Rapid Responses to:
|
|
Rapid Responses: Rapid Responses published:
-
![[Read Rapid Response]](/icons/misc/sectionDOWN.gif)
Consent and common sense
- Sath Nag (12 September 2008)
-
Trust
- Umar A Ahmad (14 September 2008)
-
Learning Disability Population and Issues Around consent
- Dr Susan Varghese (15 September 2008)
-
Consent for publication leading to publication bias?
- Gopa Sen (15 September 2008)
-
Ridiculous to get consent in all cases
- Bina S. Menon (15 September 2008)
-
The greater public interest
- Ffion C Davies (16 September 2008)
-
What happens to papers rejected by the BMJ on ethical grounds
- N A Pace, Margaret Owen, Sara Schroter (20 September 2008)
-
PC versus common sense
- Anthony Papagiannis (25 September 2008)
|
|
|||
|
Sath Nag, Consultant Physician, Acute Medicine,Diabetes & Endocrinology James Cook University Hospital,Middlesbrough TS4 3BW
Send response to journal:
|
Information in medicine is gleaned as much from anecdotes and eminence based opinion as it is from evidence based fact. Case reports are excellent educational tools as the stories they tell reflect medicine as it happens in the real world. The vast majority of patients provide consent to publication of their case details. An equally large number of patients are not bothered about their details being published as long as their names are anonymised. I could give you an example but I'll probably need to get the patient’s consent before the BMJ publishes this rapid response. Most patients are flattered and excited about ‘their claim to fame’ when they are approached about being the subject of a case report. We have no option but to move with the times. As data protection laws are tightened we have to accept that the days of unconsented case reports are over. Should these rules of consent govern other forums of discussion? What about case reports that are presented at conferences as posters or oral presentations? If these rules of consent become mandatory then the hassle factor of tracking down long forgotten but interesting patients may just lead to the demise of the ubiquitous case report. Competing interests: None declared |
|||
|
|
|||
|
Umar A Ahmad, Student University of Bristol, BS8 1TH
Send response to journal:
|
I agree with the BMJ insisting on consent for the paper. The reasons the authors gave as not seeking consent was for fear of straining the fragile relationship with the parents further, but, consider what would happen if the patient found out the doctor had published their case without their knowledge. This would have furher alienated the parents and force them to become distrustful of their doctors which isn't good for the patient, his or her carers or the doctors involved. Competing interests: None declared |
|||
|
|
|||
|
Dr Susan Varghese, Speciality Registrar ST4, Learning disability Manor House,Bierton Road,Aylesbury,Buckinghamshire HP20 1EG
Send response to journal:
|
As a clinician working with people with learning disability, I read this article with great interest. I cannot agree more with the author's view regarding the importance of consent and patient doctor relationship. In our patient groups with varying level of disabilities, issues around capacity to consent, confidentiality etc becomes even more relevant. How far to-date reluctance and perceived difficulties in overcoming these grey areas have led to the general lack of good quality evidence in the field of learning disability? Mental Capacity Act 2005 make specific recommendations regarding issues around consent for research, publication etc.This hopefully will be the right step towards safeguarding the rights of our vulnerable group of patients. Competing interests: None declared |
|||
|
|
|||
|
Gopa Sen, SPR Paediatrics University College London Hospitals, NW1 2PG
Send response to journal:
|
The debate on consent for publication reminded me of a recent experience. I hoped to submit a case report for publication but was unsuccessful in obtaining written consent from the parents of the child. The parents were of Somali origin and they were unfamiliar with the concept of medical journals. We arranged face to face discussions, provided written information and offered the service of an interpreter, which was declined.The mother was initially receptive to the idea of publication but preferred her husband to make a decision on consent. The father felt that culturally it would be inappropriate to discuss his child's illness publicly. He further explained that he could not understand the need for his formal written consent if the case details had been anonymised anyway. The episode suggested to me that educational and cultural background can influence willingness to consent for publication. Colleagues tell me that they have had similar experiences. If so, could this lead to publication bias in the literature? Competing interests: None declared |
|||
|
|
|||
|
Bina S. Menon, Associate Professor of Paediatrics Universiti Putra Malaysia, 53000
Send response to journal:
|
I think it is ludicrous that current laws require consent from the patient prior to publishing case reports.The very cases that merit a report are the difficult ones with clinical dilemmas, often the patient has died. The very last thing any doctor is about to say to parents is " by the way do you mind if we write up this case?" The only situation where I think consent is necessary is if photographs, which may clearly identify the patient are used. Otherwise there is a long tradition of case reporting in the medical literature, so long as patient anonymity is maintained, I see no reason to ask for consent. Competing interests: None declared |
|||
|
|
|||
|
Ffion C Davies, Consultant in Emergency Medicine Leicester Royal Infirmary LE1 5WW
Send response to journal:
|
This article was timely for me - I was poised this weekend to submit a Personal View to BMJ on the frustrations of publication in the field of non-accidental injury. In this situation the public good and protection of children must (to a sensible person on a Clapham omnibus) supersede the difficulty or impossibility of gaining consent from the person with parental responsibility. I and others have submitted case reports / case series to BMJ publishing journals and either had to resubmit or submit elsewhere to circumvent this politically correct bureaucracy. Meanwhile paediatricians are slammed by the courts and the GMC for a lack of evidence base to their beliefs. My case report will be resubmitted this week now I have consent from the new adoptive parents, one year on. What was the point of this? What do they have to do with what happened in this child's infancy? While I fully respect that BMJ publishing has sought legal advice, this advice is defensive and failing to see the bigger picture of the reasons why doctors share research and experience. Competing interests: None declared |
|||
|
|
|||
|
N A Pace, Lead Clinician Anaesthesia Glasgow Western Infirmary G11 6NT, Margaret Owen, Sara Schroter
Send response to journal:
|
The paper rejected by the BMJ but subsequently published by the Journal of Paediatrics and Child Health raises a further issue. What happens to those papers the BMJ committee rejected? Following permission we reviewed the committee's minutes and documentation for the period 2004-2005 and identified 6 papers rejected on ethical grounds and subsequently published elsewhere in a form which did not take account of the ethical recommendations of the committee. This was a snapshot view and we cannot guarantee that all such papers were picked up. We contacted all 6 lead authors but only received replies from 3 agreeing to further discussion of the problem and permission to quote their own paper. Hence we cannot be more specific than state that: Two failed to get consent, one used an intrinsically unethical intervention, one relied on previously published papers by the same author which were highly questionable in terms of data presented, one presented data that had already been published by the BMJ and this was not made clear in the new submission but was offered as 'new data' and one was rejected on the grounds that ethical approval had not been sought. Clearly this raises issues about differing practices or standards in different journals. It also raises the issue that perhaps any submitted paper to any journal needs to confirm whether it has previously been rejected by another journal and if so on what grounds. Competing interests: NP is a member of the BMJ Ethics Committee SS works at the BMJ |
|||
|
|
|||
|
Anthony Papagiannis, Respiratory physician St Luke's Hospital, Thessaloniki, Greece
Send response to journal:
|
Quite a few years ago I submitted for publication a case of generalised vascular occlusion (which proved rapidly fatal) in an asymptomatic patient which had been picked up by a routine physical examination. The event had occurred eighteen years before the submission, in a non-English speaking country. The case report was turned down because of lack of consent by the next-of-kin. When I asked the editor involved how ethical it would be to approach a total stranger (assuming I could trace one) and ask for permission to publish the anonymous history of a forgotten relative's final illness and demise I was referred to the journal's consent policy. At the end of the day, journal editors have the final say on what they want to publish, and on what terms. However, in these days of political correctness case reports may eventually be reduced to something like "Once upon a time a certain doctor diagnosed a certain patient as suffering from a certain illness, which had a certain unexpected outcome". Such a format is totally bland, its educational value is zilch, but at least it steps on nobody's political toes. Competing interests: None declared |
|||