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KNOWLEDGE FOR ALL

KNOWLEDGE FOR ALL. ELL 4 TH edition First on the medical side Beyond Davangere ELL think tank ELL Co-ordinators ELL For People. ETHIKOS FOR MEDICOS. Reach out to all stakeholders SOCIAL CHANGE THROUGH KNOWLEDGE. Based on academics BUT NOT AN ACADEMIC LECTURE.

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KNOWLEDGE FOR ALL

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  1. KNOWLEDGE FOR ALL

  2. ELL 4TH edition • First on the medical side • Beyond Davangere • ELL think tank • ELL Co-ordinators • ELL For People

  3. ETHIKOS FOR MEDICOS

  4. Reach out to all stakeholders SOCIAL CHANGE THROUGH KNOWLEDGE

  5. Based on academics BUT NOT AN ACADEMIC LECTURE

  6. Knowledge unites like nothing else A life beyond boundaries

  7. OUR HEALERS GODS ON EARTH

  8. Declaration • I solemnly pledge myself to consecrate my life to the service of humanity. • Even under threat, I will not use my medical knowledge contrary to the laws of humanity.

  9. Declaration • I will maintain the utmost respect for human life from the time of conception • I will not permit considerations of religion, nationality, race, party politics, or social standing to intervene between my duty and my patient

  10. Declaration • I will practice my profession with conscience and dignity • The health of my patient will be my first consideration • I will respect the secrets which are confided in me

  11. Declaration • I will give to my teachers the respect and gratitude which is their due • I will maintain by all means, the honour and noble traditions of the medical profession • I will treat my colleagues as my own brothers

  12. Leadership The “Swiss Cheese” Model of Accident Causation (Reason, 1990) • Excessive cost cutting – staffing reduction • Equipment shortages • Communication • Staff Motivation • Divided or confused accountability “Latent Errors” • Poor compliance to policies • Poor Coordination & Communication Policies/ Procedures • Deficient training program • Inexperienced X-Ray Tech Available Resources Barriers to Accidents • Failed to review allergies • Wrong X-ray marker used • Wrong procedure performed Communication Accident & Injury • Wrong Site Surgery • Medication Error • Fall Failures in the System

  13. Ethikos for Medicos Structure • Ethics • Conduct • Medical negligence • Legal status • Quality standards • Conclusion

  14. Medical ethics • Medical ethics is a system of moral principles that apply values and judgments to the practice of medicine • As a scholarly discipline, medical ethics encompasses its practical application in clinical settings as well as work on its history, philosophy, theology, and sociology

  15. Medical Universe Patient At The Center

  16. Medical Ethics History • Duty of physicians in antiquity – Hippocratic Oath • First code of medical ethics –Formula Comitis Archiatrorum published in 5th Century • Medieval/Early Modern Period – Ishaq bin Ali Rahawi – Code of a Physician • 18th/19th Centuries – Thomas Percival – first modern code on Medical Ethics -1794 • Expanded in 1803, coined the expressions

  17. Medical Ethics History… • Expanded in 1803, coined the expressions “medical ethics” and “medical jurisprudence” • In 1847, the American Medical Association adopted its first code of Ethics, with this based on large part upon Percival’s work

  18. Medical ethics Ethics is a voluntarily self-imposed code of conduct by the medical profession.

  19. Values in Medical Ethics Common framework – four principals approach by Tom Beauchamp and James Childress in their book Principles of biomedical ethics

  20. Values in Medical Ethics Respect for autonomy – patient has the right to choose or refuse their treatment

  21. Values in Medical Ethics Beneficence – a practitioner should act in the best interest of the patient

  22. Values in Medical Ethics Non – maleficence –”first, do no harm”

  23. Values in Medical Ethics Justice-concerns the distribution of scarce health resources, and the decision of who gets what treatment (fairness and equality)

  24. Values in Medical Ethics Other Values • Respect for persons – the patient have the right to be treated with dignity • Truthfulness and honesty – the concept of informed consent

  25. Values Autonomy • Rights of individuals to self determination • Outcomes that are important to patients • “Paternalistic” tradition within healthcare

  26. Values Autonomy... • Respect for autonomy is the basis for informed consent and advanced directives • Autonomy is a general indicator of health

  27. Values Beneficence • Actions that promote well being of others • Taking actions that serve the best interest of the patients • One of the core values of healthcare ethics

  28. Values Non-Maleficence • “First, do no harm” • Enthusiastic practitioners – “ the treatment was a success, but the patient died” • Non-maleficence is not absolute, balances against beneficence, together double effect

  29. Values Double Effect • Double effect refers to two types of consequences which may be produced by a single action and in medical ethics it is usually regarded as the combined effect of beneficence and non-maleficence • Morphine as an example

  30. Values Double Effect • Autonomy can come into conflict with beneficence when patients disagree with the recommendations that the healthcare professionals believe are in the patient’s best interest • On the other hand, autonomy and beneficence/non-maleficence may also overlap

  31. Values Euthanasia • Aruna Ramchandra Shanbaug vs the Union of India. • Most famous Indian case on this subject. • Since 1973 in persistent vegetative state. • In KEM hospital since then

  32. Values Euthanasia...DEAN • This one is the finest example of love, professionalism, dedication & commitment • Mature society – capacity and commitment to take care of its “invalid ones” • Society not matured for Mercy Killing

  33. Values Euthanasia...DEAN It may get misused and our monitoring and deterring mechanisms may fail to prevent those unfortunate incidences

  34. Values Euthanasia... WITHDRAWL OF LIFE SUPPORT SYSTEMS OF A PATIENT IN PERMANENT VEGETATIVE STATE, PVS. Article 226 of the Constitution, HC

  35. Ethics Informed Consent Usually refers to the idea that a person must be fully informed about and understand the potential benefits and risks of their treatment

  36. Ethics Confidentiality • Confidentiality is commonly applied to conversations between doctors and patients • Concept of patient-physician privilege • Confidentiality is challenged in sexually transmitted disease and in pregnancy in an underage patient cases • Traditionally, confidentiality has been viewed as a relatively non-negotiable tenet of medical practice

  37. Ethics Other issues • Communications – when not proper • Declaration of Helsinki regarded as authoritative in human research issues • Referral – Doctors who receive income from referring patients for medical tests • Fee splitting and payments of commissions to attract referrals of patients is considered unethical and unacceptable in most parts of the world.

  38. Ethics Other issues • Vendor Relationships • Sexual Relationships • Futility- no chance for a patient to survive. Also called non-beneficial care • Substituted Judgement

  39. Conduct • Indian Medical Council Act 1956 • Functions – Medical Register, Medical Education, Recognition of Foreign Medical Qualifications, Appeal against DA, Warning notice, Declaration of Geneva

  40. Serious Professional Misconduct • Adultery • False and misleading certificates • Dichotomy or fee splitting • Covering i.e. assisting someone who has no medical qualification • Advertising

  41. Conduct Indian Medical Council (Professionals Conduct, Etiquette and Ethics) Regulations, 2002 Rights of Medical Practitioners • right to practice medicine • right to choose a patient • right to dispense medicines • right to possess and supply dangerous drugs to his patients • right to add titles to his name • right to recovery of fees

  42. Conduct Duties of Medical Practitioners • Duty to exercise a Reasonable Degree of Skill and knowledge • Duties with regard to attendance and examination • Duties to furnish Proper and Suitable medicines • Duty to give instructions • Duty to control and warn • Duty to Third Parties

  43. Conduct Duties of Medical Practitioners • Duty to inform patient of risks • Duty with regard to poison • Duties with regard to operations • Duty to notify certain diseases • Duty with regard to Consultation • Professional Secrecy • Privileged communication

  44. Conduct Duties of Patient • Duty to provide complete information/history/facts • Duty to follow instructions of Doctor • Duties to pay reasonable fee to the Doctor

  45. Conduct Rights of Patients • CHOICE – of Doctor • ACCESS - to healthcare facilities • DIGNITY – to be treated with care and compassion • PRIVACY – to be treated in privacy • CONFIDENTIALITY • Right to know • REFUSAL

  46. Conduct Rights of Patients • SECOND OPINION • RECORDS • CONTINUITY • COMFORT • COMPLAINT • COMPENSATION

  47. Conduct MEDICAL RECORDS –Where we fail? • Basis for patients care and for continuity in the evaluation of patients treatment • To serve as documentation for reimbursement • To provide data for in medical education and clinical research • To assist in protecting legal rights of all – patient, doctor etc

  48. Conduct MEDICAL RECORDS –Where we fail? 5) To follow up the patients, evaluation of drug therapy and cost accounting 6) Medical records are needed in cases of professional negligence, for payment of third party payment in health and accident insurance, life insurance policies, policies of disability, accidental deaths, traffic accidents etc

  49. Medication-Use System Administration Prescribing Dispensing

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