Dr. Maged

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 Medical-legal aspect
 Consent
 No escort, no surgery
 Preparing patient for theatre
 Catheterization
 Hallucination
1
1)Medico-legal aspect:
Define a medico legal case
Experience of Municipal and Government Hospitals -Doctors stated that the system of recording Medico legal case, (MLC) was
introduced in the hospitals ~O years back with the objective that a certain health complaint reported by the patient may have legal
implications, this meant that such a case needs police investigation. Some Doctors classified medico legal cases in to three types,
viz accidental, suicidal and homicidal.
Members of the medical profesion are liable to be called upon to

give medicolegal assistance in varied circumstances and situation by
police and law, like any other witness, the medical practioner is also
bound to answer truly all questions posed to him in the court of law. The
law usually requires reliable evidence of facts and authoritative opinion.
A medico-legal should be maintained in the casualty of every hospital and details of

all medico-legal cases of every hospital and details of all medico-legal cases should be
entered in this register, including the time and the date of examination and the name
of the doctor who in dealing with thin case. This would be of immense help for future
reference, when the patient thought the court/ the police (2)
It is important therefore, that every concerned person of the hospital, related with treatment
and care of the patients must understand the nature of obligations and thus fulfills these
obligations to the best of their ability, to maintain nobility of medical profession.
Most of doctor, irrespective of his/her specialty, would have been faced certain cases, which
at the time or subsequently, would be labeled as ―medico-legal‖.
Thus, a doctor has not only to play a vital role struggling to save the life of the patients or relieving
their sufferings but also has to fulfill the required minimum formalities on medico-legal aspects in each
case. This emphasizes the most frequent dilemma faced by the doctors4er5 Medical Ethics
Ethics is not a prescription or set of rules to be followed blindly. There is rarely a
single ‘right’ answer to the
ethical dilemmas in practice, but ethics involves a systematic approach to moral
dilemmas. Patients and society
should be confident that difficult choices are not dealt with in an arbitrary fashion, or
simply dependent on the
particular moral stand taken by clinicians. Choices should be made or presented fairly
and usually in the best
interests of the patient. Ethics is just us much about HOW dilemmas are resolved than
with WHAT the right
choices or actions should be. Central to modern clinical ethics is the dignity and
respect for the patient as
individuals capable of understanding and where possible taking decisions about their
treatment Medical Ethics
Ethics is an understanding of the nature of conflicts arising from moral imperatives1
and how best we may deal
with them.
. Ethics does NOT decide what is morally right or wrong; rather it considers how we
should act best
in the light of our duties and obligations as moral agents. Clinicians have specific
duties of care to their patients
2
and to society. It is generally held that clinicians should always act in the best interest
of their patients; but
sometimes there is a conflict between obligations to a patient and those perceived to
be owed to the community
or to other patients.
patient is what the patient wishes or will consent to. Central to modern medical ethics
is a respect for patient
autonomy2 and the fundamental principle of informed consent. .... In practical ethics
we apply a systematic approach. In general we apply four major ethical
considerations.
First, we must define the nature of the problem. What is the major ethical dilemma?
We need a clear
understanding of the nature of the dilemma or dilemmas
1) Consent
As a general rule, no operation, procedure or treatment may be
undertaken without the consent of the patient, if the patient is a competent
adult. Adequately informing patients and obtaining consent in regard to
an operation, procedure or treatment is both a specific legal requirement
and accepted part of good medical practice.
Consent to the general nature of a proposed operation, procedure,

or treatment must be obtained from a patient. Failure to do this could
result in legal action for assault and battery a gains a partitioned who
performs the procedure.
(Consent to medical treatment- patient information policy direct,

ministry of health, NSW, Sydney http://
www.health.nsw.gov.au.policies)
A doctor must have a patients consent to perform medical procedures

Prior to performing a procedure on a patient the physician must
obtain the patient's consent. Because the nature of the relationship the
patient and doctor, maintain, the doctor's role in obtaining this consent
requires hio to provide knowledge and information to the patient in order
to ensure the patient is able to make an informed and intelligent decision
3
(A patient has a right to refuse a urinary catheter, Jemifer L.
fromeschl, RN. J.D candidate).
 Operative notes:
Operatife notes for all procedures were typed and saned in a data
retrieval system
Operative notes are an important part of a patient's medical records,

they are essentially the only firsthand information regarding the
procedures performed and operative findings during any surgical
intervention. They not only provide information for continuous medical
care but are also available for future references in clinical setups and legal
matters.
Traditionally, operative notes have been written by one of the

junior members of the scrubbed team, often supervised by a senior
surgeon,, sconsidered as an essential part of training.
Date recorded on the performa included presence or absence of

information regarding date and time of surgery, surgeon's name,
assistant's name, procedure done, type of incision made, suture materials
used, operative diagnosis, preoperative findings, complications during the
procedure (if any), details of tissue removed, closure technique, type of
suture used in closure postoperative instruction including oral intake,
intravenous fluid, analgesia, antibiotics and instruction for the nursing
staff. (6) No Escort NO surgery and Responsibilities
Hospitals are responsible for ensuring that appropriate procedures and records are
maintained to facilitate accurate reporting and to justify the admission.
The responsibility to enact the rules described in the ARDT Policy lies with the entire
health
care team including the following key members: clinicians, coders, ward and
admissions
clerks, health information staff and managers.
Clinicians (medical officers, nurse practitioners, nurses, allied health professionals)
have
a particularly important role in ensuring health services’ compliance with the ARDT
4
Policy. It is the clinical decision making and, most importantly, how these decisions
are
communicated and documented that enables the other team members listed above
to perform their duties and ensure accurate counting and labelling of activity across
1) the system.
No escort, no surgery in an important policy at harmony
ambulatory surjgery center in fortcollines. If patients arrives without a
responsible adult escort, the receptionist immediately notifies an RN. The
RN inform patients they will not have their procedure if the escort does
noit arrive.
Escorts can ensure that the patients arrives home safely and can assist the
patient with minor post operative symptoms, such as pain, names and
vomiting and in emergency, the y can obtain suitable medical help for the
patient . Requirements for patient discharge: Patients who
have received sedation or anesthesia are discharged in the company
of a designated, responsible adult.
• The transfer or discharge of a patient is based on a patient’s assessed needs and
destination site’s capabilities.
(tips for enforcing patient escort plicies OR manger vol. 22. No 7, july
2006)
2) preparing patients for theatre

On the day of surgery the majority of patients will have been pre-
assessed. If noit, the patient will beassessed on admission piror to their
operation/investigations.
On admission the named nurse identifies any problems or needs

(physchological, physical or social and informs the relevant surgeon or
anaesthiats. The named nurse completes an assessment on the HISS
system. Correct patient identification is essential to ensure that the right
person has there right operation.
Name bracelets are used to identify individual patients and these

are verified with the patient prior to them being secured to the patients,
wrist/ ankle together with any allegory bands. The nurse needs to
5
complete a pre-operative checklist, an example of which be seen during
your placement. Following assessment the patient needs to dressed
appropriately in a theatre gown, removing underwear, taping any
jewellery and removing any nail varnish and make –up.
The patients are them seen by both the surgeon and anaesthetist, who
explain again what will happen to the patient and take the patients written
consent for the procedure, depending on thesurgery the patient is to undergo
there may be other procedures to followed i.e pregnancy tests, pre-medication
to be administrated. The named nurses' responsibility is to check that:
the correct patient is consented for the right operation
he/she is fit enough for surgery/general anaesthetic
has signed the consent form

he/she is dressed in a theatre gown and all make-up removed
Blood pressure/pulse, temperature, oxygen saturation and weight/body

mass index have been recorded
(surgical day case unit information booklet for students
nursesKH/oct/2003)
Catheterization Theatre personnel must ensure that the patient’s privacy and
dignity are maintained at
all times. Excess staff/ visitors must be asked to leave the theatre.
Staff must ensure that the patient remains covered until theatre staff are ready to
perform the procedure.
1) Good visibility must be ensured by use of theatre lighting.
Details regarding the catheterization should be recorded in the
patients notes. For further information:
 Patients details.
 Procedures documented in the patients medical records and
signed by the person inserting the Cather.
 Indication for catheterization.
 Time and date of catheterization.
 Catheter details and balloon size.
6
(Canterbury continence from catheter care guidelines 2013,
CDHB nursing policies and procedures, July 2013)
How does the consent doctrine apply to insertion of urinary

catheters?
The medical standard for disclosure should logically lead the
physician to disclose such information the the patient prior to performing
such invasive procedure.
(A patient has a right to refuse a urinary cather jennifr L. Frisch,

RN, J.D. candidate 2015)
Female patient may feel sexual hallucination after psycho-mimetic

and emotional reaction following general anaestheia
Emotional and psycho-mimetic reaction may occur after protofol
anesthesia especially in day care patients with background history of
chronic stress and psychological disaorders.
Patients emerging from propofol anesthesia were more likely to

exhibit sensatioin – seeking tendencies and to feel elated and enen
euphoric. It may result in dream and hallucination in day care setting.
Even sexual hallucination and opisthotnes have been reported.
(psyche-mimetic manifestation following propofol in day care

surgery – case report. Pradipta B Hakta,M, * pragnyadipta Mishra, **
AND Quatiba Amir Tawfic. M.E.J. Anesths 20(4), 2010)

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Members of the medical profesion are liable to be called upon to

A medico-legal should be maintained in the casualty of every hospital and details of

Consent to the general nature of a proposed operation, procedure,

(Consent to medical treatment- patient information policy direct,

A doctor must have a patients consent to perform medical procedures

Operative notes are an important part of a patient's medical records,

Traditionally, operative notes have been written by one of the

Date recorded on the performa included presence or absence of

2) preparing patients for theatre

On admission the named nurse identifies any problems or needs

Name bracelets are used to identify individual patients and these

has signed the consent form

Blood pressure/pulse, temperature, oxygen saturation and weight/body

How does the consent doctrine apply to insertion of urinary

(A patient has a right to refuse a urinary cather jennifr L. Frisch,

Female patient may feel sexual hallucination after psycho-mimetic

Patients emerging from propofol anesthesia were more likely to

(psyche-mimetic manifestation following propofol in day care

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