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Lecture by Professor Omar Hasan Kasule Sr. MB ChB (MUK), MPH (Harvard), DrPH (Harvard). Professor King Fahad Medical City Faculty of Medicine & Professor of Epidemiology Universiti Malaya. EM omarkasule@yahoo.com WEB: http://omarkasule.tripod.com.
GROUP #1 (CASES ON PRIVACY AND CONFIDENTIALITY)
Case #1: A patient with diastolic blood pressure of 120 mmHg failed to return to the Health Center
GROUP #2 (CASES ON DISCLOSURE)
Case #7: A community pediatrician had reported abuse of a couple’s first child to the authorities. The authorities called in the parents to discuss the matter. The abusing father was so angry that he divorced his wife for giving information to the pediatrician. He later took the wife back under the rujuk provisions of the Law. At the next visit the pediatrician noted signs of child abuse and asked the mother. The mother confirmed the abuse but asked the pediatrician not to follow up the matter for the sake of her marriage and family. The pediatrician this time did not report to the authorities.
GROUP #3 (CASES ON CONSENT TO TREATMENT)
Case #11: A patient was brought to the emergency room by the police after attempting to kill himself by hanging. He was unconscious when first brought in and had a signed suicide note in his shirt pocket saying that he wanted to die. The doctors ignored the note and started resuscitation measures. The patient became conscious after 30 minutes and protested at the medical treatment arguing that he wanted to die. The doctor was thinking of stopping resuscitation measures when the patient’s father and wife arrived and instructed the doctor to continue resuscitation.
GROUP #4 (CASES ON REFUSAL OF TREATMENT)
Case #15: A 42-year old actress pregnant for the first time refused an elective caesarean section. She continued to refuse the procedure when labor became obstructed and signs of fetal distress appeared. The obstetrician went ahead to operate on the basis of consent by the husband. The baby was delivered alive and well.
GROUP #5 (CASES ON NEGLIGENCE & MALPRACTICE 1)
Case #18: A patient with no obvious injury after a minor accident was discharged without X-ray investigations. He developed back problems 3 months later leading to leg paralysis. He sued the hospital for negligence.
GROUP #6 (CASES ON LIFE SUPPORT IN TERMINAL ILLNESS)
Case #25: A patient admitted to the ICU after a car accident was confirmed by 3 specialist surgeons to be in a persistent vegetative state. The doctors wanted to discontinue life support but the family refused because there were signs of life like reflex flexion of joints and blinking of the eyes. The hospital decided to seek a court injunction after keeping the patient in the ICU for 6 months without any obvious improvement.
GROUP #7 (CASES ON REPRODUCTIVE ISSUES)
Case #27: A couple married for 10 years without a child decided to have IVF. Before the procedure was completed, the husband died. The wife insisted on using the stored semen of her dead husband. The relatives of the husband objected. The first wife who had been divorced 15 years earlier with one girl also asked for the semen for an IVF procedure that she hoped would enable her have another baby to act as a bone marrow donor for her daughter who had leukemia and had failed to find a matching donor.
GROUP #8 (CASES ON ORGAN DONATION)
Case #33: A patient of terminal renal disease received a cadaveric transplant and recovered well. Two years after the operation he received a note from a stranger demanding payment of a large sum of money. The stranger claimed to be the son of the kidney donor who had died during surgery for intestinal obstruction. The stranger claimed that a source within the hospital had informed him that the deceased’s kidney has been removed without the knowledge and permission of the family.
GROUP #9 (CASES ON DRUG ABUSE AND SUICIDE)
Case #35: A patient, whose engagement had been called off in the week that he failed his university entry examinations, started smoking, drinking alcohol, and using illicit drugs to forget his problems but to no avail. He was admitted to the medical ward after suffering a nervous breakdown. He was violent and abusive on the ward and refused to take his medication. Two weeks from his admission he left the ward without telling anyone and went and killed his former fiancée at her home. He later became very agitated and depressed and within 10 hours he also committed suicide. His parents and the parents of his ex-fiancee jointly sued the hospital.
GROUP #10 (CASES ON DOCTOR ETIQUETTE, adab al tabiib)
Case #38: A 60-year old surgeon was known by everybody in the hospital to cause pain while examining patients without prior explanation and consent. He used to make lewd jokes about female patients. He discussed diagnoses with his drinking partners and details of many patients were known in the community. A junior doctor who complained to the hospital director was told to keep quiet. Nobody else dared to complain about him because of his seniority.
GROUP #11 (CASES ON RESOURCES)
Case #41: The ICU staff were in a dilemma because 2 patients presented at the same time and they had only one free bed. The first patient was 90 years old and has been admitted three times before with myocardial infarction. His sons forced him to come to hospital; he had expressed preference to stay and die at home in peace. The second patient was a 30-year neurosurgeon. He was the only one in the whole country. He had been involved in a serious car accident and was in coma.
GROUP #12 (PHYSICIANS WITH DUAL OBLIGATIONS)
Case #44: A national football team physician examined a player and found that he had a chronic shoulder dislocation and advised that he should not play again until it was treated. The player protested because he had always played with that condition since he was young. The team manager threatened to dismiss the physician if he did not certify the player as fit to play because that star player was the only hope of the team to win in an international match the next day.
GROUP #13 (POSTMORTEM)
Case #46: A police officer died a few minutes after admission from what was suspected injuries sustained in the course of his duty. The police department insisted on a postmortem to determine the cause of death in order to make decisions about compensation. The family was divided. Some were opposed to postmortem and others wanted to go ahead.
CASE GROUP #14 (COSMETIC and RECONSTRUCTIVE SURGERY
Case #47: A child recovered from third degree burns with severe scarification and facial distortion. He was referred to a plastic surgeon for reconstruction. The father objected saying that it was Allah’s will and should be left as is.
CASE GROUP #15 (PRIVATE PRACTICE)
Case #54: a young doctor heavily indebted because of payment for cancer treatment for his father decided to open a private clinic near the public hospital where he worked. He started advising his patients to see him at the private clinic in the evening where he could give them better care.
CASE GROUP #16: (DOCTOR-PATIENT RELATIONSHIP)
Case #58: A specialist physician made a phone prescription of an alpha blocker for his uncle after listening to his symptoms but had never examined him before. The uncle being a pharmacist went on to fulfill the prescription.
CASE #17: FAIR CHARGES IN PRIVATE PRACTICE
Case #61: a Muslim private practitioner charged higher prices for non-Muslim patients
Case #62: A Muslim private practitioner had a graduated fee schedule charging rich patients higher than the poor ones.
GROUP #5 (CASES ON NEGLIGENCE and MALPRACTICE 2)
Case #66: a medical officer by chance at the site of an accident tried resuscitation and failed. He was sued by the victim’s family.
Case #68: A consultant at a dinner without seriously questioning the patient advised doubling the anti-coagulant dose. The patient died of hemorrhage the next day.