|
|
 |
 |
 |
| Friday, 26 December 2003 |
 |
|
 |
Features | |
| News Business Features Editorial Security Politics World Letters Sports Obituaries
|
Audiology and vision study of centenarians by Dr. Ranesh Wijesinghe, Medical Officer, Prof. Gooneratna Centenarian Study Last week Wickremarachchi, Audiologists and Opticians in Nugegoda came forward to carry out a vision and audiology study of the centenarians in the Goonaratna study and provide them with their audio visual needs to lead a more satisfying life.
The first centenarian to get this free service was K. D. Semeon 104 years of 289, Alwala Road, Pannipitiya. The company's Chairman, Clinical Optometrist and Audiologist, Mihiri Wickremarachchi himself personally went to the centenarian's residence at Pannipitiya with his mobile testing team and carried out the testing. He had found that though 104 years the Centenarians vision and hearing was upto the standard of a 50-year-old person. He needed only a pair of spectacles for easy reading, which has now been provided. Centenarian Semeon who lives in his own house has been a farmer throughout his life. He has generally been a vegetarian eating the produce from his paddy fields and vegetable plots, and occasionally taking fresh water fish. In 1940, he had won the Goviraja award from the then Government. Having suffered no serious illnesses throughout his life so far, he had never taken any kind of western medicine, whenever he had a minor cough or a cold and fever, it had been the village vedamahatmaya who had attended on him. Even today its native treatment, for him whenever the need arises. Altogether he has had eight children four girls and four boys only seven of them are living today. Wickremarachchi Mobile vision and Audiology Unit will visit all 53 centenarians in the study spread over the country to test and provide their vision and audiology needs free in honour of their rare centenarian achievement. ###### Intensive Care Unit Psychosis (I.C.U. Syndrome) by Dr. D. P. Atukorale When an illness of catastrophic nature such as a heart attack (myocardial infarction) which usually strikes a man in the middle of an otherwise healthy life, at the peak of ones career, when he is most useful to society and his family, the stress can be most detrimental and may lead to severe depression and anxiety. Same is true when a patient is admitted to Intensive Care Unit (I.C.U.) after open heart surgery or if patient gets an acute illness such as acute infective polyneuritis which usually requires admission to ICU if the muscles of respiration are affected. Reducing anxiety and stress in such patients admitted to ICU is very crucial. In the ICU the patient is surrounded by machines and the monitors and the impersonal contact with technical equipment makes the patient dehumanized, helpless and hopeless. To make matters worse some doctors and nightingales (nurses) in the ICU have hardly any time to speak to patients and examine as some of the ICU doctors and nurses depend on the information provided by the monitoring equipment. The touch of a hand or a few soothing words of reassurance addressed directly to the patients by doctors and nurses can calm down and restore hope in ICU patients. Some of these patients admitted to ICU may be confused and disoriented. The ICU nurses play a major role in determining the mental state of the ICU patients and thus the rate of their recovery. A few soothing and kind words from an understanding nurse can help the ICU patients to get over stress and the anxiety and depression which is usually transient. Some patients use denial to cope with their fear. Those who reject the reality of their illness may baulk at the necessity of treatment. Those who accept the reality of the illness have the best outcome and are less prone to ICU psychosis. The combination of strange surroundings, illness, medication and disturbed sleep can lead to ICU psychosis (Journal of Cardiac Rehabilitation 5:112; 1985). The incidence of ICU syndrome differs from country to country. The incidence appears to be higher among Sri Lankans as compared to British patients. ICU syndrome is higher in elderly patients who find themselves suddenly immobilized in strange and frightening surroundings and there are some doctors who treat them as senile or psychiatric cases when all that is necessary is a few kind words by some familiar person to help them to calm down and become oriented. If each ICU cubicle is provided with clocks and glass windows, patients are less prone to be disoriented. Even if the patient is unable to talk, if the patient can be talked to these patients improve. In some ICUs in UK, the family physician (G.P.) is encouraged to visit the ICU patient. In my experience most of the Sri Lankan G.P.s don't have time to visit their patients in the ICU and this may also be due to the fact that some VPs and VSs don't encourage the GPs to visit the ICU patients. One advantage of the G.P. visiting the ICU patients is that the busy physician (V.P.) or the surgeon (V.S.) in charge of the patient in the ICU may not be able to spare a few minutes talking to the relatives of the ICU patient who may be having severe stress and who may have so many questions to ask about the patient. The relatives obviously would like to know from the VP or VS why the patient got the acute illness (e.g. heart attack) and what the patient should do to get a speedy recovery and return the patient to gainful life and prevent the recurrence. As mentioned early, some present day specialists tend to be more technically oriented and more concerned with machines, laboratory reports, scans, x-ray and 2D-Echos than the ICU patient. Short acting tranquilizers are required by many ICU patients especially those who show heightened reactions to stress. Sometimes the ICU ward rounds by VP or VS accompanied by a battalion of junior doctors and medical students make the ICU patient very nervous especially if the consultant does not speak to the patient. During the ward rounds by specialists, blood pressure and heart rate of patients can go up and there have been instances ICU patients have got serious rhythm disturbances (palpitations) of the heart during such ward rounds. In some patients depression sets in after admission to ICU. "This has been likened to mourning after the loss; in this case a sense of lost potential or lost physical ability" (Kanpp. D and Blackwell B, 1985). Generally depression is transient and the patients stress level can be reduced through reassurance. Authoritative information can dispel concerns caused by harmful myths and misconceptions about certain acute illness such as heart attacks. Psychiatric consultation is not necessary in majority of cases of ICU syndrome. In patients with loss of appetite, severe insomnia, feeling of isolation and general apathy which may indicate serious depression, professional psychiatric care is indicated if above symptoms are not due to drugs such as cimetidine, betablockers, and other drugs used in the ICU. ###### In medical negligence cases: Ideals expected from experts not realised The ideals of dispassionate, informed and experienced opinions expected from experts in determining cases of medical negligence have not always been realised in UK. This observation was made by Lincolns Barrister-at-law and medical specialist Dr. M. A. Granthwaite (MD FRCP FFARCS) when he spoke on a recently held symposium on Medical Negligence in Colombo, organised by the Sri Lanka Association for Advancement of Science (SLAAS) jointly with the Sri Lanka Medical Association (SLMA). Dr. Branthwaite speaking on 'Applications to Medical litigation' said: Role of experts Judicial determination of actions in medical negligence rests upon an appraisal of professional opinion which must be dispassionate, informed and experienced, if a just outcome is to be secured. These ideals have not always been realised. The new procedural rules impose specific and detailed obligations on expert witnesses. They are required to support their report with a statement confirming their understanding that the duty of an expert is to the court, and that this must override any obligation to the party providing instructions. Meetings of experts are a novel and sometimes contentious feature of the new system. The court can, and often does, direct that opposing experts should meet to identify the essential issues and, if possible agree some or all of them. Alternatively the court can specify which issues are to be discussed and require the experts to prepare a joint statement identifying points of agreement or disagreement. In a proportion of cases, the outcome of such meetings renders trial unnecessary. A wide-ranging review of civil justice in England and Wales was undertaken in the early 1990s by Lord Woolf and the results published in 1996'. Medical litigation was singled out as the area where civil justice failed most conspicuously. Reasons included marked disproportion between costs and damages (the value of the claim), particularly in low value cases, a low rate of success, excessive delay, prolonged unwarranted pursuit of unmeritorious claims or indefensible defences, and more intense suspicion and lack of co-operation between the parties than in many other ares of litigation. Lord Woolf was particulary critical of the role of experts and referred to 'a large litigation support industry, generating a multi-million pound fee income... This goes against all principles of proportionality and access to justice'. Lord Woolfs report concluded with recommendations for radical reform of civil justice and his proposals were implemented early in 1999. New, simplified procedural rules were introduced and control of the conduct of cases was vested in the courts rather than the parties. The intention was to secure just results expeditiously, with proportionality between the cost and value of claims. Only those aspects of the reforms which have had a particular impact on medical litigation are considered here. Pre-action protocol A prescribed pre-action procedure is now mandatory for all personal injury claims. Its purpose is to resolve as many disputes as possible without formal litigation and, in the context of clinical negligence, to maintain or restore the relationship between patient and health care provider. The intention is to secure early investigation and appraisal of merit and promote a reciprocal willingness to share expert evidence. A request for Disclosure of Medical Records is followed by submission, on behalf of the claimant, of a Letter of Claim which in turn requires the defendant to reply with a Response to the Letter of Claim. Time limits are set for disclosure of records and for responding to the letter of claim, with cost penalties possible for non-compliance. The letter of claim is intended to summarise the facts, the allegations of breach of duty and consequential harm, and give an indication of the value of the claim. Expert evidence can be disclosed at this stage and the letter can include an offer to settle. The Response to the Letter of Claim should set out any disagreement with the claimant's chronology or statement of fact, what, if any, part of the claim is admitted, what is denied and, most importantly, reasoned arguments for any denial. A response must be made to any offer to settle, and a counter-offer can be made. Once again, expert evidence can be disclosed, or protocols or guidelines submitted. Cost penalties can be imposed, if offers to settle are refused and formal legal proceedings follow. A significant proportion of claims - particularly those of low value - are now resolved purely on the basis of the pre-action protocol, in other words, without formal proceedings, the involvement of counsel or any contact with the courts. Court proceedings If the matter fails to resolve at the pre-action stage, formal proceedings are commenced. Thereafter the court can impose time limits on procedural steps, limit the number or nature of expert witnesses, require the parties to instruct a single expert or, in exceptional circumstances, instruct a court-appointed expert. The court can also direct that there be a meeting of experts before the matter proceeds to trial. Perhaps inevitably, these new rules have themselves spawned some adversarial litigation. Other notable developments in progress or anticipated Damages have been calculated traditionally on the basis of a lump sum payment. This is unsatisfactory when injury results in long-term disability with associated care costs. Structured settlements provide a formula for an initial award to cover necessary housing and equipment costs, followed by an annuity throughout survival. The possibility of the courts imposing a structured settlement is being considered. Legal Aid is State-funded financial assistance available to persons of limited resources to pursue legal action. The availability of legal aid has been curtailed recently. Legal insurance and conditional fee arrangements are alternatives. Alternative dispute resolution, particularly mediation, has been advocated as a preferred method for resolving actions in medical negligence. Although often successful its potential role has been limited in practice by the pre-action protocol. Regularising the handling of claims against health care providers has been facilitated by the NHS Litigation Authority which is now responsible for the conduct of litigation against NHS Hospital Trusts. General practitioners and those providing private medical services are indemnified through a medical defence organisation. Avoiding litigation has been one, but only one, of the prompts to greater surveillance of clinical practices and professional regulation. New legislation has been introduced which extends to the private health care sector as well as the National Health Service. |
|
News | Business | Features
| Editorial | Security
Produced by Lake House |
