UNSTRUCTURED Recently, cases of patients recording clinical encounters without the physician's knowledge have been reported, raising ethical and legal questions. No study to date has examined surgeon's and trainee's attitudes towards this practice. An anonymous online survey was developed and administered to surgeons and trainees in a large academic department of surgery. The responses between the surgeons and trainees were then compared. There were a total of 114 responses (response rate of 12.6%). Attitudes on the utility of recording clinical encounters varied. When comparing surgeons to trainees, 22% of surgeons disagreed that memory aide alone was sufficient when discussing difficult information while only 5.3% of trainees (p<0.05) did. Surgeons were more likely to think it was reasonable (38.8%) for patients to request recording their clinical encounter than trainees (13.5%, p<0.05). Trainees were also more likely to agree that this would hinder their therapeutic relationship (62.2%) compared to surgeons (38.8%, p<0.05). Trainees were more likely to believe this could be used against them in a medico-legal dispute (52.8%) compared to surgeons (29.25, p<0.05). Trainees were also more concerned that these clinical recordings could be taken out of context (86.1%) compared to surgeons (54.2%, p<0.05). In summary, surgeons' opinion on patient recording of clinical encounters vary. Few were aware of the legal implications. Trainees are even less likely to value recording clinical encounters and more likely to believe that these recordings could be harmful.
While the aetiology of eponymous surface signs of pancreatitis, retroperitoneal haemorrhage and bile leakage is known, it is unclear what causes their characteristic appearance. The location of Scarpa's fascia, the membranous layer of superficial fascia, makes it a potential candidate in understanding the pattern of these signs. The goal of this study was to assess the distribution of Scarpa's with respect to each sign. Dissections were performed on 7 embalmed cadavers, 3 males and 4 females, aged 63 to 92. Our results indicate that Scarpa's attaches where the umbilicus emerges from the external oblique aponeurosis providing a deficiency that can cause the bruising in Cullen's sign. As the membranous layer continues into the flanks, it creates a potential space which contributes to the pattern in Turner's sign. The continuation of the membranous layer into the axilla and chest forms another potential space for bile to form the pattern in Icterus Marginatus (demarcated truncal jaundice with retroperitoneal bile leakage). The anatomical characteristics of Scarpa's fascia described by this study support the hypothesis that it is involved in delineating the physical patterns seen in these clinical signs.Grant Funding SourceWestern Graduate Research
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