Propofol

PaulS said:
Dam Gary, think positive man, I'll edit it to make it clearer.
Click to expand...

Think positive? OK, I'll try but I'm used to looking at things from a worst case scenario perspective to keep bad things from sneaking by.
 
Gary F said:
Think positive? OK, I'll try but I'm used to looking at things from a worst case scenario perspective to keep bad things from sneaking by.
Click to expand...

Well...... I would still consider that thinking positive in that you are trying to help by dealing with nasty stuff most of us don't want to face. We're not all trying to bust your balls, at least on medical stuff. :wink2:
 
airguy said:
If she thinks (mother or daughter - either of them) that she can beat cancer without treatment, then she is not competent now, nor will she be then.
Click to expand...

That is not how you define competence or decision making capacity. An adult can be fully competent, yet refuse PROVEN lifesaving treatment, and not have it challenged.

The underlying (and unspoken) theme here is that in most states, A minor, NOR their parent, has the explicit right to refuse medically recommended treatment. Search your local laws. And in Connecticut the 17 year old is a minor. Funny thing is, if she was a shoplifter in Texas she would be certified and charged as an adult...in the criminal justice system... but still a child for civil matters such as this.

What you will find is that if you disagree with the provider, and the provider feels the decision is harmful, they are required to notify the state under professional license obligations. And CPS (or their equivalent) RARELY sides with the parents over the doctors, and judges rarely side with the parents over doctors...
 
Tom-D said:
I did a little research to day just on a google search using Porpofol and aging you will get 10 or more pages of hit warning of the higher rates of ill effects of using Porpofol on the elderly.

I am becoming convinced the the medical professionals take this drug for granted and do not do the necessary screening to prevent the patiences with An Atrib condition from receiving it.
Click to expand...

I don't use google for matters such as that. I use a medically reviewed, frequently updated database called "UpToDate". Its a paid subscription.
Its not cheap.

You get what you pay for.
 
Gary F said:
What do you mean by that? Those of us who have used propofol think of it as a useful tool with specific benefits and risks. We are just trying to provide a counterpoint to those who claim that propofol is a bad drug. You should appreciate that we are willing to take the time to share our knowledge and experience.
Click to expand...

Post #72 for example. Saying he is going to violate his oath if the op needs surgery. I know he isn't serious it is just a bit touchy.
 
Doggtyred said:
That is not how you define competence or decision making capacity. An adult can be fully competent, yet refuse PROVEN lifesaving treatment, and not have it challenged.

The underlying (and unspoken) theme here is that in most states, A minor, NOR their parent, has the explicit right to refuse medically recommended treatment. Search your local laws. And in Connecticut the 17 year old is a minor. Funny thing is, if she was a shoplifter in Texas she would be certified and charged as an adult...in the criminal justice system... but still a child for civil matters such as this.
Click to expand...
True. I would like to elaborate on a few points.

It is the physician's job to obtain and document informed consent or informed refusal. The physician must determine if the patient (or the person authorized to make medical decisions on behalf of the patient) has the capacity to understand the diagnosis, possible outcomes, and risks and benefits of all treatment options including no treatment. If the physician does not believe that the patient has the capacity to understand the situation we often get an expert opinion (usually a psychiatrist or neurologist) to independently confirm the patient's ability to make decisions. If not, a judge is contacted to start a competency determination. The judge decides if the patient (or parent or guardian) is not competent to participate in medical decision making a court appointed guardian will be specified. Somebody brought the kid to the medical system in the first place and that's how it got to the court system.

So in summary:
Physician determines patient's capacity to make decisions.
Judge determines competency if the physician determines that the patient lacks the capacity to understand.

I have had a few patients make stupid decisions. I had a guy in intensive care who really needed a pacemaker. He was scheduled to have it one morning and the nurse called to inform me that he was refusing to have the procedure and about to walk out of the hospital. I had the ICU nurse come with me to the patients room. I asked a bunch of questions to determine that he was able to comprehend the situation. I also explained in excruciating detail the risks (including death) of refusal of treatment. I asked the nurse to document the encounter in the nurse's notes. I wrote a very detailed entry in the physician's progress notes. He was discharged home. Not surprisingly he was back in the ER the next day and now agreed to a pacemaker. The patient subsequently contacted the patient representative and wrote a long letter to the administration stating that I should not have discharged him (even though he had absolutely refused to remain in the hospital). I was contacted by the Chief Medical Officer and I asked him to read the physician's and nurse's progress notes from the day of discharge and to call me with any questions. I never heard back. I love it when we are overruled by idiot patients and they still want to blame us for their stupidity.
 
Last edited:
You did the right thing, letting him go and CYA. But why the grudge? Lots of stupid people, not all your patients are going to be smarty pants white people like us. Bad life decisions and bad genes are why they need your help in the first place. They are not going to suddenly start making good life decisions because of your awesomeness rubbing off.
 
ClimbnSink said:
You did the right thing, letting him go and CYA. But why the grudge? Lots of stupid people, not all your patients are going to be smarty pants white people like us. Bad life decisions and bad genes are why they need your help in the first place. They are not going to suddenly start making good life decisions because of your awesomeness rubbing off.
Click to expand...
No grudge, ever. When patients are discharged against medical advice I always tell them the best way to get the treatment if they change their mind and tell them we will not hold their previous refusal against them. I provide pre-discharge education, provide all prescriptions, offer a follow up appointment. I still can't help becoming annoyed when they try to blame me for their decision. They don't always blame me. Another time a patient refused my advice he was found dead by his roommate 2 weeks later.
 
Gary F said:
True. I would like to elaborate on a few points.

It is the physician's job to obtain and document informed consent or informed refusal. The physician must determine if the patient (or the person authorized to make medical decisions on behalf of the patient) has the capacity to understand the diagnosis, possible outcomes, and risks and benefits of all treatment options including no treatment. If the physician does not believe that the patient has the capacity to understand the situation we often get an expert opinion (usually a psychiatrist or neurologist) to independently confirm the patient's ability to make decisions. If not, a judge is contacted to start a competency determination. The judge decides if the patient (or parent or guardian) is not competent to participate in medical decision making a court appointed guardian will be specified. Somebody brought the kid to the medical system in the first place and that's how it got to the court system.

So in summary:
Physician determines patient's capacity to make decisions.
Judge determines competency if the physician determines that the patient lacks the capacity to understand.

I have had a few patients make stupid decisions. I had a guy in intensive care who really needed a pacemaker. He was scheduled to have it one morning and the nurse called to inform me that he was refusing to have the procedure and about to walk out of the hospital. I had the ICU nurse come with me to the patients room. I asked a bunch of questions to determine that he was able to comprehend the situation. I also explained in excruciating detail the risks (including death) of refusal of treatment. I asked the nurse to document the encounter in the nurse's notes. I wrote a very detailed entry in the physician's progress notes. He was discharged home. Not surprisingly he was back in the ER the next day and now agreed to a pacemaker. The patient subsequently contacted the patient representative and wrote a long letter to the administration stating that I should not have discharged him (even though he had absolutely refused to remain in the hospital). I was contacted by the Chief Medical Officer and I asked him to read the physician's and nurse's progress notes from the day of discharge and to call me with any questions. I never heard back. I love it when we are overruled by idiot patients and they still want to blame us for their stupidity.
Click to expand...

This is where your argument hits a snag........

You are preaching that ALL doctors have good sense and are superior in decision making over patients..........

Not all doctors are logical and safe in their decision making process.....

Read the thread about the Cherokee with the 46 year old ER doc killing himself and his 20 something girlfriend from a DUMB decision.....

If I am sick.. I alone want to make the decisions based on ALL the facts I can validate and digest........

YMMV...
 
N801BH said:
This is where your argument hits a snag........

You are preaching that ALL doctors have good sense and are superior in decision making over patients..........
Click to expand...
No I didn't. My statements imply that I have superior knowledge about certain medical conditions than my patients. (I do, no kidding). I'm also very good at explaining things to patients.
N801BH said:
Not all doctors are logical and safe in their decision making process.....

Read the thread about the Cherokee with the 46 year old ER doc killing himself and his 20 something girlfriend from a DUMB decision.....
Click to expand...
Where did I imply that? Who said that physicians possess superior knowledge or skill in every endeavor?
N801BH said:
If I am sick.. I alone want to make the decisions based on ALL the facts I can validate and digest........

YMMV...
Click to expand...
You are free to make your decisions. Go for it but don't be so sure you are smarter than me when it comes to most medical subjects. If you are my patient in the ICU and I ask where we are and you tell me you are shopping at Kroger, don't get mad when I call your medical power of attorney to make decisions for you. May you live long and prosper.

BTW, arrogance by patients or physicians often interferes with good decision making.
 
Gary F said:
No I didn't. My statements imply that I have superior knowledge about certain medical conditions than my patients. (I do, no kidding). I'm also very good at explaining things to patients.

Where did I imply that? Who said that physicians possess superior knowledge or skill in every endeavor?

You are free to make your decisions. Go for it but don't be so sure you are smarter than me when it comes to most medical subjects. If you are my patient in the ICU and I ask where we are and you tell me you are shopping at Kroger, don't get mad when I call your medical power of attorney to make decisions for you. May you live long and prosper.

BTW, arrogance by patients or physicians often interferes with good decision making.
Click to expand...

Agreed 100%.. That is EXACTLY what killed the ER doc and his innocent girlfriend.......

See... we can agree to some things..:yes:;)
 
N801BH said:
Agreed 100%.. That is EXACTLY what killed the ER doc and his innocent girlfriend.......

See... we can agree to some things..:yes:;)
Click to expand...

That may be one reasons so many physicians die in aircraft "accidents". They think that are too smart to screw up.
 
Gary F said:
That may be one reasons so many physicians die in aircraft "accidents". They think that are too smart to screw up.
Click to expand...

Yup....
And......
A "too smart" doctor could make a poor decision for a patient and their parents..:yes::rolleyes:
 
Gary F said:
What do you mean by that? Those of us who have used propofol think of it as a useful tool with specific benefits and risks. We are just trying to provide a counterpoint to those who claim that propofol is a bad drug. You should appreciate that we are willing to take the time to share our knowledge and experience.
Click to expand...
Ha ha, funny Gary, I would like to be the first to humbly thank you for taking time from your busy schedule to bestow your wisdom on us all day every day.:rofl:
 
Maxmosbey said:
Ha ha, funny Gary, I would like to be the first to humbly thank you for taking time from your busy schedule to bestow your wisdom on us all day every day.:rofl:
Click to expand...
Some of us have more time than others. ;)
 
DJTorrente said:
To me the instance proves once again that a liberal government doesn't care what you do, as long as its mandatory. I for one would prefer not to have such an overbearing government that can force invasive medical treatment against the will of the patient, or if a minor, his/her parent. A decision to refuse treatment (i.e., 'they just don't see things our way') is NOT prima facie evidence of mental incompetence; to think otherwise is arrogant hubris.
Click to expand...

Yea, it's the liberals. Just like with Terry Schiavo. :rolleyes2:
 
N801BH said:
If I am sick.. I alone want to make the decisions based on ALL the facts I can validate and digest........

YMMV...
Click to expand...

Sounds good.. as long as you understand that the physician/provider is not required to offer you something if it is felt to be futile or ineffective.

So you may search google high and low and find what you want, but the provider is under no obligation to offer, or provide it.

You have the right to consent or not consent to the treatments offered, or YOU find another provider.
 
Doggtyred said:
Sounds good.. as long as you understand that the physician/provider is not required to offer you something if it is felt to be futile or ineffective.

So you may search google high and low and find what you want, but the provider is under no obligation to offer, or provide it.

You have the right to consent or not consent to the treatments offered, or YOU find another provider.
Click to expand...
My point exactly....:yes::yes:
 
Capt. Geoffrey Thorpe said:
Yea, it's the liberals. Just like with Terry Schiavo. :rolleyes2:
Click to expand...

I'm not seeing any connection. The issue in the Schiavo case was WHO got to make the call concerning an incapacitated patient's care; the default case being the husband, but the parents had contrary wishes and pointed out that the husband had a readily apparent conflict.
 
You must log in or register to reply here.
Back
Top