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the patient has SOB and found unconscious at home by his/her spouse. so, when the paramedic arrived, the patient has no sign of life.
can the paramedic declare that the patient is dead or need to bring to the hospital?
what to do if the family members refuse to do post-mortem?

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Salam Dr. I'm Syu. Does houseman considered fully registered doctor?

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Salam Dr. I'm Syu. Does houseman considered fully registered doctor?

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Who is the most responsible to discuss and break bad news to pt? What if the responsible person not there? How long should we wait especially for death news?

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Salam Dr, my name is Marissa. My question is - If a victim of domestic violence comes to ED to seek treatment, does he/she have to present with Borang 59 as well? What if the victim refuses to file a police report because he/she is afraid of the consequences from the spouse? Thank you Dr.

ans
borang 59 not required in domestic violence unless she was being rape
the survivor has the right to refuse police intervention
however if the survivior is still at risk of further injury , unsfe to discgharge home or no social support by the spouse temporary lodging or safe shelter home shall be arrange for the survivor

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Salam n good evening dr. Im Soffian.
If there is a patient who brought to ED alive, but during management of that patient, he/she died. Should the doctor in charge also being investigated for that COD? if the doctor was caught to do fault, what type of punishment will be issued? If the doctor was fined, is there any chances that the hospital will take responsibility of this matter?

salam soffian.
1. be charge if comiited crime. COD based on patient diagnosis. if death unknown cause pending for post mortem
2. punishment depends on crime comiited
3. depends on medical/hospital board

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Hi Dr. I am Vong. I would like to know more about the legislation.
1. if a doctor is sued for his or her negligence in providing care, for example, a non surgical doctor performs a surgical procedure in a patient who needs surgery as treatment, is he/she going to be fined and imprisoned at the same time or just either one? Can he/she still practice in the future? if he/she can no longer practise medicine, what can he/she do in the medical field?
Thank you dr.

ans:

hi vong
for a doctor to commit negligence it must fulfill 4 criteria
1. duty of care
2.breeach of duty
3.cause harm
4. harm directly cause by as a result of breech of duty

the will be medical board that will determined either the doctor can further practice or not

if the doctor commited a crime he shall be prosecuted

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Hi, Dr Sarah. I'm Lee.
1. What is the longest duration of leave we can give via medical certificate?
2. If a patient need a leave from work for around 2/3 months (eg. post MI), will we still offer medical certificate or there is other method?
3. Who has the authority to sign DNR form for the terminal patient?
Thank you Dr

1.MC  depends on the patient illness. Beside MC patient can be give light duty if the doctor think he is eligible
2.If MC extends to certain period it's depends on the medical board of institution for futher action
3 physician who treated the patient

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Assalamualaikum Dr.Sarah... I'm Amanina... my question is regarding MC... how if from our clinical judgement, the patient is fit to work, so we just give her time sleep..but she requested for an MC as  she feels that she is unfit to go to work... we   keep to our decision to not give the MC..then the patient go to work and got some harm/injuries at work as a consequences of her health problem...can the patient sue us for that?

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Assalamualaikum Dr.Sarah... I'm Amanina... my question is regarding MC... how if from our clinical judgement, the patient is fit to work, so we just give her time sleep..but she requested for an MC as  she feels that she is unfit to go to work... we   keep to our decision to not give the MC..then the patient go to work and got some harm/injuries at work as a consequences of her health problem...can the patient sue us for that?

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to sue a doctor for negligence is not easy
negligence it must fulfill 4 criteria
1. duty of care
2.breeach of duty
3.cause harm
4. harm directly cause by as a result of breech of duty

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Hello Dr. I am Thines. i would like to know in case of medications given to a patient, what if it was wrongly given and caused a serious effect in a patient just because of a bad hand writing by a doctor and it was wrongly interpreted by a nurse or a pharmacist?

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Hello Dr. I am Thines. i would like to know in case of medications given to a patient, what if it was wrongly given and caused a serious effect in a patient just because of a bad hand writing by a doctor and it was wrongly interpreted by a nurse or a pharmacist?

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mediation error is a fatal mistake
pharmacist or staff needs to verify first before give to patient

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let say the patient came was under age ( less than 18 years, and orphan, and let say people found him by the road, do we still need consent to do any prosedure  or management on him?

thanks in advamce dr. :)

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Hi Dr. its Adzmi again.
How do you disclose to the family member regarding the patient diagnosis of HIV?

do you ask the patient to tell their family personally and if you do, how long is the duration of time that you allow for patient to vonfront the family member? days? weeks?

hi azmi. the best is if the patient tell himself about his condition. They will go for councelling regard first

under common law can be disclose if there real risk to the people and disclosure is the only way to protect them
time frame is 24-48 hours

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Hi, Dr Sarah. I am Wen Xuan. I would like to ask if the patient already sign the consent form, but unfortunately the surgery come out with the complication and the patient want to sue that doctor. The patient claimed that the doctor didn't explain well about the complication to him. So does the patient can sue that doctor? Thank you Dr.

ans:
hi wen xuan
for a doctor to commit negligence it must fulfill 4 criteria
1. duty of care
2.breeach of duty
3.cause harm
4. harm directly result of breach of duty

that's why documentation is very important

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Assalamualaikum Dr. Sara. I'm Attikah.
1) what is the difference between Physiologically futile CPR and Non‐ therapeutic CPR.
2) In malaysia do we has the DNR form?

salam atikah
medical futile means intervention that are unlikely to produce any significant benefit for the patient
CPR  should not be performed when it would be physiologically futile that is when it would not work
non therapeuthic CPR is also designed for use in patients for whom CPR is not therapeuthic That is those patients in whom CPR cannot reverse the ongoing dying process or will not provide therapeutic benefits that outweight the harms

Documentation in the patient medical record of a decision DNR must be documented clearly in patient's note

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Salam Dr, i'm che ku. My quest ; can the family or legal guardian request for aor discharge instead of the pt him/herself (let say the pt could not communicate) and what is the most common reason given by the pt who requested for aor discharge?

ans
Yes if the patient has no capacity to decide
most common: when patient has end stage of disease and required paliative care

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Good evening Dr Sara. My name is Adzmi. If a terminal patient who already declared DNR, is it okay if we let them die by switching of the ventilation machine?

Thanks Dr Sara

Commonly we don't switch of ventilator except  cases such as brain death or irreversible causes that lead to death

Mainly in DNR we don't escalate treatment they would not further benefit patients

The decision has to be made clearly by both party (physician and family members) for the best patient interest

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Assalammualaikum dr. My name is hidayah borhan. saya ingin bertanya tntg mc. Mostly patient yg datang dan kdg2 ada yg dtg semata-mata untk mc, so what we can do if seeing this kind of patient especially when they insist to have that MC?

Regarding borang 14 , in what kind of patient or criteria that we can use this form for the patient excuse from attending the court?

Salam Hidayah
Dr have the right to give MC if indicated
Patient can be exempted from court if ill and cannot give testimony

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1)If a medical student provide medical consultation, does she/he will get sued if the one who get the consultation found out it was wrong?

2) is post mortem is compulsory for brought-in-dead / DID patient? How if the family refuse for post mortem, is there any law involving this condition?

3) Do we have other OSCC which are not located in ED, maybe in Primary Care or other places?

1. medical student has no duty of act
the term of consultation is incorrect
advice is better

2.Depends on case per basis
if it a murder case, police case post mortem  need to be done

3. OSCC only in gov hospital in Malaysia
priamry care needs to refer to nearest hospital

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Hi,dr sara. I am yiwen. I would like to ask regarding the AOR discharge. Is this meaning that after they have this AOR discharge, we will be giving them full treatment that they need? and what is the certain criteria for a patient to have AOR discharge. thanks dr.

Hi yiwen
Criteria for AOR disharge : sound mind, knows the risk and complication.
Eventhough they ask for AOR discharge we still can assist them give mc, medication, followup and arrange for transport

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Good day Dr Sarah,

I am Chandra . What other personnel who may be involved in an OSCC management of a survivor aside from doctors, police and a counseling agency? Thank you in an advance Dr.

Hi Chandra
Other personnel are JKM ( social welfare) and psychiatrist

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assalam Dr. Sara, farah here, in case of mva langgar lari, the father was black tag on site and the child (around 2 years old) was brought to our ED, no relatives can be contacted, however the child had a deep laceration on the scalp, and the head look swollen, till when we should wait before proceed to any investigation?cause patient need to be registered first right, but no identity to start of...

Salam farah
in emergency setting, which we can't get the parent, the next of kin, legal guardian, or police officer/child protector can give consent

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Dr Sara,,Rukaini here..may i ask if the patient assault me,,what fill should i fill to report the assault dr?? 

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Dr Sara,,Rukaini here..may i ask if the patient assault me,,what fill should i fill to report the assault dr?? 

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ans.
police report can be made and medical report need to be done

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Assalamualaikum Dr Sara,, I am Rukaini,, Dr Sara,, if the patient age 49 come to check her virginity and claim to be raped  month ago..what should i do dr,, ?

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Assalamualaikum Dr Sara,, I am Rukaini,, Dr Sara,, if the patient age 49 come to check her virginity and claim to be raped  month ago..what should i do dr,, ?

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ans:
hi rukaini
cases presents more than 72 hours are considered cold cases.
however the 72 hours cutt-off should only be used as a guideline and not a rigid policy.

All alleged rape and sexual abuse cases can be managed in OSCC ED

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Assalamualaikum Dr Sara,, I am Rukaini,, may i know,, if the patient have hearing loss that making the communication for us difficult in emergency case..sould us take the family consent or we need to wait..since the patient is capable but only have hearing loss

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Assalamualaikum Dr Sara,, I am Rukaini,, may i know,, if the patient have hearing loss that making the communication for us difficult in emergency case..sould us take the family consent or we need to wait..since the patient is capable but only have hearing loss

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wslam.

hearing loss we can write or use sign languange but need to be documented

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Hi Dr, im Linda. if the patient was raped and dont have the police report borang 59 with her, who should made the police report for her? Should we contact her parents first?

ans:

linda, if the victim present to ED without a police report  then it can be done in OSCC room. The victim should not be mde to go to police station . Privacy and confidentiality of must be respect

for all cases below 16 years old police report need to be done urgently. it can be done by healthcare professionals.

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Greetings, Dr. I'm Yi Han. If a patient is incompetent to give consent (unconcious, mental illness), who can we obtain the consent from?

ans
hi Yi Han next of kin or legal guardian

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Good evening Dr. I'm vino. Autonomy means patient has the right to choose what they want. And we need to inform all possible treatment available. If the patient choose the least effective treatment which may worsen the  , do we still proceed with that?

ans:
Hi vino . another ethical principles are " do no harm"  we need to weight risk and benefit of the patient as well

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Good morning Dr, I am david. how do we know, whether the patient is sound enough to make a decision and therefore we can allow him to make any decision (AOR discharge and etc).

Answ:

Hi david
Gcs must be full, not under duress, not under influence of alcohol or drugs.
We can also use mini mental state to assess mental capasity :)

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what is the differences between ethics, law and moral?

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what is the differences between ethics, law and moral?

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Salam and greeting. this is the ppt slides for my session. I hope all students read this first and ask question through this padlet. -Dr Sarah