Sunday, December 26, 2010

Medical consultation between doctors in our hospitals

Consultation between colleagues of different specialties about patients in our hospitals frequently ignores proper ethical principles and may therefore create problems and bad feelings.
1.     A junior resident doctor may send a consultation about a patient directly to a consultant in another department sometimes before the patient was seen by the consultant in charge. The proper way is that the consultant in charge of the patient should send the consultation. This ensures that he has seen the patient and that the consultation is needed. Not infrequently, the consultant in charge can solve the problem when he sees the patient or decides that it is not a priority and not needed at that time. It also avoids the possible feeling by the consulted doctor of being treated without due respect because the consultant in charge has not taken the trouble of writing the consultation himself. There may be an excuse for the junior doctor to do so in a case of emergency when time is vital and delay may harm the patient but this is not frequent and should be explained in the consultation letter.
2.     A consultant doctor may ask one of his juniors to respond to a consultation directed to him by a consultant colleague. This deprives the patient of receiving the best available opinion and is not good manners as it does not show respect to the doctor who consulted him. The proper way is that the consultant should respond himself if the letter of consultation has been written by a consultant colleague.

Wednesday, December 22, 2010

Time, the Enemy

A conference call for papers attracted my attention. The conference is the 33rd of the “International Association for Time Use Research” to be held in the University of Oxford (England) on 1-3 August 2011. The subject is time use. I entered “time use” in the search engine of Google which responded by showing 1,790,000 results including innumerable articles on time use research in different countries, sites of institutes of time use research and articles about how to manage your time properly because there is not enough time in the day for all you want to do. That brought to my mind the familiar sight in many cities of people reading in their pocket book while sitting in the train or the bus or waiting in a doctor’s room or even standing in a queue.
It also reminded me of the familiar sight in our country (and in others) of people spending most or all of their time sitting on street curbs or in street cafes doing nothing or indulging in some useless games. I remember once I was driving with a visiting professor in my car when we passed by a number of these cafes. Many of those sitting in the café were just rolling the beads of their rosaries (misbaha) and staring at the unknown. I said: it is a pity they are spending their time without a useful activity. The professor corrected: They are breathing! If you ask these people and many others doing all sorts of useless things about what they are doing many will give the familiar answer: we want to kill time. I do not know what made ‘time’ that hated enemy that deserves to be killed!

Friday, December 17, 2010

هل تقاس صحة القرار بنتيجته؟

من الشائع ان يحكم على القرار بنتيجته فان كانت جيدة اعتبر صائبا ونال صاحبه الثناء وان كانت سيئة اعتبر خاطئا وتعرض صاحبه للنقد. وهذا حكم غير منصف لانه يستند على المعلومات التي توفرت بعد اتخاذ القرار ولم تكن متوفرة حين اتخاذه. ان الحكم على صواب القرار يجب ان يعتمد على مدى حسن التقدير بناء على المعلومات المتوفرة حين اتخاذ القرار فان متخذ القرار لا يعلم الغيب وانما يبني قراره على الاحتمالات التي يتوقع حدوثها في كل حالة. ويتضح الامر بضرب مثال. فلو فرضنا ان شخصا اراد السفر من مدينة الى أخرى وكان هناك طريقان احدهما خطير نسبة الحوادث فيه 95% والاخر أمين نسبة الحوادث فيه 5% فاختار الطريق الامين ولكنه تعرض لحادث وان شخصا اخر اختار الطريق الخطر ولكنه نجى ولم يتعرض لحادث فهل نقول ان الاول اخطأ باختياره الطريق الامين وان الثاني اصاب باختياره الطريق الخطر؟
ان الحكم على صواب قرار ما يجب ان لا يعتمد على النتيجة وانما على صحة التقدير بناء على المعلومات المتوفرة حين اتخاذ القرار. ولو عمل الناس بهذا لقل بينهم الخلاف واللوم والتأنيب.
( ولو كنت أعلم الغيب لأستكثرت من الخير وما مسني السوء) – قران كريم (الأعراف 188)