Mock 29: practicing on recently deceased patients

[Guest shutterbug]

A patient in the ER has recently expired...your resident then asks if you want to practice a procedure on the cadaver since 'it will be a while before the relatives get here'. What do you do?

[Guest peachy]

I would absolutely refuse.

 

That isn't something that really happens, is it?!

[Guest lots of thinking]

There must be stricter regulations than just letting a student perform procedures on a cadaver. First of all I would think it would depend on whether the patient has signed to allow their bodies to be used for research.....:rolleyes

[Guest hmsdread]

Hmm, well I'm just a first year student, but I can say with relative confidence that this scenario is a loooooong shot to occur. (I mean, REALLY long). At least there is no way it would ever go down the way it was described in this scenario, ie. "practice a procedure".

 

Also, just because you're dead, that doesn't make you a cadaver. Even if the recently deceased proclaimed from the top of a building that their one wish in life was to have medical students learn from them after death, there is still a certain procedure that takes place of embalming, fixing, etc. You don't actually see cadavers in the lab until at least 6 months or so after they died.

 

There is a great deal of respect for the dead and especially for cadavers amongst medical professionals - I personally can't see anyone ever offering you such a scenario, and if by some wild chance someone did - well, I would hope that it would be a very open and close decision on what to do.

 

hmsdread

[Guest Carolyn]

I have never heard of such a thing happening! I think 99.9% of physicians, residents and students would look at whoever suggested it with absolute disgust and amazement...

 

That is the kind of story you hear from way back...

 

Don't worry, there is a very very very slim chance you would be asked to practice a procedure on a cadaver!

 

There is an interesting article done by some UofT students in the BMJ from a couple of years (2000/2001 maybe - one of the authors was Lin) back that sparked a huge move to insure student's were not being put in comprimising positions during their learning. This article was blown up in the media and having spoken to some people in the class of the group that wrote it - they found it a little much...

 

My experiences at McMaster have been great -- I can't say I've felt like I have ever been put in such a comprimising position.

 

These mock situations are great - you might want to check out the "Doing Right" book -- has lots of great ethical examples.

 

Carolyn

[Guest UWOMED2005]

That's a GREAT medical ethics book for med and premed students. . . I think it might have been your suggestion, Carolyn, a couple of years back on Delphi that influenced me to read it before my interview. While I didn't end up getting any ethics questions during my interview, that book would have been help if I had.

 

I don't think this would be a likely scenario at all.* Even ignoring the ethical implications or the fact the whole proposition is rather disgusting, a cadaver would be useless for practicing most physical exam maneouvers (ie listening to the heart sounds.) There may not always be a plethora of patients (standardized and real) to practice maneouvers, but there's surely enough that this kind of scenario would never happen.

 

*I'd like to point out two exceptions, though. Most first year med school anatomy courses include dissection of cadavers who voluntarily donate their bodies for our education. Also, there is the question of assisting on organ donation procedures. The latter I have personally been involved with - at the end of last year I helped a rural doctor remove the eyes from a patient who donated his corneas for tranplantation.

[Guest canstowski]

Where can i get that book? local bookstore?

[Guest UWOMED2005]

Or University Library.

[Guest shutterbug]

It does seem like an unlikely situation now that I think about it more. And, I don't think I would have gone through with it in any case...anyways, here is where I found the scenario:

 

eduserv.hscer.washington....udent.html

 

...which I found by linking from this site:

 

www.medicalethics.ca/

[Guest mtws]

I'm not sure I would have reacted with such abject shock as some seem to have. What about simple procedures like intubation? Didn't they do that on an episode of ER?

 

How many of us might simply have thought it was a normal practice? I'd probably ask the guy, "is this O.K.?", or "Do we do this sort of thing?". Does that make me a bad guy, or unethical? I hope not.

 

I'd learn how to intubate and avoid mauling the next guy's vocal cords?! Definately! (While being as "respectful and only as invasive as necessary", of course.)

 

Great site, by the way. Thanks.

 

Matt

[Guest Carolyn]

Matt,

 

thanks for your honesty -- I guess you're right - sometimes you are swayed by what the others in the room think is okay -- that said, practicing on recently deceased is generally considered unethical and I'm pretty disgusted by the idea and I'm obviously not in the minority...

 

In fact, I could see the scenario going the opposite way... If it got out that a student/resident took part in such unprofessional, unethical behaviour, I wouldn't be surprised if it was grounds for disciplinary action! You would have a lot of support if you refused to do something you felt unethical, most schools have avenues for dealing with it if you felt that you were being treated unfairly for making such decisions.

 

I don't remember an ER episode with such an experience - but I haven't yet had a make-out session in one of the utility rooms yet either during my clerkship!

 

There are many many ways to learn procedures without trying them on recently deceased. Perhaps on a cadaver that has been donated for learning is different. However, there are many many 'dummies', computer assisted models, and in some cases animals used for learning a lot of procedures. As well, you often learn procedures on real patients but you are so guided (often "Hand-over-hand") with so many people watching, it would be hard to screw up. The scarier times are when you are just starting to get comfortable with the procedure and don't have anyone around for back-up... I always ask for help when I run into any problems in those cases because I think that is where you see the most mistakes.

 

That said, Doing procedures themselves for most people are actually not that hard! Intubating itself is quite easy.. I did a bunch on dummies in my ACLS and ATLS course as well as other opportunities on dummies; then in Anesthesia I did a number while under general (much easier), I have yet to do one in the emerg but I'm hoping that is a just a matter of time (and a successful match on Thursday hopefully!) -- I have yet to intubate the esophagus - one day I will as everyone does and I have to remember each time how to check immediately for that and what to do (pull out the tube immediately!) If you are having trouble with a procedure it is likely a difficult one (i.e. a tough airway, difficult line, difficult poke etc.) - and you may watch your resident or staff struggle away with it as well.

 

It is the knowledge around all of the procedures that are very important... For example: Why do you use an internal jugular central line over a subclavian or a femoral. What are the potential complications of each? How do you landmark for each of them (got to know your anatomy very well)... How do you manage each complication? If you don't know these than you shouldn't do the procedure...

 

Yikes I'm addicted to this board tonight! I'm finding it impossible to study and fortunately I don't have any pressing things this week to study for... Thursday is our Match Day for residency and the stomach is starting to churn constantly!

[Guest mtws]

Good luck on Thursday.

Thanks,

Matt