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?

Pinknotperky - you should be asking consent to send discharge letters to GPs. Unless the the pt is referred to the GP for continuing care after discharge - but then that would be required as part of the discussion anyway. And of course, you copy patients into the discharge letters, don't you? And sending discharge letters to GPs should not be automatic - asking consent first should be automatic, then if the response is affirmative, then you send the discharge letter. I do not know why hospitals and their staff think they are above the law? And of course, in the specific case of children, there are specific laws to follow. And there are ways to circumvent those laws for those who may wish to do so.

DinoSnores if you work in A&E, then a GP is not your 'colleague'. If the patient's treatment ends upon their departure from A&E, or a quick visit to Boots for some over the counter painkillers is all that is required, there is no need to inform their GP. Therefore, you need to ask for consent to send a letter to the pt's GP. If a referral to the GP is required for ongoing care, then that is different, but a referral involves consent anyway. But for a normal, competent adult, there is no need to write a letter to a GP without the patient's consent. A GP works for a different organisation, therefore is not your 'colleague', unless you are liaising with the GP regarding the patient with their consent. A canteen assistant working in your hospital is more of a colleague than a GP, but you wouldn't be discussing the patient with them, would you? And of course, there are specific laws requiring you to report TB, gunshot wounds and certain other issues, like there are with children, but there are no laws requiring you to report to a GP that a fully non-vulnerable adult has been in to A&E.

And Dino, I would like to know how you can get hold of my GP's details without asking me, or if I'm unconscious, or if I refuse?

And the law requires you to inform a relative if you are referring to a coroner - it is not something you are doing out of 'good practice'. Just like you are required to inform someone if you are passing on their information without their consent - unless exception circumstances prevail. It is called the Data Protection Act - it is not because you are doing it out of the goodness of your heart, or good practice. It is because laws have had to be introduced because hospital staff have not followed good practice or professional codes of conduct in the past.

The point about coroner's referrals is that while there is an obligation to inform relatives, NOK cannot legally refuse referral. If the coroner deems an autopsy necessary, NOK cannot withhold consent.

Yes, I know. I was talking about the passing of information.

Yes, Information can be passed to coroner without NOK consent.

Do you think that in the future (more privatised health services etc) consent for elective treatment at least will reverse , in that people will decide what specific treatment they want (based on Dr Google and similar) and then they'll shop around to find a doctor etc who will consent to deliver it? Not sure this would translate to emergency treatment

It would be an awful burden to ask a relative to decide if a drug should be used in the event of CA, which is the implied result of asking for consent. They would never know if their decision had a bearing on the outcome.

Oh dear, pseudonym, you really don't know what you are talking about, do you?!

Of course a GP is my colleague! 'Good Medical Practice' makes clear that all medical and healthcare professionals involved in a patient's care are colleagues and that we must share information to provide good healthcare to that patient.

I am guessing that NCISaddict is a paramedic/technician so won't be employed by the NHS Trust of the doctors and nurses as she (he?) will be employed by an ambulance service. Just because we don't have the same employer, it doesn't mean that we are not professional colleagues obliged to share information to the benefit of that patient.

And I would be negligent (as a number of us have explained) if I did not let the main medical caregiver, that is the GP, know of an admission to hospital, change to medication, new diagnosis. Not doing so could HARM a patient. It is to PROTECT patients, not some odd conspiracy!

As for finding out GP details, I don't know the ins and outs of it as the admin people do it, but it is based on your NHS number that we all have. That way, we can contact the GP for relevant past medical history, medication history etc, if the patient is unable to give us details for whatever reason (tends to be because they are unconscious although a few people just don't seem to know which practice they are registered at).

Why don't you have a good read of the GMC website and see what the rules actually are, rather that what you think they (rather oddly) should be?

It's a peculiar form of trolling/goading pseudonym is participating in.

But if the GP is not involved in that episode of care, there is no need for them to know. Therefore you need to seek my consent to tell them.

I think everyone is goading / trolling me!

Its a serious question, though. Why is it not normal practice to seek consent to pass information to a GP who has not been involved in the care of a patient in a particular instance, when there is no need for continuing care?

I quite agree, lyndie. I am undecided as to whether pseudonym is just spoiling for a fight or whether they actually believe this. I've certainly never met a patient with such an "immovable stance".

I actually think that if there genuinely is no need for GP follow up, something along the lines of "we would normally write to your GP for information / in case you have any further problems / so your records are complete - do you have any problems with that?" should be said. And for the (I suspect) very small number of patients who object, that objection recorded in the notes for that treatment episode to indicate that they have declined.

There is a precedent to this already, as many HIV services will see patients without any communication to / from their GP (of course, this creates other problems - HIV services in hospitals massively over-busy with HIV non-related primary care issues, and In the event of a patient turning up to their GP possibly getting a poorer quality of care because the GP isn't aware of their history / medication. Sexual health services in general will prescribe contraceptives and treat STIs anonymously without informing GP.

Ethically, the main problem as I see it with this fragmentation of care is that it can lead to patients experiencing poorer quality of care from services in the future because no-one has an overall picture of their health issues / interventions. It's very common to see people complain online and IRL about an apparently disparate group of symptoms or recurrence of symptoms thar haven't been put together to make a diagnosis until much time has passed, potentially with much distress and suffering in the meantime. I suspect this would be more likely in patients who opt-out of GP information. Of course, adults with capacity are entitled to make decisions that potentially jeopardise the quality of care they receive, but whether people would understand this risk (and therefore give informed consent!) isn't clear.

Having said that, the number of patients who do not require some form of continuing care will be tiny, given that secondary care providers can no longer refer between specialties or prescribe on-going medication or do on-going monitoring (with a couple of exceptions).

Pseudonym, your GP as your usual medical practitioner needs to know about all episodes of care, even if he is not directly involved. Imagine you are admitted to A and E and subsequently to a medical ward after suffering a severe, life threatening allergic reaction to an antibiotic or other drug, do you not think it is crucial for your GP to know this? Partly so they can avoid giving you that medication in future but so it can be shared with other medical practitioners in the future?

We cannot rely on patients knowing and disclosing all of this information, they often forget, or don't think it's relevant when it often is. Also if we asked consent from every patient to share information like this, we wouldn't have time to do anything else.

Im honestly not goading/trolling. Im telling you how it is in my trust. We dont seek permission to pass details on to a gp!

I have to say that I do ask for consent before sending a letter to a GP, unless they were the referrer. If they were the referrer, then consent to the referral in my view includes consent for the referrer to be informed of the outcome.

Pseudonym, I'm assuming that you've opted out of the NHs Spine records, in which case I don't think I would know who your GP was unless you tell me or unless you have preexisting records in the hospital/treating clinic.

I actually think consent is done quite well in the NHS. Informed consent, not so much.

When i discharge someone from hospital , there are various copies , one for the patient , one to go into the patient notes and one to be sent to the GP . I always explain this to the patient and in 14 years doing this have never met one single person who objected , why on earth would they ?

joan - you seem to understand where I am coming from. Although you cannot opt out of the NHS spine, my record is flagged so that no one can access my demographic locational information. My GP fully understands my issues surrounding confidentiality and consent, and I am fully prepared to accept the risks this entails. I was shocked when I discovered this database exists and is so accessible, and I am sure many others would be too, if they knew.

And I am perfectly willing to participate (and have done) in research when asked in a proper manner, unless I have a specific objection, and will bend over backwards to assist, but when we have care.data and other non-consenting projects occurring, I am reconsidering my position and will object so strongly, that researchers will just wish they had asked for proper consent from me, or my legal representaive, should I not be able to consent, in the first place.

I guess at least this sort of conversation does prompt people to review their practice, even if people like Pseudonym wouldn't agree with most of the outcomes.

This thread may well also have served to inform some MNers about how they are protected by ethics committees.

I think Pseudo's ideas are mostly rather unreasonable or unworkable to say the least but we do need people to question the system because sometimes the points they make are valid and it changes for the better as a result. At other times it's just nice to have a reason to stop and think and feel reassured that we are getting it right as far as possible.

Well, I do agree that my views are perhaps at the extreme end of the range, but people like me are needed to ensure that others meet in the middle to ensure that the majority are protected, happy with the situation and research can proceed. Hopefully systems can evolve in the future so that I can sleep soundly knowing that should I have a cardiac arrest during the night, I will not have my information included in a research project without my prior consent. The technology exists - we just need the NHS to catch up with it.

Hopefully systems can evolve in the future so that I can sleep soundly knowing that should I have a cardiac arrest during the night, I will not have my information included in a research project without my prior consent.

I can think of few worse reasons for insomnia than the thought that it might be. If it is keeping you awake can I send my DD2 round to keep you company?

Lol! But do the ethics committees consider during their deliberations that people might actually be worried about this stuff, keeping them awake at night and potentially making them ill? And, due to my concerns, I will not be going to my GP for something to be calming me down for fear of what might happen to that information?

And you have this care.data thing. You can opt out. But are you really opted out? Or are they just saying that to make you feel better? Can we trust them at their word? Or are they lying to those that have opted out, and are still including them anyway? Can we trust these people? I don't know. Perhaps the ethics committees get overridden when needed, without anyone's knowledge?

It's the whole way the NHS is set up, Pseudo. A GP is your gateway guide to NHS services. They debrief you after a visit to hospital, they help you access non-urgent hospital services, they are incentivised to offer all sorts of screening & preventative care.
If like most old people you end up with multi-morbidities, the GP is the one who is supposed to advocate, direct and delegate most of your health care needs.

So basically by saying you don't want a hospital (say A&E) doctor to communicate with your GP, it's saying you want the entire system to be restructured just for you. Even though hospital doctors don't do preventative care & GPs can't offer much urgent care, etc. Others moan about restructuring the whole system, though, you're not the first.

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My mother died of cardiac arrest (so good to finally understand the difference between that and a heart attack). My brother was there to witness her death (his birthday today). Brother trained as a cardiac technician and understood everything that was happening as she died, especially the actions of the medics. It still weirds me out that she was declared dead while her heart was still beating, but she'd had no pulse for 20 minutes at that point.

Hopefully systems can evolve in the future so that I can sleep soundly knowing that should I have a cardiac arrest during the night, I will not have my information included in a research project without my prior consent.

Really? It isn't the prospect of the possible death or brain damage from cardiac arrest that stops you from sleeping soundly but the personal data implications? (You mean "OMG what if Tesco somehow got hold of this information about my cardiac arrest and used it to sell me aspirin" kind of thing?)

There are some kinds of study where the data would be affected by the seeking of consent. If you want a quantitative study on survival outcomes in cardiac arrest patients, then allowing the surviving patients the right to withdraw consent for their data to be included (but not the ended-up-dead patients, because their rights are not being infringed, since they're dead, obvs) - then clearly this will skew the data and render it pointless for predicting clinical outcomes.

Allowing the NoK of a dead person the right to withdraw data retrospectively for the dead patients is a bit nonsensical - and in fact against patient autonomy (do you want your relatives to be able to interfere with your patient data choices after death?)

Sometimes clinical research isn't compatible with current notions of consent - and "consent" in any case is a shifting idea, very historically specific, and can be a bit of a useful fiction as an idea. Not that it isn't a good thing, but it certainly isn't a fixed or immutable thing, or something that you have an inalienable right to, either legally or morally.

And in the end, really, you think issues of consent should always override essential research into saving lives, even if the information can't be obtained any other way?

What about other kinds of medical situation? Suppose we had an outbreak of Ebola here and some patients refused to "consent" to treatment? Would you be averse to them being rounded up by the military and put under forced quarantine, or would their right to "consent" trump everyone else's wellbeing? Just wondering....