Tag: Adam Sandell

Essential law for GPs: if CPR would be futile what do I tell my patient?

Adam Sandell is a GP in Cumbria, and a barrister at Matrix Chambers. If CPR would be futile, do I have to tell my patient about a decision not to attempt it? The busy-doctor answer: Normally, yes. In more detail: Mr Bloggs has end-stage COPD. He knows he’s unwell. But he’s an anxious man with an anxious family. He hasn’t asked you about prognosis. And he’s deteriorating. Forward planning seems wise: indeed, the General Medical Council says that, when patients become clinically unstable and there’s a foreseeable risk of arrest, a judgment about the likely benefits, burdens and risks of CPR should be made as early as possible. You reckon CPR would be futile, so a decision not to attempt cardiopulmonary resuscitation (‘DNACPR’) looks right. Were Mr Bloggs to arrest, pummelling his chest in the back of an ambulance to nowhere will do no-one any good. So surely there’s no need to cause him further distress by discussing this with him? It’s futile, so isn’t it as relevant as discussing whether you’re going to certify him fit to climb Kilimanjaro? Not so, said the Court of Appeal last year in a case called Tracey. Mrs Tracey had lung cancer and was on a ventilator following a road accident. An intensivist completed a DNACPR form without discussing it with Mrs Tracey (who was apparently conscious and communicating at the time)...

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Essential law for GPs: discussing treatment risks

Adam Sandell is a GP in Cumbria, and a barrister at Matrix Chambers. A Supreme Court judgment last week changed the law about the discussions we need to have with patients about the risks posed by treatment. “Doctor knows best” has just suffered another stroke. The busy-doctor version: We must discuss with patients any material risks involved in proposed treatment, as well as reasonable alternative approaches. A risk is ‘material’ if the patient is likely to attach significance to it. Ask yourself whether knowing about the risk might alter the patient’s decision: if so, tell the patient about it. If you’re more interested: Remember the Bolam test? Bolam’s the case about breaching your duty of care. You’re not negligent if you act in accordance with a practice accepted as proper by a responsible body of medical opinion, so long as the practice isn’t nuts. Until now, Bolam was how the courts determined what we have to tell our patients about the risks of treatment. You didn’t have to discuss a particular risk if there were other suitably-qualified doctors who wouldn’t have done so. That’s been changed by Montgomery, a Supreme Court case last week. Mrs Montgomery was small, diabetic and pregnant with a large baby. Her obstetrician didn’t normally warn such women of the risk of shoulder dystocia because she believed the risk of serious harm to be small,...

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