A retrospective review of almost , births showed that the risk of severe respiratory distress syndrome was The risk of an early term neonate being admitted to the NICU is approximately one in 20 deliveries, compared with about one in 50 for neonates born between 39 and 40 weeks. If elective inductions before 39 weeks gestation are apparently harmful, why are so many patients consenting to them? The authors point to a variety of reasons, including lack of knowledge, maternal discomfort, convenience, and patient and physician preference.
In addition, family physicians and other primary care clinicians who do not provide maternity care themselves can educate their patients and colleagues about the unnecessary harms that may result from this practice.
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Pediatric Genitourinary Imaging. Pyelonephritis Acute. WeigertMeyer Rule. AlphaFetoprotein AFP. Carcinoid Tumor. Diencephalic Syndrome Russell Syndrome. Immune Deficiency and Cancer. Pediatric Interventional Radiology. Musculoskeletal Disorders Osteoradiology. Periventricular Leukomalacia PVL. Pediatric Neuroimaging. Canavan Disease. Your browser is not compatible with Shopee Video Favorite 1. Shipping Fee. As noted above, Hippocrates showed little interest in diagnostics as we understand the concept but concentrated on course, therapy and prognosis.
The theory and practice of Hippocratic medicine can be found today only in the ministrations of some practitioners of holistic and alternative medicine. The corpus, however, contains the thoughts of the Hippocratic school on what we might call the philosophy and ethics of medicine and, indeed, pediatric radiology. Throughout the writings, Hippocrates showed great respect for the individual patient whose welfare was the means and end of Hippocratic practice.
Perhaps of most importance is that Hippocrates established the earliest extant code of medical ethics. Ethical teachings are found in several Hippocratic treatises, notably Epidemics I and the Hippocratic Oath. Within the corpus is the repeated admonition to do no harm to the patient.
The ethical issues frequently dealt with fees charged by the physician, but issues of equality and patient privacy played a prominent role.
This latter concept may have been practiced more in the breach than in the observance in that it is likely that citizen-physicians treated citizens and slave-physicians treated slaves [ 4 ]. The most famous statements of medical ethics are found in the Hippocratic Oath. Likely written a century after Hippocrates practiced and taught, it is an oath sworn to the relevant deities. Prominent among its admonitions is to show respect for teachers and to acknowledge that all physicians have an obligation to teach.
We are admonished to treat the sick, refrain from harm and injustice, and respect patient privacy among other responsibilities.
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Why should pediatric radiologists concern themselves with medical ethics? What role does ethics play in our technologically oriented specialty? Acute, chronic, critical, reversible, emergent, terminal? In sum, how can this patient benefit from an imaging examination and how can harm be avoided?
Can we obtain relevant clinical information from the referring physician by personal communication or written order? Can we, or should we, ethically refuse an examination that we believe to be nonindicated, especially if potentially harmful, in the absence of appropriate clinical rationale?
Can the question be answered by the requested examination? Is there a different examination that can better answer the question? Have indications, benefits and risks been explained? Have the risks of radiation, especially in children, been discussed? Have we explained the procedure in language the patient can understand? How do we communicate the results? Do we deal directly with the patient or only through our report to the referring clinician?
Justice is regarded as the equal distribution of health care among the population without regard to the ability to pay. An issue for physicians since the time of Hippocrates, and even before then in the Egyptian surgical papyri, has been the concept of doing no harm. Looking at pediatric radiology one can discern three cardinal sins that may harm the patient.
Sins of omission generally are overlooking the pertinent imaging findings or diagnosis. The most common sin of commission is making an incorrect diagnosis or interpretation of the findings or performing a clearly nonindicated or contraindicated examination. All of us have been guilty of these sins of omission and commission, and there is no doubt that all of us strive to reduce these errors as much as possible in our own practices. Informed consent, not just formal written consent but being sure that the patient truly understands the benefits and risks of the examination we are about to do.
Patient protection has become a major topic in the past few years. It is a credit to our subspecialty that pediatric radiologists have been preaching radiation protection in children for decades. This list of ethical responsibilities is largely self-evident. However, the increased use of electronic technology has separated some of the processes from their traditional methods.