The current scientific literature that documents the positive outcomes of reducing and or elimiating transfusion should be enough for the reasonable clinician.

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Michelle Thomas, RNC

I agree with Michelle, the evidence mounting clearly shows that transfusions many time lead to problems in the course of the patients hospital stay.
Have you considered though trialing new devices that assist in reducing/eliminating the need for blood transfusions in the surgical setting? I my view, anyone in a leadership position in blood management should be looking for and introducing new technology to the surgeons to assist them in reducing there dependance on the use of allogenic blood. If they are not interested, move on to others.

Bradford Ray

The keyword to Michelle's post is reasonable clinician. Although not a physician, one could assume this as a possibility. After years of attending school to become a doctor and truly wanting to help patients, one should respect someone's decision to want no blood, but if push comes to shove, some professionals cannot and will not allow a patient to die and will order blood should it come to that. Why? A lawsuit looms each time a scapel is used. Already a physician has to pay an immense amount of money because of that. Anything will be done to avoid that. Remember...this is strictly my interpretation.

Perhaps I am wrong in my thinking, but one cannot dismiss the fact that this society is a lawsuit society. Easy money. How does one convince a doctor that no matter the outcome, if his expertise was truly demonstrated during surgery, no one could ask anything more. If only it were that easy.

And of course, "reasonable" is defined by each person using it, whether a medical professional or the general public. Wherever that word leads for whatever goal purposed.

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Sybille
“Think highly of yourself
because the world takes you
at your own estimate.”

I work as a nurse in the OB unit of a hospital in Colorado. There is still a lot of old habit/"tradition" surrounding the use of blood, and also - as sybillruth points out - defensive medicine due to fear of litigation. They still don't see blood as being as risky as it really is.

However, I am trying, in my own small way, to breach some of the old attiitudes of the doctors I work with. For example, several had never heard of the recent research revealing that without nitric acid, oxygen is not adequately transferred from RBCs to the cells, thus transfusions of stored blood have not been achieving the oxygenation it was previously thought they were. Their response is generally skeptical, and some wave the information off as if it was irrelevant or inconsequential.

I locate the research online, in full text if possible, and try to send these docs emails so they can check it for themselves. I also frequently send our perinatal clinical nurse specialist the same kind of research references. She is in a great position to point these things out to the physicians, since she frequently interfaces with the physicians during meetings and rounds. I send her links from this site as much as possible, giving her the opportunity to monitor some of the threads for additional resources.

You just do what you can. Maybe post some of the research (if you can get full text versions) in conspicious places around the unit. Hope this helps.

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Jan Grossberg, RN, BSN
Editorial Team

I notice that you are from Ireland. It may be that the relationship you have with the a doctor in Ireland differs from we living in the States.

Can you give some background to your question? For example, have you tried to reach doctors in your area or are you commenting on what you have read and heard?

I know that in Ireland, Jehovah's Witnesses have been very busy reaching out to physicians. Many physician's have changed their outlook as a result of the Witnesses Hospital Liaison Committees'. I have spoken to the fellow who heads up that office at the Irish Branch of Jehovah's Witnesses and have heard him speak of progress they have made there.

I do know that the relationship between doctor and patient suffers a much larger gulf there in Ireland. It used to be that way here in the States but changes in health care law have forced doctors to listen and show greater respect to patients. And one more thing...I have noticed that in the States the "old school" doctors have left the scene into retirement. The younger physician's seem to be much more open with their patients.

I guess the point I am making is it takes time to change the status quo. One thing is sure, having a tactful, respectful attitude is better than carrying an activist mentality. Judging the doctors as either reasonable or not reasonable is a negative act and will hurt efforts to influence hospital administrators and physicians. Don't you like to feel understood and respected even by someone who is trying to influence you to change a certain point of view? I know I do :-) .

All the best to you.

Jan

__________________
Mr. Jan B. Wade
Blood Management Consultant
Enhance Outcomes - Control Cost
For Information Call - 360 296-1807
Email

I do agree with the above statement, although it is very hard, at times, to accord physicians the respect they deserve when their treatment of patients is less than professional. From the time spent in waiting rooms to a hurried consultation, one cannot help but feel they are being unheard. No wonder, patience is not one of the greater virtues demonstrated when keeping appointments. If doctors respond to patients in such manner, what guarantee does a patient have when it comes to a reasonable explanation of not wanting to be transfused with blood? Will the doctor even hear what is said let alone why it is said? Respect begets respect. It is as simple as that and works both ways.

__________________
Sybille
“Think highly of yourself
because the world takes you
at your own estimate.”

I want to thank all the above for their comments. The question was general and not to a specific doctor(s) I understand it take time to change.

In promoting any advances in medicine, promote the benefits, not features.

Here is the catch. Humans make decisions based on varied criteria.

One anesthesiologist just weeks from retirement was excited to get the information on how he could keep a patient alive at lower counts. He just lost a patient at a hgb of 5.5. Benefit...empowerment, improved outcomes.

A new resident was walking away from a conversation when I said a certain unit at a regional hospital had a 3 million profit in the first year of operation. He turned around and talked. Benefit...Profits

One doctor who sat in on an educational meeting was faced with a patient, 87 year old hip fracture who needed blood, was obliged not to use it. On seeing her do better than a 35 year old, same fracture, who got blood, and the 87 year old got out of the hospital faster, he could not get enough information.

Benefit...improved outcomes.

Note in the last case although he was the Chief of Surgery and started using these techniques with all his patients, 10 years later he is still unable to get the hospital to switch over. It is a small rural community hospital. I had doc's complaining to me that some other docs were still giving blood at Hgb 10 back then when the standard was 8.

They would say, can't you educate them or something? I was just an LPN at the time.

Interestingly, he did not even give the blood from knee surgeries back. His anecdotal evidence was that they did better even though it was their own blood they were not getting. The nurses loved it. Less work, improved healing, less complications. To the nurses this was a benefit, to the doctors, the benefit to the nurses could be a feature.

One other thing. Make sure the information you share is up to date. They generally do not want to read anything over 3 years old and the cut off is 5 years.

Also some doctors will accept anecdotal evidence. Others want science. You better know the dissenting views too. I have more than once been questioned about the down sides. On being fluent in them, they would listen to the up side.

I am a doctor in India, which does not have the kind of litigation that is in western countries. But here the problem is physicians are taught to save life at any cost. For them it is the ideal of life which is higher than a patients wish. So it is not so much blood but patient's rights that need to be understood. Unfortunately in developing countries patients are not educated and so doctors most of the time make decisions and many times even provide treatment free of cost from their own pockets. So they are used to making decisions for their patients as they are poor and illiterate. Many doctors are like unsung heroes working in orphanages, villages etc. Sometimes the patient load is so heavy it is difficult to maintain a pleasant countenance. Doctors are also human and will err, unfortunately the stakes are high but then what alternative is there. In any profession you are going to make mistakes and learn from them. That is just the sad reality of this system. So it really doesn't make sense to blame the doctors. We need to educate them about patients rights, and "cut them some slack" for other issues. One positive thing is with globalization and info available, many of the new doctors are willing to consider these issues. So don't give up, the message will reach them eventually.

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Dr Amit Char
Editorial Team