Waiting for medical records “after discharge” is of no help for decision making

6 years ago Bernard W Freedman, JD, MPH 0
  Medical records: Waiting for medical records “after discharge” is of no help.  Reviewing medical records  in the hospital allows the patient and/or a surrogate decision maker to obtain the greatest amount of information possible over the cross section of medical specialties providing care.  It provides a clear picture of the condition of the patient Read More

Autonomy: the Basis of Respect and Dignity

6 years ago Bernard W Freedman, JD, MPH 0
“Be a good girl and take your medicine.” Part 1 This statement was made to a 60 year old end stage leukemia patient who demanded to be discharged from the hospital. The patient refused the prescribed medications.  No attempt was made to discuss the risks attendant in not taking the prescribed medication. The patient was Read More

What’s wrong with Romney’s Plan to just send more people to Emergency Rooms: Ethnic and racial disparities in Health Care – All Patients are Not Created Equal

7 years ago Bernard W Freedman, JD, MPH 0
All patients are not created equal Many emergency departments and hospitals in low socioeconomic areas, sometimes referred to as “safety net hospitals,” have closed, resulting in serious problems for poor and minority populations due to reduced or no access to emergency care. This results in exacerbating illness or injury due to either waiting time to Read More

Withdrawing Life Sustaining Treatment – Early Withdrawal of Life Sustaining Treatment in Severe Traumatic Brain Injuries, by Bernard W. Freedman JD, MPH

8 years ago Bernard W Freedman, JD, MPH 0
  CDC Statistics Traumatic Brain Injuries On August 29, 2011 the Canadian Medical Association published the findings of a multicenter cohort study evaluating the withdrawal of life-sustaining treatment for patients who had suffered a traumatic brain injury. This study is of particular interest because by the nature of the injury  patients cannot make decisions for Read More

Withdrawing Life Sustaining Treatment – End of Life Care: the Doctor-Patient Relationship A Refusal to Communicate

8 years ago Bernard W Freedman, JD, MPH 0
  The New England Journal of Medicine recently published an article entitled: “ The Palliative Care Information Act in Real Life,” (NEJM 364;No.20 May 2011), regarding a New York statute that requires a physician to have discussions of end of life treatment options with the patient when the patient is “terminally ill.” Alan Astrow MD and Read More

Rationing Medical Care Part II

8 years ago Bernard W Freedman, JD, MPH 0
  Efforts to encourage (or compel) physicians to lie to their patients were faced years ago when “gag clauses” were inserted into contracts between HMO’s and contracted physicians. The gag clause established a contractual obligation on the part of the physician to withhold information regarding treatment modalities that were not within the HMO protocol of Read More

Clinical Bioethics – Rationing – the Ethics of Lying to the Patient – Part I

8 years ago Bernard W Freedman, JD, MPH 0
  Rationing : Withholding Medical Care by Lying to the Patient Rationing of medical care and “triage” are different. Triage prioritizes the use of limited medical resources when resources are insufficient for immediate treatment.  Rationing is the withholding of available care for political/economic reasons. With respect to rationing, therefore, it must be decided whether or Read More

Withdrawing Life Sustaining Treatment -From Conscious, Non Terminal, Incompetent Part II

8 years ago Bernard W Freedman, JD, MPH 0
  Physician Liability: Withdrawing and Withholding Life Sustaining Care From  Conscious, Non Terminal, Incompetent Patients – Part II There are different standards that must be appreciated and respected before a physician can support a decision to withdraw life sustaining treatment from a non terminal and incompetent patient. This scenario requires the highest degree of protection Read More

Survival in Hospital Cardiac Arrest – Challenges for Hospitalists

9 years ago Bernard W Freedman, JD, MPH 0
The September 2010 publication of “The Hospitalist” reviews the overall survival rates for cardiac arrest patients. This article reports that patients frequently have unrealistic expectations and overestimate their chances of survival. Patients predict post-arrest CPR survival at 64%, while the rate is 17%. Most important is that in nearly half of the patients who initially expressed Read More