{"id":4560,"date":"2024-03-04T12:18:50","date_gmt":"2024-03-04T11:18:50","guid":{"rendered":"https:\/\/blogs.bmj.com\/medical-ethics\/?p=4560"},"modified":"2024-03-04T12:20:06","modified_gmt":"2024-03-04T11:20:06","slug":"marthas-rule-rebalancing-power-dynamics-between-patients-or-families-and-clinicians-to-improve-patient-outcomes","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/medical-ethics\/2024\/03\/04\/marthas-rule-rebalancing-power-dynamics-between-patients-or-families-and-clinicians-to-improve-patient-outcomes\/","title":{"rendered":"Martha\u2019s rule: rebalancing power dynamics between patients or families and clinicians to improve patient outcomes"},"content":{"rendered":"

By Ilaria Bertini.<\/p>\n

UK media outlets have reported<\/a> the upcoming implementation of Martha’s Rule within NHS foundation trusts, starting from April 2024. This rule will enable swift second medical opinions for patients, healthcare practitioners, or families who express concerns regarding the patient’s response to care provided.<\/p>\n

This new pathway takes its name from a 13-year-old girl, Martha, who tragically lost her life at King\u2019s College Hospital in London due to a series of medical errors. Martha was admitted at Rays of Sunshine ward in Summer 2021 to treat her pancreatic injury caused by a fall from her bicycle \u2013 a condition considered serious but treatable. Unfortunately, doctors overseeing her care dismissed multiple times not only numerous red flags that Martha\u2019s condition was raising but also her parents\u2019 concerns about her rapid deterioration. By the time clinicians decided to admit her to the Paediatric Intensive Care Unit (PICU), Martha\u2019s septic infection was so widespread that it was too late to be reversed.<\/p>\n

Merope Mills, Martha\u2019s mother, not only extensively documented and discussed on many occasions the circumstances surrounding her daughter\u2019s tragic death, but also passionately advocated for measures to prevent similar occurrences in clinical settings. Martha\u2019s death was deemed preventable not because of deficiencies in hospital staffing, funding or bed availability \u2013 common issues within the NHS \u2013 but rather because Martha\u2019s symptoms and her family\u2019s concerns went unnoticed and were disregarded for too long: \u201cI was not listened to while at Martha\u2019s bedside. I raised concerns but was ignored. I was \u201creassured\u201d but not told the full truth. My opinion about Martha, whose trajectory I was following closely, was never sought by any doctor, junior or senior.\u201d<\/a><\/p>\n

With children, parents may naturally be seen as the most effective advocates for their overall well-being because of their intimate connection and closest proximity to their child. Parents are quick to notice any changes (positive or negative) in their child\u2019s condition particularly in hospital settings where they are often present at their child\u2019s bedside around the clock. Therefore, they are ideally positioned to raise concerns about their child\u2019s care. However, the primary challenge is to make sure that these concerns are actively listened to and addressed.<\/p>\n

A recent cohort study, as part of the Investigating Neuropsychiatric Symptom Prevalence and Impact in Rheumatology Patient Experience (INSPIRE) research project, looking at patients affected by systemic lupus erythematosus pointed out that \u201cpatients \u2018may be the most underutilized resource for mitigating diagnostic error\u2019\u201d<\/a>.\u00a0 The study also adds weight to \u201ccalls for improved \u2018bidirectional trust\u2019, and diagnostic partnerships between patients and clinicians.\u201d<\/a> Martha\u2019s rule aims to promote a \u2018bidirectional trust\u2019 model, moving away from the traditional paradigm that \u2018doctors know best\u2019 \u2013 which can conflict with the informed medical consent process which by its nature already assumes a balance of power between patients and clinicians.<\/p>\n

In contemporary healthcare settings, it is noteworthy that parents and\/or patients in healthcare settings are the individuals responsible for consenting to medical procedures, whether they are undergoing treatment themselves or consenting on behalf of patients who cannot give consent as they are underage or incapacitated.<\/p>\n

As the NHS website highlights, consent<\/a> must be voluntary:<\/em> \u201cthe decision to either consent or not to consent to treatment must be made by the person, and must not be influenced by pressure from medical staff, friends or family.\u201d It must be informed:<\/em> \u201cthe person must be given all of the information about what the treatment involves, including the benefits and risks, whether there are reasonable alternative treatments, and what will happen if treatment does not go ahead.\u201d And, finally, the person should be \u201ccapable <\/em>of giving consent.\u201d These three features of medical consent already rely on establishing a mutual relationship of trust and understanding between patients and clinicians. Legally speaking, this mutual trust is the sine qua non<\/em> for starting any medical treatment (except in specific emergency situations). However, this foundation \u2013 coupled by the holistic approach endorsed by Martha\u2019s rule \u2013\u00a0 could potentially lead to ground-breaking improvements in patient outcomes. As one of the key points highlighted in the INSPIRE\u2019s study aforementioned demonstrates: \u201c[C]ollaborative and empowering medical relationships likely facilitated more informed attributional decisions by combining patients\u2019 depth of experiential knowledge with clinicians\u2019 breadth of medical knowledge.\u201d <\/a><\/p>\n

 <\/p>\n

Author:\u00a0<\/strong>Ilaria Bertini<\/p>\n

Affiliations<\/strong>: Bios Centre<\/p>\n

Competing interests:<\/strong> None declared<\/p>\n","protected":false},"excerpt":{"rendered":"

By Ilaria Bertini. UK media outlets have reported the upcoming implementation of Martha’s Rule within NHS foundation trusts, starting from April 2024. This rule will enable swift second medical opinions for patients, healthcare practitioners, or families who express concerns regarding the patient’s response to care provided. This new pathway takes its name from a 13-year-old […]<\/p>\n

Read More…<\/a><\/p>\n","protected":false},"author":354,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[8053,8094],"tags":[],"class_list":["post-4560","post","type-post","status-publish","format-standard","hentry","category-consent","category-nhs"],"yoast_head":"\nMartha\u2019s rule: rebalancing power dynamics between patients or families and clinicians to improve patient outcomes - Journal of Medical Ethics blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/medical-ethics\/2024\/03\/04\/marthas-rule-rebalancing-power-dynamics-between-patients-or-families-and-clinicians-to-improve-patient-outcomes\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Martha\u2019s rule: rebalancing power dynamics between patients or families and clinicians to improve patient outcomes - Journal of Medical Ethics blog\" \/>\n<meta property=\"og:description\" content=\"By Ilaria Bertini. 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