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The ethics of anaesthesia learning curves
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| Article Type: | Letter to the editor |
| Author: | Doyle, D. J. |
| Pub Date: | 01/01/2010 |
| Publication: | Name: Anaesthesia and Intensive Care Publisher: Australian Society of Anaesthetists Audience: Academic Format: Magazine/Journal Subject: Health Copyright: COPYRIGHT 2010 Australian Society of Anaesthetists ISSN: 0310-057X |
| Issue: | Date: Jan, 2010 Source Volume: 38 Source Issue: 1 |
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| Accession Number: | 221657256 |
| Full Text: |
White's excellent article on the ethics of anaesthesia
learning curves (1) raises a number of interesting issues. I would like
to highlight one of these. While White appropriately emphasises that
informed consent is paramount, the unfortunate fact of the matter is
that it is rare that one is able to offer even approximate risk data to
our patients undergoing procedures carried out by trainees under
supervision. In each instance, one should ideally identify the potential
risks and the anticipated benefits for the patient, taking into account
factors such as the expected difficulty of the planned procedure,
patient comorbidities and the skill of the trainee. Almost always,
however, in such cases there is no situation-specific data available to
guide us. Consequently, experience and intuition must substitute for
scientific data. Further complicating this issue is the fact that although some risk data is available from some studies (2), there is evidence that physicians conducting or supervising medical procedures may sometimes be badly misinformed about the degree of risk involved. For instance, a study by Kronlund and Phillips (3) tested the knowledge of clinicians about the risks associated with common surgical and invasive diagnostic procedures. The authors found that "overall accuracy of physician knowledge was low, with 27% of responses correct, 26% underestimates, 27% overestimates and 21% admitting no knowledge". They also noted that "for every complication, many physicians made underestimation or overestimation errors by several orders of magnitude and a few consistently denied existence of any risk". In the final analysis it should be apparent that any hope of providing patients with specific empirical data about the special risks associated with trainees conducting medical procedures under supervision is many years away. References (1.) White SM. The ethics of anaesthesia learning curves. Anaesth Intensive Care 2009; 37:824-829. (2.) Schroeder SA, Marton KI, Strom BL. Frequency and morbidity of invasive procedures: report of a pilot study from two teaching hospitals. Arch Intern Med 1978; 138:1809-1811. (3.) Kronlund SF, Phillips WR. Physician knowledge of risks of surgical and invasive diagnostic procedures. West J Med 1985; 142:565-569. D.J. Doyle Cleveland, Ohio, USA The ethics of anaesthesia learning curves (comment)--Reply Furthermore, the common law, at least in England and Wales, sensibly appears to require only an approximate revelation of the risk that a reasonable patient might want to know when deciding whether or not to consent for the training aspect of anaesthetic interventions. As mentioned in my paper, the additional risk to a patient of a training procedure performed under strict supervision is likely to be negligible and it would therefore seem pragmatic to quote the generally accepted procedural risk rate (if available), with which all anaesthetists should undertake to familiarise themselves. References (1.) White SM. The ethics of anaesthesia learning curves. Anaesth Intensive Care 2009; 37:824-829. (2.) Jenkins K, Baker AB. Consent and anaesthetic risk. Anaesthesia 2003; 58:962-984. S.M. White Brighton, East Sussex, United Kingdom |
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