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You'll have to forgive my family doctor ignorance here, but aren't the majority of procedures on kids fairly short anyway (like the aforementioned ear tubes and tonsils) OR things that can't be postponed, like cardiac cases or emergencies like intusseception, NEC, appendix?
But we also do get a lot of mole removals, circs, etc that can wait.
It is a dicey subject. I don't like dropping it on families the morning of surgery unprompted because that's not really fair to freak them out over one more thing (that is still pretty fuzzy). I am happy to talk about it if they bring it up (which happens less frequently than you might think). And we don't see the vast majority of healthy outpatient kids in pre-op clinic so can't really bring it up there.
Dental cleanings, hernias, urologic reflux procedures, all sort of diagnostic test like ct, mri, endoscopies, skin hemangiomas, etc.Yes the vast majority are very short - 1-2 hours total anesthesia time or less. And the majority are medically necessary. But we also do get a lot of mole removals, circs, etc that can wait. And then there's a lot of MRIs for headaches, joint pain, etc in healthy kids that almost never show pathology.
I doubt practice will change much because concerned families have asked about this for years and I assume would already have been wary of elective cases, but we'll see. I'm assuming much of those decisions will be made in the surgeons' offices before they get to us.
That is not informed consent.
sketchy MRI orders (although most of those get prop infusions anyway).
Yikes!why not? Informed consent does not require you listing every possible side effect or complication to a procedure, let alone ones where the evidence is a little iffy at best.
Yikes!
I'm not even going to try to argue with you. You are far too gone.
Are we supposed to believe that you already sat down with your insurer and their "army" of lawyers to hash out this new issue when the ASA, SPA or other societies haven't even had time to react to it? Right!My med mal insurer and their army of lawyers disagrees with you.
Also, I do find it amusing that stating the legal standard is "too far gone" for your taste.
Are we supposed to believe that you already sat down with your insurer and their "army" of lawyers to hash out this new issue when the ASA, SPA or other societies haven't even had time to react to it? Right!
Plus you are giving me too much ammunition. Why do you think your insurer needs an "army of lawyers"? I would imagine they need quite a few just to deal with your screw ups.😆
Why would you even be so cozy with your insurer? Special needs people get more attention, did you know?🤣
I agree with your statement in general, but I don't think it applies in this scenario. What you say is true for human error related bad outcomes.I'm not even sure informed consent really covers your ass. In the end the way they will probably get you is if you deviate from the standard of care. Even if you have a bad outcome (regardless of specifically outlining EVERY single one) as long as it was not caused by you doing something stupid or not reacting appropriately, then the chance of losing a lawsuit is probably low.
That is not informed consent.
"All the studies in children had limitations, and it is unclear whether any negative effects seen in children’s learning or behavior were due to the drugs or to other factors, such as the underlying medical condition that led to the need for the surgery or procedure."
Yet we publish these warnings in the event that they are
Informed consent is not signing a standard paper. It is the process of explaining the patient what they are getting into in whatever language you deem more adequate.Informed consent is a joke and you know it. Consent forms are written at the first-grade level so that patients can understand it. Yet no one in their right mind would say that a first-grader is capable of actually giving consent.
I also know you don't spend 30min getting "consent" from each of your patients every day, which is at least how long it would take to go over the myriad complications and the incidences thereof for adults, as well as answer any followup questions.
I cover things that are "common" to pediatric anesthesia and things that are specific to their procedure. Shockingly, I also don't routinely talk to mom about the risk of heart attack and stroke for her 2 year old getting ear tubes.
Are we supposed to believe that you already sat down with your insurer and their "army" of lawyers to hash out this new issue when the ASA, SPA or other societies haven't even had time to react to it? Right!
Plus you are giving me too much ammunition. Why do you think your insurer needs an "army of lawyers"? I would imagine they need quite a few just to deal with your screw ups.😆
Why would you even be so cozy with your insurer? Special needs people get more attention, did you know?🤣
Informed consent is not signing a standard paper. It is the process of explaining the patient what they are getting into in whatever language you deem more adequate.
Do I spend a lot of time going over all possible complications? Not when I feel pretty confident I can avoid them. I'm not telling the Mallampati 1 patient with huge mouth opening and solid teeth that I might dislodge a tooth. I will tell the Mallampati 3/4 with poor mouth opening and loose teeth that there is a good chance of all teeth being dislodged.
But this new issue is completely different. There is nothing you can do about it. It is totally out of our control.
Luckily our dentist are quick. No messing around. But I'd say 70% of our dental cases are under 3yo. I have shared this information, prior to this FDA warning, with our dental colleagues. They don't care. These cases put a lot of money in their pockets and I'm finding that most dentists are all about the money. X-rays for every visit, whiteners, cosmetic procedures, cavity repairs when there isn't a cavity. The list goes on and on. It's like they are doctors!!What about dental procedures under GA for little kids (age less than 3)? What if the dentists takes 3 hours per case?
No, Mag Mutual has one of their lawyers (who is also a doc) come give a lecture periodically in every area they have docs in and if you attend they take 10% off your bill for the year. It's great. You get to hear a physician that is also a malpractice defense attorney lecture (and take questions) on what he considers very relevant topics in malpractice. Last year, he spent 1 of the 2 hours talking about informed consent. It was great. 2 hours of time and I basically get paid almost $1000/hr to attend.
But no, I should listen to you that has no legal training whatsoever. You obviously know everything.![]()
You are forgetting that it also says: "Parents and caregivers should discuss with their child’s health care professional the potential adverse effects of anesthesia on brain development, as well as the appropriate timing of procedures that can be delayed without jeopardizing their child’s health."Honestly, this is mostly semantics and hypotheticals, and I'm just poking you to play devil's advocate. If you look at the wording of the FDA document: "Health care professionals should balance the benefits of appropriate anesthesia in young children and pregnant women against the potential risks, especially for procedures that may last longer than 3 hours or if multiple procedures are required in children under 3 years," I can't think of a single case in the last 3-ish years of doing pediatric anesthesia that would fit into that category.
"Since the existence of anesthetic neurotoxicity in children is still unclear, conversations with parents should be undertaken with care. Given the unclear benefit of such a discussion, there does not appear to be a compelling medical argument to actively raise this concern during the anesthetic consent process. If families or clinicians have questions about anesthetic neurotoxicity, physician anesthesiologists should be prepared to answer them and participate in discussions with the perioperative team. Conversations about modifying medical care should be undertaken with particular caution, as unintended harmful consequences may result from delaying necessary surgery or changing a patient’s anesthetic management. "- This statement is from: A 2015 consensus statement about the use of anesthetics in children is available from SmartTots, a collaborative effort between the International Anesthesia Research Society, U.S. Food and Drug Administration and many others working together to make anesthesia safer for infants and children. The consensus statement has been endorsed by a wide range of anesthesia and pediatric societies including the American Society of Anesthesiologists and Society for Pediatric Anesthesia.
http://www.kevinmd.com/blog/2016/12/anesthetic-neurotoxicity-infants-children-current-state-art.html
Agreed. I just had a dental pts mom ask me about this. And she wasn't someone I would consider "well informed".Emphasis on 2015 consensus statement.
It it a different world now. A week ago you could ignore it but I don't think you can now.
"Since the existence of anesthetic neurotoxicity in children is still unclear, conversations with parents should be undertaken with care. Given the unclear benefit of such a discussion, there does not appear to be a compelling medical argument to actively raise this concern during the anesthetic consent process. If families or clinicians have questions about anesthetic neurotoxicity, physician anesthesiologists should be prepared to answer them and participate in discussions with the perioperative team. Conversations about modifying medical care should be undertaken with particular caution, as unintended harmful consequences may result from delaying necessary surgery or changing a patient’s anesthetic management. "- This statement is from: A 2015 consensus statement about the use of anesthetics in children is available from SmartTots, a collaborative effort between the International Anesthesia Research Society, U.S. Food and Drug Administration and many others working together to make anesthesia safer for infants and children. The consensus statement has been endorsed by a wide range of anesthesia and pediatric societies including the American Society of Anesthesiologists and Society for Pediatric Anesthesia.
http://www.kevinmd.com/blog/2016/12/anesthetic-neurotoxicity-infants-children-current-state-art.html
That is very good. But it was last year's talk. I maintain my position that is different from all consents you have ever obtained.