Rapid responses are electronic comments to the editor. They enable our users
to debate issues raised in articles published on bmj.com. A rapid response
is first posted online. If you need the URL (web address) of an individual
response, simply click on the response headline and copy the URL from the
browser window. A proportion of responses will, after editing, be published
online and in the print journal as letters, which are indexed in PubMed.
Rapid responses are not indexed in PubMed and they are not journal articles.
The BMJ reserves the right to remove responses which are being
wilfully misrepresented as published articles or when it is brought to our
attention that a response spreads misinformation.
From March 2022, the word limit for rapid responses will be 600 words not
including references and author details. We will no longer post responses
that exceed this limit.
The word limit for letters selected from posted responses remains 300 words.
I have no problems with the law in regards to the obligation to offer
treatment or not when they think it is appropriate or not. My concern is
who will assess the ill elderly patient to make those decisions. Elderly
with fractures often fall because of a complex medical problem, the extent
of the medical problem need to be assessed by the most senior doctor in
the field of medicine. This is what is patchy and we need to improve on.
There are other issues which also may be muddled up with the decision not
for CPR e.g. who should then decide are these medically ill patients for
HDU or ITU. In my mind this again should be decided upon by the most
senior doctor in the field of medicine.
In my opinion, every elderly patient with a hip fracture should come under
combined care and the decision of CPR, HDU, ITU.. made by the consultant
care of elderly medicine and countersigned by the consultant orthopaedic
surgeon. Whether a sticker is put in the note or not will become
irrelevant as long us this combined decision is documented. A junior
medical registrar or SHO, and orthopaedic SHOs should do their best to
improve the care but should not make the decision of life or death.
who should or should not decide on CPR
Dear Sir
I have no problems with the law in regards to the obligation to offer
treatment or not when they think it is appropriate or not. My concern is
who will assess the ill elderly patient to make those decisions. Elderly
with fractures often fall because of a complex medical problem, the extent
of the medical problem need to be assessed by the most senior doctor in
the field of medicine. This is what is patchy and we need to improve on.
There are other issues which also may be muddled up with the decision not
for CPR e.g. who should then decide are these medically ill patients for
HDU or ITU. In my mind this again should be decided upon by the most
senior doctor in the field of medicine.
In my opinion, every elderly patient with a hip fracture should come under
combined care and the decision of CPR, HDU, ITU.. made by the consultant
care of elderly medicine and countersigned by the consultant orthopaedic
surgeon. Whether a sticker is put in the note or not will become
irrelevant as long us this combined decision is documented. A junior
medical registrar or SHO, and orthopaedic SHOs should do their best to
improve the care but should not make the decision of life or death.
Thank you
Adnan Faraj
Competing interests:
None declared
Competing interests: No competing interests