¿A quien pertenece la ficha clínica? / On the ownership of medical records

It is not clear if medical records belong to the physician, the institution or the patient. There is a bill being discussed in the Chilean Congress that establishes that "the patient, personally or through a representative, has the right to access and review his medical record. In case of death, this right may be exerted by his inheritors". In this article we postulate that this bill infringes a number of legal norms in force and universally accepted ethical principles. We distinguish between patient's advocacy to be informed and their free access to medical records. The main ethical principles violated are those of beneficence and non maleficence

Sobre el control de la ética profesional / On the control of professional ethics

Professional colleages lost the ethical control of their members in 1980, when a free market economical model was implemented in Chile. Courts of justice have failed to accomplish this task. To recover such control, the Chilean Medical Association would need to modify its internal organization, separating its functions as a union from those required to control professional ethics. The health reform that is being set forth in the country, proposes a "new instance" for the control of professional ethics, within the Health Services and forming part of the Health Care Authority

De los derechos del paciente / About patientïs rights

This article discusses the difficulties and requirements to accomplish medical obligations of veracity, confidentiality, fidelity and respect to intimacy. Veracity consists in not saying all what we think but nothing contrary to our thoughts. In the fields of terminal care and genetics, conflicts arise between the right to veracity and the principles of beneficence and avoiding harm. The so called "therapeutic privilege" or the right of physicians to withhold information, has been considered among the exceptions to informed consent and is rejected by some specialists in ethics. Confidentiality is, for many people, an ideal more than a reality, not fulfilled by many physicians in the full sense of the word and threatened by third parties. Patients should claim their right to confidentiality. The obligation of loyalty or fidelity, that is the obligation that physicians have to give priority to patient's needs over own needs, has generated divided loyalties in many fields of medical practice due to changes in health organization and social context. The right to territorial, body and psychological or spiritual intimacy are three aspects of the right to intimacy that must be considered. Maybe, patient's rights are just the other face of medical obligations towards them. If we physicians become defenders of patient's rights, this could be another subtle facet of paternalism

Leucemia mieloide aguda del adulto: resultado del protocolo nacional de drogas antineoplásica: Hospital del Salvador 1990-1998 / Acute myeloid leukemia in the adult: results of the national antineoplastic drug protocol (Panda) at Hospital del Salvador, Chile

Background: The incidence of acute myeloid leukemia is 3 cases per 100.000 inhabitants/year and its five years event free survival is 15 to 20 percent. Since the incorporation of trans retinoic acid, event free survival of M3 acute myeloid leukemia is 80 percent. Aim: To report the results of acute myeloid leukemia treatment at the Hospital del Salvador, between 1990 and 1998. Patients and methods: The medical records of 117 patients (66 female, mean age 48.2 years), treated between 1990 and 1998 using PANDA protocol, were retrospectively reviewed. Immunophenotyping was done in 69 patients and cytogenetic studies were done in 65. Results: Sixteen percent of patients had M3 acute myeloid leukemia. The most frequent phenotype was the association of DR, CD34 plus a panmyeloid marker. DR and CD34 were negative in seven of nine patients with M3 acute myeloid leukemia. Cariotype was abnormal in 78 percent of patients. Complete remission was achieved in 65 percent of cases with a 13 percent of failures. Early mortality was 21.3 percent and decreased to 6.1 percent in the last three years. Infections and coagulation disorders were the main causes of death. Mean survival was 10.5 months. Five years event free survival was 11 percent. In M3 acute myeloid leukemia, the figure is 50 percent. Conclusions: Treatment results are less effective than protocols that consider more aggressive chemotherapeutic protocols or bone marrow transplantation. The reduction in early mortality is due to a better management of febrile neutropenia