What makes his ethics questionable is that he should have heavily qualified his original opinion, or requested to review all of the materials prior to giving the original opinion.
I know, it was basically just two sentences.
That’s why it was kind of weird to not even deal with it in its entirety.
You are incorrect in your assertion that he used all Data available to him at the time. He did not.
As shown in that previously linked article, he did not even read the available opinions of the other doctors who had worked the case and examined the child.
Thanks. I’ve previously said that Tort reform is at best 10-30 billion dollar cost saving or less than 1%. It is helluva of a lot more important than various liberal like say capping Pharma/Insurance CEO pay at $1 million (much less than the even more ridiculous idea of eliminating the deductibility of CEO pay over $500K ACA did.) . I’m not even sure that Doctors even orders excessive tests primarily because of fear of malpractice. I think is a combination of a desire to make more money, and because they want to give the very best care to their patients. But it is a lie to say that tort reform will save healthcare in the US
As for letting insurance be sold across state lines. I think it generally a good idea but wouldn’t move the needle much more than a 1-2%. On the other hand, it might be a solution of limited options for rural America. So, for instance, Eastern Oregon is basically a desert with very few people living there. Western Idaho has Boise so letting Eastern Oregonian buy insurance for an Idaho based plan might help.
In contrast encouraging consumer shopp[ing for maternity is actually a pretty big deal. If we could increase out of hospital births from 6% to say 56% with midwives/birth centers. We have 4 million births a year with an average saving of $6K/birth that’s a $120 billion a year cost savings or ~4% of medical care cost in the country.
It’s an opinion. Nobody is ever ethically required to qualify their opinion. That’s why it’s called an opinion.
Again, not unethical. Not even unremarkable. If you transfer your care from Harvard to Stanford, the doctors at Stanford will not give the slightest damn about the opinions of those dummies at Harvard.
I’m totally serious. It’s quite possible, even likely, that they would never read the former docs opinions. And of course, vice versa.
So, just to be clear here, you believe that it’s totally reasonable to make an opinion on a patient you have not personally examined, without even reviewing all of the existing data, or even reading the opinions of numerous doctors who had already examined him and given opinions.
And he’s still doing it… personally examined, like that’s a requirement yet somehow my crime is not focusing enough on the second part of the statement as if he doesn’t pound on the first one like it’s some sort of rule… which it is not.
Here’s the deal, physicians are not frequently traveling to other hospitals to personally examine the patients BEFORE they transfer.
This was a transfer… the baby could have arrived and after an assessment they not proceed but before the transfer… get real.
I believe doctors’ opinions are not data, so they are completely unnecessary.
A physical exam is also often unnecessary. In the age of MRI, the physical exam is usually just a ritual that helps to solidify the doctor-patient relationship. It is actually most useful for healthy people, to reassure them that they don’t need any tests.
Finally, I believe it’s totally reasonable to make an opinion on a patient based on all the data you have at hand. Patients are frequently referred for a second opinion, but do not bring all the existing data. This is normal. Medical records are not as portable as people seem to think.
So, case in point. A neurosurgeon is referred a patient from another hospital. The only data they have is the last brain MRI, which shows a glioblastoma. They do not have the radiology report, so they don’t know how the other hospital diagnosed the patient.
Problem? Not at all. We have all we need. A new MRI report will be generated by local staff, and the original report will likely never be read. Likewise, any clinic notes from the old hospital will never be read.
The surgeon will read the new report and the surgical approach will be determined even before they meet the patient. The only purpose of the meeting is to explain the procedure and ask the patient if they want to proceed. There will probably be a physical exam (for billing purposes), but it won’t change anything.
Where I work, that scenario literally happens every week.
You wouldn’t request to have access to the data available? Like requesting The most up to date scans? And while you keep saying opinions don’t count, they would have highlighted the reason why every other ductile thought it was a lost cause.
If we need a more up-to-date scan, we do it ourselves. There’s a whole discussion we could have about duplication and health care costs.
Sometimes we do need to request old records, in order to track changes in a very longstanding condition. That’s the exception, though, not the rule. It’s a PITA because half the time we won’t be able to get access to them.
Yes, and any academic doctor would love to be the one that proves the other idiots wrong.
To extend my example, no neurosurgeon I know gives a damn about whether the previous surgeons thought something was operable or how they previously would have approached the surgery. They will decide that for themselves, thankyouverymuch.
You are assuming that having access to more data means being more likely to get the right answer, but that’s not the case.
Trump has access to more data than you do. He’s still an idiot. His opinion is still worthless.
And I think it’s fair to say that doctors treat the opinions of outside doctors the way you and I treat the opinions of people on reddit. They are unlikely to change your mind, and if they are right then they were probably just lucky.
Or maybe our opinion is wrong, and Trump is right. That doesn’t mean we are unethical.
Ethics demands that you deliver an honest opinion, not a correct one.
— EDIT
You know, I like Nesrie’s answer below better than mine.
What’s the point of getting a second opinion if you believe it should parrot the first?
I don’t know what you are arguing against here. For every case the first physician was right there is probably another case where second and third was correct. Before you lob anything off or prepare your grave, a second, third or fourth opinion is worth it. And no, they’re not going to rubber stamp the first opinion, nor should they.
So really, data is just bull. The opinion of all the other doctors is just bull. Is there anything which isn’t?
Trump is largely an idiot because he consistently does exactly what you are defending. He ignores the data and just died whatever his “feels” tell him to do.
And it results in him being wrong all the time.
But in their opinions, they actually explain WHY they think what they do, which in this case would have highlighted the fact that the kid had massive irreparable brain damage.
Ah, see I wasn’t saying that he should have read their opinions so that he could just repeat them.
I was saying that reading then would have informed his own opinion, because it would have illuminated the fact that other data he hadn’t reviewed was showing that his treatment had no chance of helping the kid.
You cannot reach a diagnosis without data. But that doesn’t mean that all data are equally valuable, and it certainly doesn’t mean that you need “all the data” to reach a diagnosis.
And what does “all the data” even mean? You can’t see tomorrow’s bloodwork today. But that’s data. So do you wait until tomorrow to form your opinion? If so, tomorrow you won’t have all the data either. At some point, you need to decide when you have enough data to form an opinion. You cannot be bound by an obsession to have every scrap of data in front of you before deciding. People can die while you dither.
How is another doctor supposed to judge whether his treatment had any chance to help the kid? It’s experimental. They likely didn’t even know exactly what he was planning to do.
Timex, you’re a computer scientist right? Imagine your buddy says they need your help fixing a computer. You agree to check it out. Then they mention that their son, who is in middle school, looked at it already. He thinks that it’s probably a computer virus and there is no way to fix it.
What is going through your head? I imagine it would be something like, “Does their son really have any experience with this sort of thing? Certainly not as much as I do. He may be completely wrong. But even if he is right, maybe he just doesn’t know how to deal with a virus. Regardless of what he thinks, I haven’t looked at this computer yet. And I’d like to take a crack at it myself before giving up. Maybe I could help where others couldn’t.”
So you ask for the computer, work on it a while, and eventually give up. Were you unethical?
As I mentioned earlier, brain damage is not a good reason to avoid treatment.
The reason Hirano decided not to treat was because of the results of a muscle MRI, not because of brain damage. And though you seem to be implying that he should have made that decision sooner, the actual MRI was performed only a week before his decision.
I’m not saying that the other doctors opinions would have referenced whether his experimental drug would have been applicable.
I’m saying that the other doctors’ opinions would have highlighted the more recent brain scans which showed massive brain damage.
You see what I’m saying here? You don’t read the opinions of the other doctors for their conclusions. You read them for the information that went into their conclusions. The stuff that they noticed. Indeed, such a thing can even support countering then, because you can say, “oh, they never even checked X”.
Two things here…
First, we aren’t taking about a layman’s opinion here. It’s not like some random kid says, “that kid is done.” These were a large number of professionally trained physicians.
Second, fixing your computer is not the same as saving a human life, much less the life of an infant child. There is a dramatically different emotional component involved.
But, to deal with the example anyway, I generally would in fact ask what the previous tech did, if for no other reason than to avoid repeating wasted effort.
The difference in emotional weight is important to the ethical considerations here.
For a computer, I can take a look at it and really do no harm either way.
But with a child? First there are the considerations another whether the child itself may be suffering, and whether dragging out their death when no good can be done is the right choice. Secund, there are three ethical considerations centered around giving the family false hope, and causing even more emotional harm to them.
Those considerations are what would lead me to believe that a doctor had an ethical duty to fully inform himself prior to making those kinds of statements that kept this kid on a respirator for an additional period of time for really no good reason.
The one reason you gave, that every academic doctor wants to prove the other doctors wrong, is problematic. Allowing hubris like that to drive one’s actions is explicitly unethical.
I disagree. If you don’t strive to make a difference where others have failed, you shouldn’t be in medicine.
Also, your post crossed my edit. Brain damage is a red herring. Doctors can, and do, treat infants with brain damage. Even those with a short life expectancy. Sometimes the little guys will surprise you.
Hirano did not change his mind because of a brain MRI. He changed his mind because of a muscle MRI, taken a week before his decision. The other opinions really were irrelevant.
Now this is actually something I do know something about. While there have been cases where significant brain damage has been seemingly reversed, such as in the case with drowning victims, I do not believe there have ever been any cases where the type of massive brain damage suffered by the Gard kid was recovered from. Increased Neuro plasticity can make children more resilient in such cases, but there is a limit.
He was deaf, couldn’t move or even breathe on his own, and had massive epileptic seizures. And yet, even then, he was still likely able to feel pain and suffer. So dragging it out itself had a real tangible cost for the child.
It’s not a question of recovery. It’s a question of improvement.
There are lots of deaf children, lots of children who can’t move or breathe on their own, lots of children with seizures. And children with all of the above.
Their treatment is not up to you. It’s up to their parents.
But those children aren’t also in a state where they unable to respond meaningfully to their environment, while also suffering pain.
And no, it’s not always just up to the parents. Because sometimes parents might be a little too close to the case to be able to see it clearly. There is a responsibility to the child as well.
But ultimately, that’s why the academic doctor’s actions strike me as unethical, because he dragged out the situation, and made the child and his family suffer more.
Your opinion is different. So be it. It’s often the case with ethics.
Legally, the parents are fully responsible for the child’s treatment. To paraphrase Thorin Oakenshield, “They have the only right.”
Let’s try an ethical thought experiment.
You learn you have a terminal disease, which in two years will leave you deaf, unable to move or breathe, and subject to seizures. And possibly pain, who knows.
You write advanced directives that in two years time, if you are unable to make decisions for yourself, then you want your care transferred to Columbia University. You have made arrangements to be seen there, and set aside the funds to pay for it.
Two years pass by. You are in the hospital, just as predicted.
An acquaintance brings your letter to the doctors. They read it, and rip it up. “This sounds like a bad idea, for so many reasons”, they say. Then you are promptly disconnected from life support.
