RESUMO
Facing an investigation into performance concerns can be one of the most traumatic events in a doctor's career, and badly handled investigations can lead to severe distress. Yet there is no systematic way for National Health Service (NHS) Trusts to record the frequency of investigations, and extremely little data on the long-term outcomes of such action for the doctors. The document-Maintaining High Professional Standards in the Modern NHS (a framework for the initial investigation of concerns about doctors and dentists in the NHS)-should protect doctors from facing unfair or mismanaged performance management procedures, which include conduct, capability and health. Equally, it provides NHS Trusts with a framework that must be adhered to when managing performance concerns regarding doctors. Yet, very few doctors have even heard of it or know about the provisions it contains for their protection, and the implementation of the framework appears to be very variable across NHS Trusts. By empowering all doctors with the knowledge of what performance management procedures exist and how best practice should be implemented, we aim to ensure that they are informed participants in any investigation should it occur.
Assuntos
Competência Clínica/normas , Médicos , Prática Profissional , Profissionalismo , Desempenho Profissional/normas , Humanos , Responsabilidade Legal , Erros Médicos/legislação & jurisprudência , Erros Médicos/prevenção & controle , Gestão de Recursos Humanos/métodos , Médicos/psicologia , Médicos/normas , Prática Profissional/organização & administração , Prática Profissional/normas , Profissionalismo/ética , Profissionalismo/legislação & jurisprudência , Profissionalismo/normas , Medicina Estatal/normas , Reino Unido , Recursos Humanos/organização & administraçãoRESUMO
BACKGROUND: Congenital heart block affects 2% of all mothers with anti-Ro/La antibodies, can cause heart failure in utero, and has a 20% mortality rate in the first 3 years of life. Maternal fluorinated steroids to prevent or reverse congenital heart block can cause pregnancy complications. Intravenous immunoglobulin (IVIG) has been given with maternal steroids to prevent the recurrence of congenital heart block, although its efficacy is unproven. CASE: We report the use of IVIG to prevent progression of 2:1 congenital heart block with intermittent complete heart block. After two maternal infusions of IVIG (0.4 g/kg) at 31 weeks of gestation, the fetal heart rate reverted to long periods of sinus rhythm, which was sustained until postnatal life. CONCLUSION: Our case supports investigating IVIG in the prevention or treatment of this life-threatening condition.
