Sufficient informed consent to medical treatment of adults legal and ethical perspectives from Malawi

This special communication discusses the current legal and ethical requirements for informed consent to medical treatment of adults in Malawi. It analyzes the scope of the laws and code of ethics on professional discipline, including criminal privilege for surgeries and clarifies when insufficient disclosures entitle patients to compensation under civil law. Inconsistencies and uncertainties in the law are made apparent. It evaluates to which degree disclosure standards of other Commonwealth jurisdictions (e.g. the case of Montgomery) would be suitable for the health care setting of a country like Malawi that is characterized by shortages of resources, high illiteracy rates and a communitarian cultural context. Doctor-patient communication is not alien to African culture and part of sufficient informed consent. In order to balance the need for efficiency in health care delivery, accountability for quality care, fairness and effective patient-doctor communication the authors suggest to adopt the reasonable patient test only, if a defence of heavy workload on case-to-case basis is introduced at the same time. This does not dispense the need for organisational diligence on part of the institutional health care provider within its capacity

Effect of bedside teaching activities on patients' experiences at an Ethiopian hospital

Background. Clinical bedside teaching is more effective when done at the bedside. The number of medical schools in Ethiopia has increased tenfold in 8 years to meet the Millennium Development Goals. The increased number of students at the patient's bedside has been met with mixed feelings by patients. Objective. To determine patients' perceptions of bedside teaching during their admission to the medical and surgical wards at Mekelle University Hospital; Ethiopia. Methods. A 32-item questionnaire was used for data collection. Patients used a Likert scale to rate their perceptions of the quality of their hospital stay with regard to teaching; clerkships and physical examinations. Items where respondents scored less than the median of 67 (interquartile range 21) were categorised as displaying a negative attitude. Results. Patients (60%) did not favour the bedside teaching activities. No significant association was found with age; sex; occupation; literacy level; duration of hospital stay; and ward. Patients (80%) also did not understand the discussions following teaching sessions; and claimed to be unaware of the teaching status of the hospital. Patients (80%) did not understand the role of the students and were anxious when left alone to be examined and clerked by them. Conclusion. The rights of patients in medical education should be emphasised. Patients should be informed about the role of students at teaching ospitals and about their rights and responsibilities as patients. Institutional protocols and country-wide guidelines can help to regulate the number of times that a patient should be clerked and physically examined by students. Instructors should ensure that patients understand the purpose of the discussion that follows the examination