Surgical Ethics and

Law,Audit & Research

Presenter:
Dr. Mehfuj Emdad
MS phase A(Paediatric surgery)
DMCH
Current placement:SU-5

Moderator:
Assistant prof. Dr. Md. Nayeem dewan
 Surgical Audit & Research
Previous year question
• Short note:Evidence based practice(jan20,jan19)
How evidence based practice help in the management of
patient?
• Short note:Surgical Audit(July 19)
• Write down the importane of medical documentation?
(july16)
Evidence Based Surgery:
• Evidence based surgery is a move to find the best ways of managing
patients using clinical evidence from collected studies.
• Evidence based practice is an approach to health care that promotes the
collection,interpretation and integration (into clinical practice)of
valid,important applicable patient reported clinician observed and
research derived evidence.
Aims &Objecives:
To enrich personal experience
To recognize the factors those help or hinder more widespread
applications
Identify the best suggestion for action.
Requirements:
Collecting,analyzing and publishing evidences require reviews of
multiple randomized trials.

Steps of EBP:
1.Ask an answerable question
2.Track down the best evidence
3.Critically appraise the evidence.
4.Use the evidence in your clinical practice or management of patient.
5.Evaluate the effectiveness of applying that evidence.
Conclusion: Surgical practice has been considered as an art as
management of same disease varies among the surgeons
worldwide.So there is so much clinical information available that no
surgeon can know it all.No one had gather all the available
information together.Centers have been collecting RCTs & reviews to
provide up to date information for clinitians.
Surgical Audit:
Surgical audit is the systemic review of surgical practice including the
procedures used for diagnosis and treatment,use of resources and the
resulting outcome and quality of life for the patient.
Aims and objectives of surgical audit:
1.Improvement of standard surgical practice.
2.To highlight the area of highrisk of complication,death,cost etc.
3.Implementation of changes in surgical practice for patient benefit.
4.Professional education and team development
5.Raises overall quality of the clinical care
6.Ensuring the greatest possible health care by the available resource.
Component of Surgical audit:
1.Audit of structure(resource):doctors,nurse,equipment.
2.Audit of process : service to the patient
3.Audit of outcome:care,complication,death
Types of surgical audit:
1.Clinical audit
2.Medical audit
3.Comparative audit
4.Criterion audit
Audit cycle:
Importance of Medical Documentation/Records:
1.For the patient:
• Documentation of clinical history
• Continuity of treatment
• Claiming insurances
• Issue of medical certificate
• Legal evidences
2.For the Doctor:
• Medical review of treatment
• Research and publication
• Assist in legal proceedings
4.Medicolegal:
• For claiming insurance and tax benefit
• Malpractices and negligence
• Evidence in Court of Law
• Certification of Birth & Death
• Certification of invalid person
• Certification of mental status
5.Hospital:
• Quality,quantity and adequacy of treatment
• Medical audit
• Future planning and decision making
• Administration and management
• Medicolegal protection,Disease surveillance,Epidemiological studies
6.Research and training:
• Education and training
• Clinical and epidemiological research
• Health system research.
Surgical Ethics and Law:
Previous year question
• Write note on valid informed consent?
• Write down the importance of informed consent?
• How will you maintain confidentiality in surgical practice?
• How will you counsel a patient for a high risk operative procedure?
Importance of counselling before surgery?
Informed consent:
It is the fundamental thing on which the morality and legality of good
surgical practice depends.
General components of Informed consent should be:
1.Details about the diagnosis and prognosis
2.Option for management of the condition
3.A detailed explanation of the proposed procedure
4.Side effects and probable complications
Including side effects of drugs and post operative complications
Side effects of G/A,bed rest,catheter,I/Vinfusion,blood transfusion
5.Risk and benefits of each treatment option
6.Surgeon will take the consent
7.Two way communication and allow the patient to ask question
8.Give time to the patient to make a decision
Consent form:
1.Should be written
2.Signed by the patient >16 years (age of giving consent is 16 years)
Consent in special situation:
1.Children <16 years from parents
2.Unconscious patient:Surgeon as proxy
3.Emergency situation:no need of informed consent to save life,but keep
a good record of the situation.
4.Mentally handicapped or psychologically upset
psychiatrist+Surgeon+Relatives
Importance condition regarding informed consent:
• A quiet venue for discussion should be found
• Written material in the patients preferred language
• Should be provided diagrams where appropriate
• Patients should be given time and help to come to their own
decision
• The person obtaining the consent should ideally be the surgeon
who will carry out the treatment.
Legal importance:to avoid allegation of battery or negligence
Every surgeon should practice legl aspect of medicine to protect
himself and to respect human rights.
Battery : any doctor performing a procedure on a patient without
their consent can be found of battery.
Negligence: a doctor failed to give adequate information to allow
them to give informed consent can be found guilty of negligence.
Medical benefit for the patient : as the patient and the relatives are
well informed about the disease and the treatment process it helps
them in managing the patient and give psychological support.
Medical benefit for the doctors:
Maintain good professional reputation
Build good doctor patient relationship
Confidentiality :Surgeons must not discuss clinical matters with
relatives,friends,employers,unless the patient explicitly agrees.
Confidentiality may be breached in public interest like:
1.As a result of court order
2.Requirement for public health legislation
3.Preventing serious crime
4.Protect the safety of the individuals who are at risk of serious harm.
5.In the interest of the patient while they are unable to communicate
clearly because of psychological or physical illness.
Proper maintenance of confidentiality make the surgeon trustworthy to
patient.