Reasoning Of Doctors Research Articles

The Duty of Explanation of using Medical AI

在医疗人工智能引起的法律议题中，运用医疗人工智能的说明义务亟须规范解释。医疗人工智能无法被当前的说明义务体系所涵摄，原因在于医疗器械不是知情同意制度所调整的对象，但这无法回应人工智能所带来的新型科技风险。说明义务的开放框架为披露医疗人工智的使用创造了弹性空间，技术水平、法律规范与医疗实践等多元基础进一步证立此项披露告知的必要性和重要性。医疗人工智能的说明义务在现阶段应采取理性患者与具体患者之混合标准、排除理性医生标准，在程度上应以简洁为要，照顾社会公众对医疗人工智能的认知水平。医疗人工智能说明义务的内容由“标准的风险与利益披露”所衍生，结合医疗决策主导权归属问题的探讨，应包括医疗人工智能的参与程度、固有风险、期待利益及替代措施四项基本信息。 In the legal issues caused by medical artificial intelligence, the duty of explanation of using medical artificial intelligence urgently needs to be normatively interpreted. Medical artificial intelligence cannot be covered by the current system of explanation duties, as medical devices are not the subject of the informed consent system. However, this cannot respond to the new technological risks brought by artificial intelligence. The open framework of the explanation duties creates flexible space for disclosing the use of medical artificial intelligence, and the diverse foundations of technological level, legal norms, and medical practice further establish the necessity and importance of this disclosure. The duty to explain medical artificial intelligence at the current stage should adopt a mixed standard of the reasonable patient standard and the subjective patient standard, excluding the reasonable doctor standard, and should be concise in terms of degree, taking into account the public’s awareness level of medical artificial intelligence. The content of the duty to explain medical artificial intelligence is derived from the “standard risk-benefit-disclosure” and should include four basic pieces of information: the level of involvement of artificial intelligence in medical decision-making, inherent risks, expected benefits, and alternative measures, combined with the exploration of the issue of medical decision-making authority.

Navigating the legal complexities of telesurgery in China: An assessment of tort liability and the path forward.

This study investigates the legal challenges posed by telesurgery, an emergent healthcare modality facilitated by advancements in 5G and Artificial Intelligence. It highlights the urgent need for a comprehensive legal framework reconciling the complexities of healthcare delivery and technology integration. The paper examines the Chinese adjudication of negligence and the evidentiary hurdles in telesurgery, interrogating the application of the 'reasonable doctor' standard, the intricate causation-negligence nexus and the distribution of evidentiary burdens. The analysis contends that current statutes require revision to apportion telesurgery-induced damages fairly. Further, it proposes the formation of multidisciplinary committees to oversee medical technology, calls for systemic reforms, more reasonable liability differentiation and fortifying medical insurance frameworks.

The Supreme Court’s decision in McCulloch v Forth Valley Health Board: Does it condone healthcare injustice?

The UK Supreme Court’s recent judgement in McCulloch v Forth Valley Health Board clarifies the standard for the identification of ‘reasonable’ alternative medical treatments. The required standard is that of...

GAMBARAN PENGGUNAAN COMPLEMENTARY ALTERNATIVE MEDICINE (CAM) PADA PASIEN HIPERTENSI DI WILAYAH KERJA PUSKESMAS BLAHBATUH II

Hypertension is an increase in a person's systolic blood pressure ≥ 140 mmHg and diastolic ≥ 90 mmHg. The importance of hypertension sufferers to control blood pressure to prevent cardiovascular risk, one of which is the non-pharmacological alternative of Complementary Alternative Medicine (CAM). This study aims to describe the use of CAM in hypertensive patients in the working area of ​​the Blahbatuh II Health Center. This research method is a non-experimental quantitative descriptive study with a cross-sectional method. The results of this study found that the most use of CAM for the treatment of hypertension in the working area of ​​the Blahbatuh II Health Center were women (59.6%), aged 56-65 years (51.4%), high school education (42.2%), most of them not working/household (33.9%), income ≤ Rp. 2,627,000 (39.4%), suffer from hypertension for 1-5 years (76.1%), have no family history of hypertension (56.9%), hypertension medication, namely amlodipine (52.3%), drinking schedule every day (45.9%). Respondents used CAM since diagnosis (66.1%), CAM was combined with conventional drugs (62.5%) and was recommended by the family (45.8%), the reason that using CAM was very trusting CAM (47.2%), and the reasons for not using CAM were the reasons doctors did not recommend (54.1%), felt a positive effect (94.4%) and were satisfied (94.4%) using CAM. The most common types of CAM were biological therapy in the form of herbs (56.9%), the frequency of using CAM once a day (45.8%), the types of plants used were celery and starfruit (19.5%), plant parts namely leaves (41.5%), the method of processing is boiled first (61%), with a dose of one glass (48.8%) and the use of herbal medicine is taken orally (80.5%). The conclusion of this study was that the sociodemographic characteristics of the use of CAM were mostly aged 56-65 years (51.4%), female sex (59.6%), last education SMK/SMA (42.2%), and the use of CAM was mostly used since suffering from hypertension as many (66.1%) of respondents with the most types of CAM namely biological therapy in the form of herbs (56.9%).

Consent for Medical Treatment: What is ‘Reasonable’?

The General Medical Council (GMC) instructs doctors to act ‘reasonably’ in obtaining consent from patients. However, the GMC does not explain what it means to be reasonable: it is left to doctors to figure out the substance of this instruction. The GMC relies on the Supreme Court’s judgment in Montgomery v Lanarkshire Health Board; and it can be assumed that the judges’ idea of reasonability is adopted. The aim of this paper is to flesh out this idea of reasonability. This idea is commonly personified as the audience that has to be satisfied by the doctor’s justification for offering, or withholding, certain treatments and related information. In case law, this audience shifted from a reasonable doctor to a ‘reasonable person in the patient’s position’; and Montgomery expands the audience to include ‘particular’ patients, too. Senior judges have clarified that the reasonable person is a normative ideal, and not a sociological construct; but they do not set out the characteristics of this ideal. John Rawls has conceived the reasonable person-ideal as one that pursues fair terms of co-operation with other members of society. An alternative ideal can be inferred from the feminist ethic of care. However, the reasonable patient from Montgomery does not align with either theoretical ideal; but, instead, is an entirely rational being. Such a conception conflicts with both real-life constraints on rationality and the doctor’s duty to care for the patient, and it challenges the practice of medicine.

한의사의 진단을 위한 의료기기 사용에 관한 소고

South Koreaʼs medical system is dualized into Western medicine and oriental medicine, and accordingly, the doctorʼs license and oriental medical doctorʼs license system are in operation. Until now, the Supreme Court has judged the criteria for determining whether an unlicensed medical practice is established for the use of diagnostic medical devices by oriental doctors as follows. First, the legislative purpose of the dual medical system, Second, the provisions and purposes of laws related to the medical practice, Third, the academic principles underlying the medical practice, and Fourth, the course, purpose, and appearance of the medical practice, Fifth, it is necessary to comprehensively consider whether medical schools and oriental medicine universities have secured expertise through curriculum or national tests, and to make a reasonable judgment in light of social norms. However, the recent Supreme Court's Decision 2016Do21314 Decided December 22, 2022 ruled that oriental doctorsʼs using an ultrasound diagnostic device did not constitute unlicensed medical practice. The criteria for judging the majority opinion of the en banc judgment are as follows. First, the relevant laws and regulations should prohibit oriental medical doctors from using the medical device. Second, in light of the characteristics of the device and the level of basic and professional knowledge and technology required for its use, oriental medicine doctors should use it as an auxiliary means of diagnosis. Third, in light of the circumstances, purpose, and appearance of the entire medical practice, it should be considered whether it is clear that the use of the diagnostic device by oriental doctors is irrelevant to the application and application of it based on the principle of oriental medical practice. Fourth, from the perspective of criminal justice, the meaning of oriental medical practice should be clearly and strictly interpreted from the perspective of oriental medicine doctors, it was judged that diagnostic medical devices should be excluded from criminal punishment unless it is clear that they are not related to the principle of oriental medical practice. The use of medical devices by oriental doctors presupposes or links to oriental doctorsʼ diagnosis and treatment behavior, and diagnosis has a significant role in determining whether to treat or not and setting treatment methods. This paper aims to reduce the possibility of harm associated with medical accidents and help establish a reasonable doctor and oriental medical doctor license system by comprehensively examining diagnostic medical devices that have been mainly problematic.

The evolution of informed consent in gastroenterology.

With medical litigation on the rise, physicians require a nuanced understanding of the legalities of consenting patients to reduce their liability while practising evidence-based medicine. This study aims to a) clarify the legal duties of gastroenterologists in the UK and USA when gaining informed consent and b) provide recommendations at the international and physician level to improve the consent process and reduce liability.A bibliometric analysis of the Web of Science database with the MeSH terms "gastroenterology" and "informed consent" yielded 383 articles, of which 228 were excluded due to not meeting the inclusion criteria. Of the top 50 articles, 48% were from American institutions and 16% were from the UK. Thematic analysis showed 72% of the articles discussed informed consent in relation to diagnostic procedures, 14% regarding treatment, and 14% regarding research participation.Both the USA and the UK have progressed from previously paternalistic Natanson case (1960) and Bolam test (1957), respectively, where physicians were held to the standard of a "reasonable and prudent medical doctor". The American Canterbury case (1972) and the British Montgomery case (2015) radically shifted the standard of disclosure during the consent process by requiring physicians to explain all information pertinent to a "reasonable patient".It is our recommendation that a two-pronged approach be taken; a) creation of international guidelines for consenting patients for invasive procedures in gastroenterology, and b) development of internationally standardised endoscopy consent forms containing all the details pertinent to a "reasonable patient".

The impact of a digital wheeze detector on parental disease management of pre-school children suffering from wheezing\u2014a pilot study

BackgroundViral airway infections are a major reason for doctor’s visits at pre-school age, especially when associated with wheezing. While proper treatment requires adequate recognition of airway obstruction, caretakers are often struggling with this judgment, consequently leading to insufficient or late treatment and an unnecessary discomfort of the patient. Digital technologies may serve to support parental decision taking. The aim of the present pilot study is to acquire data on the feasibility of recruitment and observation procedures for a randomized controlled trial on the impact of a digital wheeze detector in a home management setting of pre-school wheezing.MethodsThis single-armed pilot study enrolled patients with a doctor’s diagnosis of wheezing aged 9 to 72 months. Participants were asked to use a digital wheeze detector (WheezeScan, Omron Healthcare, Japan) 2×/day for 30 days and record the child’s respiratory symptoms, detection of wheezing, and medication intake via an electronic diary (eDiary) app. Demographic and clinical data were collected at the recruitment visit. The asthma control test and the Parent Asthma Management Self-Efficacy Scale (PAMSES) were assessed both, at recruitment and follow-up.ResultsTwenty families were recruited and completed the monitoring. All but one completed the follow-up after 30 days. The recruitment procedures were feasible, and adherence to daily monitoring reached an average of 81%. The use of the wheeze detector was rated as uncomplicated. Parents detected wheezing without digital support in only 22/708 (3.1%) of the recorded events. By contrast, the wheeze detector indicated an airway obstruction in 140/708 (19.8%) of the recordings.ConclusionIn parallel to feasible recruitment procedures, we observed good usability of the wheeze detection device and high adherence to eDiary recording. The positive outcomes show that the WheezeScan may empower parents by increasing their capacity for wheeze detection. This deserves to be investigated in a larger randomized controlled trial.

Regional anaesthesia: risk, consent and complications

SummaryThe risks of regional anaesthesia relate primarily to the technical nature of the procedure, chief among them being neurological. While rare, the direct relationship between nerve damage and the procedure itself means that patients need to be aware of this complication when consent is sought. In order to give valid consent, a patient must be informed. The extent of the information required has been defined by a 2015 legal ruling which established that the standard is the expectation of a reasonable patient, rather than the information deemed consequential by a reasonable doctor. The implications of this for clinicians are profound, and mean that the process of consent must, for example, include alternatives to the proposed treatment. Additionally, patients must have capacity and give their consent without coercion. Effective communication of risk can be challenging. As well as the barriers to comprehension that can result from language, literacy and numeracy, clinicians need to be aware of their own biases, often in favour of a regional anaesthetic approach. Patients also have biases, and doctors must be aware of these in order to best target their provision of information. Careful use of language and employing adjuncts such as information leaflets and visual aids can help to maximise the individual's autonomy. Particular care must be taken in special situations such as where patients have capacity issues or time is limited by the emergency nature of the intervention.

Antibiotic self-medication and knowledge about antimicrobial resistance among medical and non-medical students of the University of Dodoma, Tanzania

Background: Antibiotic misuse and overuse are the major driving factors of antimicrobial resistance (AMR). High-income countries have been conscious of the problem for several years, while Tanzania shows the increasing trend of self-medication with antibacterial drugs. This study aimed to compare the antibiotics use practice and awareness about AMR among undergraduate students of the largest Tanzanian university. Methods and materials: Self-administered questionnaires were distributed among 2nd year medical (MDS) and non-medical students (non-MDS) at the University of Dodoma, Tanzania. A total of 356 respondent's answers were analyzed in the study. Statistical analysis was done by using MedCalc statistical software. p < 0.05 was considered statistically significant. Results: Non-MDS were more prone to use self-medication with antibiotics compared to MDS group: 46.2% and 35.1%, respectively (OR 1.58, 95%CI: 1.0 to 2.5). Among them, 45.5% of non-MDS and 49.2% of MDS reported an inability to visit a doctor as the main reason for the self-treatment. Moreover, non-MDS replied that they did not attend the doctor for financial reasons (OR 4.64, 95%CI: 2.05 to 10.46). Most students relied on a previous experience to choose medicine type: 76.3% MDS and 57.6% non-MDS (OR 2.36, 95%CI: 1.09 to 5.13). The next most common approach, notably popular among Tanzanian students, was to follow Pharmacist's recommendations: 22% MDS and 24.2% non-MDS. All surveyed participants demonstrated a high level of awareness regarding the antibiotic indications. However, less than half of MDS (46.2%) knew about AMR, and only 19.1% of non-MDS were familiar with the problem (OR 3.63, 95%CI 2.22 to 5.95). Furthermore, 48.8% of MD and 27.3% of non-MD students did not finish an entire course of antibiotics (OR 2.54, 95%CI 1.58 to 4.09) and stopped taking a drug mainly when the symptoms of disease disappeared. Analysis of antibiotic trends showed Ampicillin, Amoxicillin and others from Penicillin group to be the most popular among Tanzanian undergraduates. However, many students confused antibiotics, pain killers and antiallergic medicines. Conclusion: Our findings indicated the high rate of self-medication with antibiotics and AMR illiteracy among undergraduate students that proved the necessity of educational programs, antibiotic use guidance and the control of sales of antibiotics in the country.

The Association of Post-Materialism with Health Care Use. Findings of a General Population Survey in Germany.

(1) The aim of this study was to identify the association between post-materialism and health care use (in terms of the frequency of doctor visits and the reason for doctor visits). (2) Data were taken from the German General Social Survey (a representative sample of individuals aged 18 years and over, n = 3338). The Inglehart’s post-materialist index was used to quantify post-materialism. The doctor visits (self-reported) in the past three months served as an outcome measure. The reasons for seeing a doctor served as an additional outcome measure (acute illness; chronic illness; feeling unwell; requesting advice; visit to the doctor’s office without consulting the doctor (e.g., need to get a prescription); preventive medical check-up/vaccination). (3) After adjusting for several covariates, negative binomial regressions revealed that compared with materialism, post-materialism was associated with decreased doctor visits (total sample; women). Moreover, the likelihood of visiting the doctor for reasons of chronic illnesses was lower in post-materialistic women, whereas the likelihood of visiting the doctor for reasons of preventive medical check-up/vaccination was higher in post-materialistic women. (4) Study findings identify an unexplored link between post-materialism and doctor visits in women. One may conclude that in the long-term, the increased likelihood of preventive medical check-ups in post-materialistic women will be beneficial in decreasing the need for doctor visits for reasons of chronic illnesses. However, future research is required to elucidate the underlying mechanisms.

The effect of the Montgomery judgment on settled claims against the National Health Service due to failure to inform before giving consent to treatment.

A landmark legal judgment in March 2015 (Montgomery) changed the test for determining negligence due to failing to inform patients before consent, by moving away from asking what a reasonable doctor should disclose and asking instead what a reasonable patient would expect to know. We sought to determine the effect Montgomery has had on settled claims due to failure to inform compared with claims for other reasons and whether legal firms are adding contributory claims of failure to inform to other principal allegations of negligence. A Freedom of Information request to NHS Resolution provided data on the number of settled claims against the NHS (2005-19) for any cause and where failure to inform before consent was the principal or contributory cause. Time-series regression was used to compare trends before and after 31 March 2015. The trend in claims/year increased 4-fold for failure to inform (an increase of 9.8/year before 2015 vs. 39.5/year after 2015, P < 0.01), 2.7-fold when failure to inform was the principal cause (7.9/year vs. 21.2/year, P = 0.02) and 9.9-fold as a contributory cause (1.9/year vs. 18.3/year, P < 0.01). There was no material difference in claims due to other causes (334/year vs. 318/year, P = 0.84). Montgomery has led to a substantial increase in settled claims of failure to inform before consent, with no coincident change in claims for other causes. The increase in contributory compared with principal causes suggests that lawyers are using the judgment to increase the chances of a successful claim against the NHS.

Pelvik Organ Prolapsusunda Semptomlar ile Kliniğe Başvuru Süreleri Arasındaki İlişki

Pelvic organ prolapse is the descent of one or more of the anterior vaginal wall, posterior vaginal wall, the uterus, or the vaginal vault. Many patients with pelvic organ prolapse do not actually come to the doctor or seek medical support too late, although it may impair quality of life. This study aimed to determine the period when the patients with pelvic organ prolapse applied to the doctor, the time between the onset of symptoms and the time of admission to the doctor, and the cause of seeking medical advice. In this prospective study, Pelvic Organ Prolapse Quantification System (POP-Q) classification of the patients who came to our urogynecology outpatient clinic with the complaint of vaginal bulging was performed and the time between the prolapse symptoms and the moment when the patient was admitted to the clinic was investigated. 1473 patients admitted to our urogynecology outpatient clinic with pelvic organ prolapse between 01.01.2018 - 31.05.2019. Although 11.4% of the patients applied to the doctor as soon as they had become symptomatic, 42.7% applied to the doctor after 1-3 years. Even though anterior or apical compartment prolapse was frequently seen at admission, the probability of developing complete uterine prolapse increased significantly as the time of admission to the doctor was prolonged. The main reason for seeking medical support in prolapse patients was the deterioration in the quality of life. Although pelvic floor defects are common in women with advancing age, only about 10% of the patients go to a doctor as soon as they are symptomatic. All the remaining patients delayed admission to the doctor for various reasons and attempted to solve this problem on their own. There is a need to raise awareness of pelvic organ prolapse and the pelvic floor in the whole population.

Fears and fallacies: Doctors’ perceptions of the barriers to medical innovation

In 2014, Lord Saatchi launched his ultimately unsuccessful Medical Innovation Bill in the UK. Its laudable aim was to free doctors from the shackles that prevented them from providing responsible innovative treatment. Lord Saatchi’s principal contention was that current law was the unsurmountable barrier that prevented clinicians from delivering innovative treatments to cancer patients when conventional options had failed. This was because doctors feared that they might be sued or tried and convicted of gross negligence manslaughter if they deviated from standard practice. Concerns about fear of the law and potential negative effects on medical practice are not new. Fear of litigation has been suggested as the reason for doctors practising “defensive medicine,” by opting for treatments regarded as “grievance-resistant,” rather than clinically indicated, for example, by ordering diagnostic tests or performing certain procedures, which are not strictly medically necessary. Whilst this claim is plausible and apparently accepted by the courts, there is limited empirical evidence in support of it so far as practitioners in the UK are concerned. In this paper, we report on our empirical research which provides a snapshot of medical opinion to begin to rectify this gap. We ran focus groups of different medical specialties, asking what these medical practitioners thought the barriers to medical innovation to be. We found that fear of the law was not the principal barrier to be lowered, and that the answer was far more multifaceted.

Are perceived bad working conditions and perceived workplace bullying associated with doctor visits? Results of the nationally representative German General Social Survey

BackgroundThe reason for doctor visits associated with bad working conditions (and workplace bullying) remains unknown. Therefore, the aim of this study was to examine the association between perceived working conditions as well as workplace bullying and the number of doctor visits as well as the reason for seeing a doctor.MethodsData were derived from the German General Social Survey, a representative cross-section of the population in the year 2014. Self-reported doctor visits in the last 3 months were used as outcome measure. Self-rated working conditions (noise, bad air; time/performance pressure; bad working atmosphere; overtime; shifts/night work; hard physical labour) and workplace bullying were assessed. The reason for seeing a doctor was also recorded (acute illness; chronic illness; feeling unwell; requesting advice; visit to the doctor’s office without consulting the doctor (e.g., need to get a prescription); preventive medical check-up/vaccination). Regression analysis stratified by sex was conducted.ResultsAdjusting for various potential confounders, Poisson regressions showed that workplace bullying was associated with increased doctor visits in men, but not in women. Contrarily, time/performance pressure at work was only associated with increased doctor visits in women, but not in men. Furthermore, the probability of visiting the doctor for reasons of acute illness or feeling unwell increased with workplace bullying in men. The probability of visiting the doctor because of feeling unwell increased with time/performance pressure in women.ConclusionsOur findings stress the association between adverse working conditions (workplace bullying as well as time/performance pressure at work) and doctor visits, with remarkable gender differences. Longitudinal studies are required to confirm the present findings and to obtain further insights into this relationship.

The influence of employee training and information on the probability of accident rates

The construction industry is one of the most important socio-economic sectors of the Spanish economy and one of the most affected by workplace accidents. An analysis of the data on accident rates is needed, in order to identify variables related with workplace accidents and to define the measures that need to be taken for their reduction. In this study, an analysis is conducted using Bayesian Networks and data from the 7th National Survey on Working Conditions (VII NSWC), to study the relations between workplace accidents, visiting a doctor for occupational reasons, time in the company/sector, information that workers have on workplace risks in the workplace, and information and training on workplace risks that workers have received over the past two years. The NSWC survey, which is conducted every four years, was administered to 8892 workers, in Spain, in 2011. The values derived from the analysis yield certain implications involving the aforementioned variables and how to reduce the probability of workplace accidents. From among the variables under study, information on workplace risks is the most important, with the probability of suffering an accident in the construction industry doubling when such information is insufficient. In accordance with the results, these implications could also help with decision-making focused on improvements to training and on-the-job information, intended both to prevent and to reduce workplace accidents.

Alcohol-related social and health service use patterns as predictors of death and remission in patients with AUD

AimThis study examines the extent and continuity of alcohol-related social and health service utilization (HSU) of individuals with alcohol use disorder (AUD) and predicts longitudinal care outcomes in a prospective cohort study, by using electronic health records (EHR). In addition, use of mental health (MH) services is examined. Data and methodsData on alcohol-related social and health care visits and treatment periods were gathered from the EHR and municipal social service client databases in the North Karelia district of Finland, between 2011 and 2016 (n = 396). ResultsInstitutional care (odds ratio [OR] 1.55), contact with MH nurse (OR 1.22), and visits to the primary health care (PHC) doctor for MH reasons (OR 1.89) were associated with increased odds of remission. Alcohol-related visits to the PHC doctor were associated with increased odds of death (OR 1.67). A high number of permanent diagnoses (OR 0.19), drunk driving incidences (OR 0.28), visits to specialized AUD doctor (OR 0.36), and visits to MH doctor (OR 0.50) decreased the odds of death. ConclusionsDifferences in HSU were identified according to the outcome status. MH-related visits were associated with achieving remission. Alcohol-related visits to PHC services were associated with an increased risk of death. Thus, the current capacity of PHC alone to address the care of patients with AUD seems insufficient. The integration of social and health services, access to specialized AUD care, and care coordination should be improved.

Informed Consent to Medical Treatment Post-Montgomery: Causation and Coincidence.

If a patient suffers physical harm during medical treatment when a risk materialises which the doctor failed to warn the patient about, there are two key issues when a negligence claim is brought by the patient. First, it must be shown that the doctor was negligent in failing to warn the patient about the particular risk. Secondly, it must normally be shown that this failure to warn was a cause of the damage suffered, although courts also allow claims to succeed when a patient may still have undergone treatment even if adequately warned. The recent decision in Montgomery v Lanarkshire HA [2015] UKSC 11 changes the test for the first of these steps, by moving away from asking what a reasonable doctor would warn about and asking instead what a reasonable patient, or indeed the actual patient, would want to know. This article considers how that change ought to impact on the second step, causation. The first part of this article traces the development of the law on the standard of disclosure of risks, from Sidaway to Montgomery in order to expose the place that patient autonomy now occupies and the conception of autonomy that underlies the decisions. The second section addresses the causation issues arising in cases of medical non-disclosure of risk, and includes but is not limited to discussion of Chester. It first considers the modified objective approach to proof of causation adopted in Canada and argues that English law would be wise to reject such a development. The Chester problem is then addressed, and the analysis will focus primarily on what is actually meant by 'coincidence' since this term is often used but rarely explained. Finally, considering the situation that arises when the risk that materialises is different from the risk about which the doctor failed to warn the patient, it argues for a closer delineation of the relevant risks in English law.

Private and institutionalised patients' use of homeopathy in the early nineteenth century

Medicine underwent a major crisis in the 18th century and several approaches, including homeopathy, were formulated to fill the void left by the fall of traditional Galenic medicine. While most of the literature deals with the reasons doctors had to shift to homeopathy, the patients' views became the focus of increasing scholarly attention along the past 20 years. In this article I present and discuss the current knowledge about the socio-demographic characteristics and medical complaints of patients who sought homeopathic care in the early 19th century in both private and institutional settings. The results show that not only patients from the higher and more educated classes sought homeopathic care, but a considerable number of individuals from the middle and lower strata did so too, even though they also had access to conventional hospitals. As to the clinical complaints, the reasons to seek homeopathic care were the typical ones for any general practice or hospital in the period considered.

Thefaut v. Johnston (2017)

All orthopaedic surgeons consenting patients for elective surgery should be aware of the recent High Court decision in Thefaut v. Johnston. Lisa Thefaut won her claim for damages against very experienced spinal surgeon Francis Johnston on the basis that the consenting process for an elective discectomy had been substandard. This decision sets the bar for clinicians higher than ever before. Mr Justice Green made clear that surgeons are required to engage in a consenting process tailored to the individual patient with detailed, accurate and realistic explanations of the pros and cons of surgery. This was a spinal case but a patient’s rights would be the same with any other operation. The Judge’s starting point was the landmark decision of the Supreme Court in Montgomery v. Lanarkshire Health Board in March 2015. Nadine Montgomery was pregnant and diabetic. The risk of shoulder dystocia during a vaginal delivery was about 10% and the risk of serious harm to her baby as a result was about 1%. A consultant obstetrician did not tell Ms Montgomery of the risk or offer her a caesarean section. This was because the consultant believed that, given the choice, Ms Montgomery would opt for a caesarean section, something which the consultant thought better avoided if possible. The Supreme Court decided that the time had come to assess consent on the basis of what the reasonable patient wanted to know rather than what a reasonable doctor chose to say. Where different treatment options were available, it should be the patient rather than the doctor who decides which option to take. Two limited exceptions were preserved where it would be ‘seriously detrimental to the patient’s health’ to provide information to a patient and cases of necessity, for example where an unconscious patient requires urgent treatment. The decision in Montgomery is …