lives or dies (more likely dies).

What HARM is done now as a result of recording in an anonymised way whether Patient A lived or died following their arrest?

Bet you don't seek consent before sending the form off, though? These attitudes need to change. If someone opts out of care.data, will that prevent the information being sent off?

No, I don't. Why would I? You clearly just don't get how things work!

I don't explicit ask for consent to write in the notes, write the blood results from the lab into the notes, send a copy of the discharge letter to the GP etc.

I'm not going to ask for permission to write in the notes about what happened at an arrest. It is my DUTY to record it.

www.nhs.uk/nhsengland/thenhs/records/healthrecords/pages/overview.aspx

I participated in a study a few weeks ago on sleep deprivation in parents of children with Autism. I volunteered to give personal information that wouldn't otherwise going to be recorded and it was appropriate that I was offered information on how that data was going to be protected before I chose to give it.

I was also given information on support I could get should participating in the study give me reason to need it. That was very appropriate as completing the questionnaire highlighted to me just how abnormal my sleep pattern was. The support was put in place to protect me from the effects of participating in the study.

If you are in cardiac arrest, the information about the outcome will be recorded anyway. There are no expected ill effects on you of participating in the study or having that information recorded and included in the data. If evidence emerged that there were ill effects on the participants, the study would be stopped or changed, in consultation with the ethics committee responsible.

The ethics committees involved in both studies have protected me as an individual who chose to participate in the first one, as a potential participant in the second one and as a future possible patient in cardiac arrest who is entitled to the best, most securely evidenced-based treatments.

But surely you ask consent to write to the GP? Wouldn't you need to be asking the pt who their GP is anyway?

But surely you ask consent to write to the GP? Wouldn't you need to be asking the pt who their GP is anyway?

Would you have every medical professional get specific consent from every patient before communicating with any other medical professional?

The GP's details are recorded in the patient's notes.

Consent is required to pass information between different organisations under the Data Protection Act. So yes, I would expect consent to be sought. And to record GP details in the notes, would you not need to ask the pt who their GP is?

Pseudonym
Not all data is gained with consent. Sometimes procedures are carried out without consent, resuscitation is one. Sometimes a Dr has a duty to pass on information with or without patient consent, things like informing the DVLA

But a dr would first have to find out if you were already on the DVLA's database, so they would first have to ask, sashh.

And a medical professional cannot pass on information about you to another medical professional without your consent. It is illegal. So before telling my GP I've been to A&E, I need to be asked for my permission. It is the law, as well as common courtesy. And in their professional codes of conduct.

Pseudonym99. I work in an A&E.

Everyone who comes in who's registered to a GP automatically gets a discharge letter sent to the GP. We don't ask permission!!

The doctors/nurses don't ask permission before informing the school/health visitor that a child has been in either!

Whenever I have been treated in hospital the end of the consult or discharge ends with so I will write to your GP. If you didn't them to write you would say at this point.
There are instances where legal obligations over ride patient confidentiality and a gunshot wound would be one of these.
One of the flaws I can see in your plan pseudo is that by preventing contemporaneous notes and inclusion of your data in clinical audits you are removing two of the most successful methods of protecting patients from medical negligence.
Additionally without clinical audits to suggest that current treatment protocols have disadvantages no progress would ever be made and patient care would eventually deteriorate.

"And a medical professional cannot pass on information about you to another medical professional without your consent. It is illegal. So before telling my GP I've been to A&E, I need to be asked for my permission."

No, it isn't illegal. You are misinformed or just making stuff up to be controversial. I'm not convinced it isn't the latter now.

The GMC's Good Medical Practice, which I must follow or be struck off, says:

44. You must contribute to the safe transfer of patients between healthcare providers and between health and social care providers. This means you must:

a. share all relevant information with colleagues involved in your patients’ care within and outside the team, including when you hand over care as you go off duty, and when you delegate care or refer patients to other health or social care providers 5,10
b. check, where practical, that a named clinician or team has taken over responsibility when your role in providing a patient’s care has ended. This may be particularly important for patients with impaired capacity or who are vulnerable for other reasons.

www.gmc-uk.org/guidance/good_medical_practice/continuity_care.asp

As for the DVLA, if I believe that someone has a driving licence and shouldn't be driving but is, I can inform the DVLA of this. It is good practice to let the patient know I am doing this, but that is different from asking permission to share that information.

And, of course, we ask a patient who their GP is, but, such as in the case of an unconscious patient who can't give that information if we don't already have it, we can get it. Anyway, where do you think referrals come from? I see a patient in hospital, on the wards or in clinic. They have most likely been referred by their GP for our specialist opinion/care etc.

I participated in a medical study hours after I was born. Nobody asked me for my consent and I wasn't given the option to retroactively withdraw consent once I turned 18. I bet my anonymised data is still floating around inside some scientist's computer. It's a fucking outrage that I added to medical knowledge about temperature regulation in newborns while coming to no harm!

Disgusting scientist SCUM!

While we are at it, I don't need to ask your permission to refer concerns about your children to social work, although again good practice would say that in all but the more dire of circumstances, I tell you that I am passing on that information.

I don't need your permission to tell the police if I believe that a serious crime causing harm to persons or property has or will be committed.

I don't need your permission to inform Public Health of your diagnosis of TB so that they can do proper contact tracing and hopefully prevent other people becoming infected, becoming ill and dying.

(I'm sure I'll think of others later.)

THIS is what is in our professional codes of conduct.

fairphyllis,

Dino - Coroner's autopsy?

That's a good one, parallax80. Yes, I can refer a death to the coroner without the patient's permission (because they are dead) and without the permission of the next of kin.

www.gov.uk/after-a-death/when-a-death-is-reported-to-a-coroner

The coroner can then decide whether or not to order a post mortem. Again, it is good practice to inform the relatives of this and I always do, but they can not deny permission for it.

(In practice, if someone has a very strong objection to post mortems as some faiths do and depending on the circumstances of the death, the coroner may decide to order a limited post mortem or agree to do just a post mortem CT scan where that is available.)

I fill in a form for each patient I see in the pre hospital environment, when I get to A&E with the patient I handover to the clinician in charge and I don't have to ask the patients permission before I do it.
After all it would be a bit daft if I walked in and said' here's a patient, guess what's wrong with them'
Records are kept of each cardiac arrest and of the outcome, how else would we know how many ROSC's we had? We don't ask consent of either the patient or the relatives for that form to be filled in or the details collated. We don't complete patient report forms for a bit of writing practice but to assess and inform our practice.