Re: release of patient based on NRCREG 35.75

[csmarcus <csmarcus@ucla.edu>]

At 07:32 AM 11/24/98 -0600, you wrote:
>>...
>>I would like to know who still keep the patient in-house for treatment 
>>with NaI131 above 33 milliCi.
>>...
>>
>
>We do, if the physicians feel it is better than the patient's home
>environment.  For example, there may be young children around.  Also, there
>have been occasions when the patient had to remain in the hospital for other
>reasons.
>
>-psrao
>--
>P. Sridhar Rao, Mailstop BSH5056, Univ Hospitals, Cleveland, Ohio 44106.
>Tel: 216-844-1295.   Fax: 216-844-3300.   E-mail: psr@po.cwru.edu
>
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>Dear Radsafers:

I frequently hospitalize patients for large doses of I-131, and I wrote the
petition that resulted in this rule.  Sometimes the patient is too
uneducated or too socioeconomically challenged to have a high probability of
successful compliance with instructions.  Sometimes the patient has other
health reasons to be hospitalized.  Once in a while, I hospitalize patients
when I am just too busy to spend the hour or so with them to educate them
appropriately.  

This rule was written for physicians.  It was not meant to be ditched on
physicists or RSO's, who are the wrong people for this responsibility.

It is the RSO's job to make sure that the physician knows how to do the
calculations and advise the patient.  It is not the RSO's job to try to
practice medicine to cover for a doctor who is ignorant or lazy.

This is not a technologist's activity, either.  While the technologist can
assist the physician by obtaining certain information, technologists are not
educated anywhere near the level of calculating or estimating
radiopharmacokinetic parameters, performing the dose calculations,
evaluating the importance of the calculations, or tailoring advice to the
individual patient's lifestyle.

This rule is getting some bad press from RSO types who seem to have accepted
responsibility that should never have been given to them in the first place.
Maybe a lot of RSO's would feel better if they dumped it back in the
physicians's lap, where it belongs.  Just because NRC licenses a doc to do
therapy doesn't mean the doc is competent to do therapy.  NRC will license
almost anybody because it needs the User Fees.  Third party payors of
healthcare should simply restrict therapy providers to those who understand
how and when to use this rule, not just to those who have therapy licenses.

In California, this rule is resticted to docs who understand the physics,
math, radiopharmacokinetics, radiation biology, and relevent
pathophysiology, and who will take time to educate their patients.  It is
not for everybody.

I have had this rule for about 10 years.  I have a rather large therapy
practice.  I have never once delegated these duties to a tech, a resident, a
physicist, or my RSO, and I have never caused a problem at a sanitary landfill.

Ciao, Carol Marcus, Ph.D., M.D.
<csmarcus@ucla.edu>

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