Where are you at?

Now that you have been through 75% of this class...

1. Are you still interested in Medicine? If so elaborate.

2. What has been your favorite lecture and why?

3. What excites you about the future of medicine in this country? ...and what scares you about the future of medicine in this country?

An 80-year-old Asian woman is hospitalized with weight loss, generalized weakness, and a pulmonary mass. Work-up reveals that she has pulmonary tuberculosis. Her family approaches the physician and asks that the patient not be told, stating that in her upbringing in mainland China tuberculosis was considered fatal and to tell her would be like giving her "a death sentence."

Should you respect the family's concerns?
(From the University of Washington webpage)

Is withholding information the same as lying to a patient? Are there instances when leaving out information is appropriate?

Group 9 HIV case 4

Should this person who has HIV but uses drugs and sometimes doesn’t take his medicine and is a drug user be proscribed protease inhibitors? Is this person capable of taking the medicine and is it worth giving it to him?

Do Not Resuscitate Orders: Case 1

Mr. H is a 24-year-old man who resides in a skilled nursing facility, where he is undergoing rehabilitation from a cervical spine injury. The injury left him quadriplegic. He has normal cognitive function and no problems with respiration. He is admitted to your service for treatment of pneumonia. The resident suggests antibiotics, chest physiotherapy, and hydration. One day while signing out Mr. H to the cross covering intern, the intern says "he should be a DNR, based on medical futility."

1.)Do you agree? Is his case medically futile, and if so, why?
2.)Should he have the right to say whether he receives resuscitation or not? Or should it be the doctors choice?
3.) Should family members have any say in this situation?
4.)How do you determine if his probability of success is less than 1%?
5.) What is his quality of life now?What will it be like if he received resuscitation?

Group 8 HIV case 2

Should we change the UNAID policy to require those at risk to be tested for HIV/AIDS?

Mistakes??

Case 2:
A 3-month-old has been admitted to the hospital with a newly diagnosed ventricular septal defect. She is in early congestive heart failure and digoxin is indicated. After discussing the proper dose with the attending physician, you write an order for the drug. Thirty minutes later the baby vomits and then has a cardiac arrest and dies. You discover that in writing the digoxin order you misplaced the decimal point and the child got 10 times too much digoxin.

The baby had a low chance of survival since he had a hole in his heart. Does it matter that the baby died because of your mistake if he probably would have died soon anyway?

Are you obligated to tell the parents the truth?

Termination of Life-Sustaining Treatment

Mr. S is a 70 year old male with COPD (chronic obstructive pulminary disease), he has had respitary failure with multiple attempts at weaning him unsuccessful. Through a writen note he asks you to remove his ventilator, which most likely will result in death. How would you handle the situation?

Maternal Vs. Fetal

CASE: A 22-year-old woman in her first pregnancy with an unremarkable prenatal course presents with preterm labor at 28 weeks gestation. Her contractions were successfully stopped with terbutaline. Discharge planning was reviewed with her, and she was instructed to follow a regimen of bedrest and oral terbutaline. She reported that she did not intend to comply with these instructions. She believed that God would not allow her to labor unless it was time for the baby to deliver, and she indicated that He had communicated this to her.

• How can the physician ensure nonmaleficence towards the mother and still promote beneficence towards her fetus?
• Is the mother competent?
• Should maternal autonomy prevail over other ethical concerns?
• Does the fetus have rights that prevail over the rights over the mother?
• Where can a line be drawn between a parent's decision based on cultural values and protecting the health of the fetus?

Dealing with Mistakes

"A 3-month-old has been admitted to the hospital with a newly diagnosed ventricular septal defect. She is in early congestive heart failure and digoxin is indicated. After discussing the proper dose with the attending physician, you write an order for the drug. Thirty minutes later the baby vomits and then has a cardiac arrest and dies. You discover that in writing the digoxin order you misplaced the decimal point and the child got 10 times too much digoxin.
What is your duty here? Will you get sued if you tell the truth?"
http://depts.washington.edu/bioethx/topics/mistksc2.html

'Causes' of Mistakes - inherent uncertainty (inaccurate/incomplete info), negligence, doc's conditions (exhausted, stressed...)
Prevalence - 8th most common cause of death
Digoxin - increases strength of heart, possible to treat overdose with anti-digoxin or high level of K+

Is it completely this doctor's fault? Wouldn't the pharmacist at the very least see the order and the person who applies the medicine realize that it's a very high dose for an infant?
Since there will most likely be legal action, what can the doctor do to prevent more serious consequences than have already occured in the death of a child?
Has the doctor committed serious errors such as this before?
Is this negligence or a simple error? Or both considering it was a decimal point change with the ramification of death?
What were the circumstances of this case and how would this affect the outcome? (time of day, parental pressure...)
Would you sue the doctor if this was your child?

Cadaver Lab

If you have gone to the Cadaver Lab, please tell us about your experience. Be as detailed as you can be!

Traumatic Brain Injury

Please spend a moment to reflect on what you heard from Dr. Weintraub as well as Dr. Gerber. This is completely wide open! What were your thoughts? What went through your mind during their lectures? Please spend some time putting a thoughtful response together.

Medical Career???

The main objective of this class is to help you decide whether a medical profession is for you. Having a very limited background, please comment on the following questions:

What interests you about a career in Medicine?

What scares you about a career in Medicine?

At this point, what area of Medicine do you consider to be the most interesting and why?

Be as detailed as possible!