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?

Surely you'd have to give consent before being resuscitated or given adrenaline when in cardiac arrest, then.

The default here should be saline, or nothing, and there should have been studies about the use of adrenaline. I wonder how it was introduced in the first place. Guess work?

Essentially, there are some things over which we don't have control over our own bodies and other people will have to make judgement calls.
Being given adrenaline is not a right. It is a medical act.
I'd say that once doctors have to act on our bodies when we can't give consent, we have to trust them to exercise their best judgement. If the best judgement is that they use saline and not adrenaline to see what the result is, fair enough.
We are essentially dead anyway and any intervention can only improve our chances.
AFAIK there is a window of opportunity for resuscitation and if saline doesn't work initially, it's likely that it will be followed by other methods.

But more medicine and intervention is not always the best. And still patients often expect X-rays when not really needed, or antibiotics for colds and so on.

I was NOK when my DH had a heart attack.
The paramedic needed my consent to give an injection of a particular drug which was quite new at the time. He explained what it would do and gave me a closely printed sheet A4 sized to sign. The drug would start repairing the heart tissue but there was an increased risk of a stroke.
The paramedic was marvellous and was doing what he had to do with the utmost competence. He also explained what I had to consider very clearly. It was the paper itself that threw me.

The point I am making is that I was in no condition to take in the information and was very scared. I tried to read the paper but couldn't focus on it. My DH who was conscious gasped, 'For fucks sake sign it,' so I did. It made a huge difference to DH's subsequent recovery. My consent was necessary but really I should not have hesitated for a second. These people know what they are doing - the NOK doesn't!

The medical profession and the researchers have made enormous strides and are refining procedure all the time. In a life or death situation we have to trust them absolutely and, in my experience, the skill & care from ambulance staff to consultant has been superb.

cakedays - the effect of seeking consent, and the then people refusing, should not be used as an excuse by researchers not to seek that consent. If they are worried that not enough people will seek consent, they need to find another way that people will consent to. The RECs would need to go back behind their closed doors and do some more debating.

And it is not about NoK interfering with patient choice - it is about the NoK informing the NHS what that patient choice is in the first place. It is not nonsensical - who are the NHS to decide what the patient wants? The NoK would be better at protecting patient autonomy.

And you do have a legal and moral right to give consent - it is not a 'fiction'. If I consent to treatment, and then something happens to the data that is created that I was not informed about during the consent process, and to which I object, that consent then becomes invalid and the treatment therefore was an assault, for which the healthcare 'professional' would be criminally liable.

So yes, consent should override research into saving lives. If people trusted the system, I would be more than happy to provide consent. But trust is breaking down.

You could refuse treatment for Ebola - there might be enforced quarantine, but they couldn't treat you for it if you had refused.

But data about patients is used all the time, the details I record are used to assess my performance, to collate my non conveyance rate, to check I have treated the illness condition correctly to name but a few. There are lots of other uses that I know nothing about. If I was going to go through every possible way a patient's data can be used and gain their consent for it before I write anything down they'd be dead before I did anything.
In your scenario every medical professional becomes a criminal and you won't have any left.

And a medical professional cannot pass on information about you to another medical professional without your consent.

Rubish

I had an op on Monday. Before that I wen to the preop clinic. The nurse and HCA between them took blood, measured blood pressure / weight /height then sent me for an ECG.

I did not give my permission for the blood to be sent to the lab, I did not give my permission for the lab to analyse my blood and then relay the information back to the ward, In fact all this is done electronically and anyone with access could look at my information.

Back in the days of working in cardiology I was doing routine ECGs one morning when a gentleman came in, I started recording, thought, "shit, he's having an MI" and called for a porter with a trolly and defib to take him to A and E.

It did not even occur to me that I should call his GP for permission to talk to a colleague, or even ask his (patient's) permission. He needed to be in A and E. That was the best place for him and the quicker the better.

'And a medical professional cannot pass on information about you to another medical professional without your consent.'

What on earth do you think a handover at the beginning of a shift is? It's one set of staff passing on information about patients to the next set of staff. They don't ask each patient for their consent for this to happen.

But the staff involved in a handover will be dealing with that patient's care. A medical professional should not pass on information to another medical professional, about a patient, who is not involved in that episode of care. Even so, it is good practice to tell the patient about this passing of information. Even if it obvious to the staff it has to happen, it does not follow it is obvious to the patient.

NCIS - if a patient objects to the use of information for uses other than their own care, you must respect that objection.

sashh - you would have consented to the passing of that information when consenting to the operation. They would (should) have explained these tests would be done. Consenting to the operation includes consenting to the tests.

Unless it falls within one of the statutory provision of information categories.

(eg child protection, public health)

That would be impossible to do, there is just no facility for not including the data, the forms are scanned and the names/addresses taken off. Patients are not asked for their consent and no one has ever even asked what happens to the paperwork.

If a patient did not want the paperwork completed then I would be unable to treat them.

sashh most of that would fall under implied rather than explicit consent. You will not necessarily be explicitly consented for every blood test done pre-op, nor every conceivable drug that might be used in your anaesthetic, not every possible piece of equipment that might be used. A certain amount is assumed within consent for the surgery itself.

parallex - yes, of course.

*NCIS - Perhaps no one has ever asked what happens to the paperwork because it doesn't occur to them that you would do something with it. Most people probably think it is just archived away with their file. Some people might be shocked about what you do with it. Which is why you need to tell them (and tell them they have the chance to, and give them the chance to object), or seek consent. Not having the time to seek consent is not a good enough excuse not to seek it. 'No facility for not including the data'! Rubbish. If a patient doesn't want THEIR data input, don't input it! Put zeros in the data fields. Put refused in free text boxes. Put whatever!

Data Sharing: Patients could carry own gadgets (phones?) that had all their records on it, HCPs would have to type all the new info into the phone & no data would be held centrally. Does anyone else remember pregnant women having huge folders of paperwork we were supposed to lug with us to every antenatal appt? I was always forgetting mine. At least I didn't actually lose or damage it.

And if the NHS introduced a new service or initiative there'd be no good way of measuring efficacy because we wouldn't be able to track whose health status or outcomes changed.

Of course if patient were unconscious and couldn't unlock the records-gadget, then no records could be obtained, either.

Consent: what if you had collapsed unconscious in the street; No one could help you because you hadn't given consent for their help? Does anyone besides Pseudo actually think this would be a better system?

But if we put that then we are at fault for not recording important info like the drugs we've given, the observations we've done. That lack of information could kill a patient and guess who would be in trouble then. You obviously have no knowledge or understanding of the situation.

Killing someone because you spent half an hour explaining what could/is done with that information is not considered good practice. I'm in the market of saving my patients life not killing them.

The principle of requiring informed consent for treatment and information sharing is that it protects people. If you take it too far and every medical professional and every part of the data recording and collation process is effectively paralysed until specific consent is sought and obtained from the patient, it then becomes harmful.

The example given earlier in the thread where a relative was asked to give consent for a new drug to be used was an example, IMO, of the REC or research coordinator getting it wrong. Asking for consent at that point was inappropriate and harmful. The responsibility for deciding whether that drug should be administered in those circumstances and that data collected should have been taken by someone else beforehand.

Consent, informed or otherwise, cannot always be obtained and to insist that it should always be the one overarching consideration when treating patients and collecting and sharing data would cause much greater and more serious harm than that which could befall an occasional patient who might have chosen to withhold consent had they been given the opportunity to do so.

There has to be a balance, a point at which it is recognised that to require full informed consent from every participant or family member causes significantly more harm than to proceed in a carefully planned manner without doing so but other with safeguards in place.

It is, of course also important that these decisions are reflected on regularly and changes made as the need becomes apparent.

About passing on information.....

DH had superb care during and after his heart attack. Where the NHS fell down was in the handover back to the GP. His notes should have been received by the practice ready for his first appointment with the GP during recovery. They weren't. Not the fault of any medic, it was a clerical problem and potentially dangerous.

Of course information about patients should be available to other health care professionals. What if he had another attack away from home? We would expect another hospital to be able to access complete data on his history and drug regime.

AND - DD who was 14 at the time is now a 5th year medical student. Medical ethics is burned into her brain as a matter of course.

Pseudonym of course "consent", like lots (most) of other legal and moral concepts, is a useful fiction - that's why it includes all sorts of grey areas and yardsticks (implied consent, informed consent, Gillick competence, to name but a few). It isn't an immutable or clearly defined standard or absolute. It is a working fiction that allows us to negotiate the competing demands of autonomy, safety, professional practice and collective good. That's what medical ethics and the law are there for, because "consent" isn't clearly defined or some kind of overriding arbiter of everything. And everywhere there are exceptions - as others have pointed out, there are many circumstances where professionals' statutory duties override consent - I don't get to give consent for my health visitor to be informed if my child visits A&E, nor to prevent medical professionals from passing my details to the police if they suspect that I am either the victim or the perpetrator of a crime.

The issue about medical information and records is when it can be linked to you personally.
If information is anonymous and cannot be linked to the actual patient then it's perfectly fine. Research projects only have to show that information is properly anonymised (double blind trials).

As for informed consent, it's mostly about things that can make you worse than you already are. You can't get much worse than dead. Unless you end up with brain damage, which seems to be a serious side effect of adrenaline. So, I can see how research on the use of saline alone would pass an ethics committee.

If I consent to treatment, and then something happens to the data that is created that I was not informed about during the consent process, and to which I object, that consent then becomes invalid and the treatment therefore was an assault, for which the healthcare 'professional' would be criminally liable.

No, you have a very odd idea of what constitutes assault. If you were successfully treated for a heart attack and then someone made use of the data about your treatment without your explicit consent (which happens every day by the way - are you objecting to professionals information sharing about cases so that they can improve their own and colleagues' care? Really?) then the professionals who treated you do not then become liable for criminal assault - no assault has been committed by them.

This is getting ridiculous now - you are clearly mixing up consent to treat and consent to the use of data. And coming out with some nonsensical conclusions.

If you are an interesting case as a patient, it will be presented to the hospital and published without your consent because nobody but your doctor or medical team will know who you were.
If consent was required here for publication it would hinder scientific and medical advancement, and publication of your case doesn't cause harm to you in any way. Even photos could be used, just as long as you can't be identified.

A bit like any of us commenting here in an anonymous forum about someone we know without giving names.

And that's fair enough.

Patients are not always the best people to handle their own information too.

A HO Jr Dr() years ago asked a patient whey he had blood transfusions every 3 months, the answer was, 'my blood is too thin', so the Dr asked him about his medication and then stopped both the transfusions and the anticoagulant that the patient had been on for 10 years.

Sometimes Drs have to talk to each other. I have a number of medical conditions, the treatment for one may be contraindicated by the treatment for another, sometimes a discussion needs to take place in my best interests.

Lweji - if I was an interesting case, the uniqueness would make me identifiable, so you would require consent. And as doing it without consent would cause harm (mental harm), you would not be able to publish it without my consent. All you had to do is have the common courtesy which seems to be lacking in most of the NHS employees on here, and ask. You never know - I might say yes.

Identifiable to whom?
Only to those privy of your medical records. Nobody else would be able to link the technical stuff with your name.

I disagree. Courtesy and respect should trump bad attitudes from healthcare staff..