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Lehman K, Aroney E, Wu I. ChatGPT in private practice: The opportunities and pitfalls of novel technology. Australas Psychiatry 2024; 32:214-219. [PMID: 38545872 DOI: 10.1177/10398562241241473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/21/2024]
Abstract
OBJECTIVE This article explores the transformative impact of OpenAI and ChatGPT on Australian medical practitioners, particularly psychiatrists in the private practice setting. It delves into the extensive benefits and limitations associated with integrating ChatGPT into medical practice, summarising current policies and scrutinising medicolegal implications. CONCLUSION A careful assessment is imperative to determine whether the benefits of AI integration outweigh the associated risks. Practitioners are urged to review AI-generated content to ensure its accuracy, recognising that liability likely resides with them rather than with AI platforms, despite the lack of case law specific to negligence and AI in the Australian context at present. It is important to employ measures that ensure patient confidentiality is not breached and practitioners are encouraged to seek counsel from their professional indemnity insurer. There is considerable potential for future development of specialised AI software tailored specifically for the medical profession, making the use of AI more suitable for the medical field in the Australian legal landscape. Moving forward, it is essential to embrace technology and actively address its challenges rather than dismissing AI integration into medical practice. It is becoming increasingly essential that both the psychiatric community, medical community at large and policy makers develop comprehensive guidelines to fill existing policy gaps and adapt to the evolving landscape of AI technologies in healthcare.
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Pina IM, Omar AM, Floyd MS. Medical photography and the reconstructive urologist: A 6-month prospective study. Urologia 2024:3915603241241183. [PMID: 38651825 DOI: 10.1177/03915603241241183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
Medical photography has multiple, important roles. The education of medical practitioners, documentation of disease, response to treatment, research, publication, intraoperative recording and trauma documentation all rely on medical photography. Additionally, there are important medicolegal implications pertaining to medical photography across many medical disciplines. Other than specific image use to document cases, there remains a paucity of urological literature regarding the use of medical photography in Urology. The aims of this 6-month study were to document the use of medical photography by a Reconstructive Urological Service in a tertiary referral centre and to assess the range of urological conditions photographed. A secondary aim was to specifically document intraoperative use of the medical photography.
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Affiliation(s)
- Ines M Pina
- Department of Reconstructive Urology, Whiston Hospital, Mersey and West Lancashire Teaching Hospitals NHS Trust, Prescot, Merseyside, UK
| | - Ahmad M Omar
- Department of Reconstructive Urology, Whiston Hospital, Mersey and West Lancashire Teaching Hospitals NHS Trust, Prescot, Merseyside, UK
| | - Michael S Floyd
- Department of Reconstructive Urology, Whiston Hospital, Mersey and West Lancashire Teaching Hospitals NHS Trust, Prescot, Merseyside, UK
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Ryan PJ, Duckworth AD, McEachan JE, Jenkins PJ. The incidence of surgical intervention following a suspected scaphoid fracture. Bone Jt Open 2024; 5:312-316. [PMID: 38626919 PMCID: PMC11021995 DOI: 10.1302/2633-1462.54.bjo-2023-0059.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/19/2024] Open
Abstract
Aims The underlying natural history of suspected scaphoid fractures (SSFs) is unclear and assumed poor. There is an urgent requirement to develop the literature around SSFs to quantify the actual prevalence of intervention following SSF. Defining the risk of intervention following SSF may influence the need for widespread surveillance and screening of SSF injuries, and could influence medicolegal actions around missed scaphoid fractures. Methods Data on SSF were retrospectively gathered from virtual fracture clinics (VFCs) across a large Scottish Health Board over a four-year period, from 1 January 2018 to 31 December 2021. The Bluespier Electronic Patient Record System identified any surgical procedure being undertaken in relation to a scaphoid injury over the same time period. Isolating patients who underwent surgical intervention for SSF was performed by cross-referencing the unique patient Community Health Index number for patients who underwent these scaphoid procedures with those seen at VFCs for SSF over this four-year period. Results In total, 1,739 patients were identified as having had a SSF. Five patients (0.28%) underwent early open reduction and internal fixation (ORIF). One patient (0.06%) developed a nonunion and underwent ORIF with bone grafting. All six patients undergoing surgery were male (p = 0.005). The overall rate of intervention following a SSF was 0.35%. The early intervention rate in those undergoing primary MRI was one (0.36%), compared with three in those without (0.27%) (p > 0.576). Conclusion Surgical intervention was rare following a SSF and was not required in females. A primary MRI policy did not appear to be associated with any change in primary or secondary intervention. These data are the first and largest in recent literature to quantify the prevalence of surgical intervention following a SSF, and may be used to guide surveillance and screening pathways as well as define medicolegal risk involved in missing a true fracture in SSFs.
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Affiliation(s)
| | | | | | - Paul J. Jenkins
- Centre for Sustainable Delivery (CfSD), NHS Golden Jubilee, Clydebank, UK
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4
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Brown SP. Plausible Mechanisms of Causation of Immediate Stroke by Cervical Spine Manipulation: A Narrative Review. Cureus 2024; 16:e56565. [PMID: 38510520 PMCID: PMC10954208 DOI: 10.7759/cureus.56565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2024] [Indexed: 03/22/2024] Open
Abstract
It has been proposed that cervical spine manipulation (CSM) can cause dissection in healthy cervical arteries, with resultant immediate stroke. However, research does not support a causal association between CSM and cervical artery dissection (CAD) in healthy cervical arteries. The objective of this study was to review the literature to identify plausible mechanisms of causation of immediate stroke by CSM. Immediate stroke is defined as a stroke occurring within seconds or minutes of CSM. Our review found plausible thromboembolic and thrombotic mechanisms of causation of immediate stroke by CSM in the literature. The common premise of these mechanisms is CAD being present before CSM, not occurring as a result of CSM. These mechanisms of causation have clinical and medicolegal implications for physicians performing CSM.
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Affiliation(s)
- Steven P Brown
- Integrative/Complementary Medicine, Brown Chiropractic & Acupuncture, PC, Gilbert, USA
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5
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Plevin D, Herriot P. Perceived injustice: a historical and clinical review of a useful concept for psychiatry. Australas Psychiatry 2024; 32:41-43. [PMID: 37903456 DOI: 10.1177/10398562231211133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2023]
Abstract
OBJECTIVE Perceived injustice, a concept that arose in pain medicine, refers to an individual's experiences and perceptions of victimisation from injuries resulting in chronic pain. Here, we have undertaken a historical and clinical review on the role of perceived injustice medicine in psychiatry and a systematic review on psychotherapeutic interventions for perceived injustice. METHOD For the systematic review, two studies were identified from a search of six databases. RESULTS Though evidence is limited, psychotherapeutic interventions show promise in addressing perceived injustice and associated symptomatology. CONCLUSION Perceived injustice is a concept which may have great potential utility to psychiatry, particularly in occupational and medicolegal areas. Interventions addressing perceived injustice may help improve clinical outcomes.
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Affiliation(s)
- David Plevin
- Ramsay Clinic Adelaide and Clinical Academic, University of Adelaide, Gilberton, SA, Australia
| | - Peter Herriot
- Pain Management Unit, Flinders Medical Centre, Bedford Park, SA, Australia
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Agrawal D, Heda A, Ghosh S, Kalia S, Bhatia K, Kumar N, Tripathy K. Knowledge, attitude, and practice patterns of Indian ophthalmologists regarding medicolegal issues. Indian J Ophthalmol 2023; 71:3690-3695. [PMID: 37991305 PMCID: PMC10788763 DOI: 10.4103/ijo.ijo_1084_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 07/14/2023] [Accepted: 08/05/2023] [Indexed: 11/23/2023] Open
Abstract
PURPOSE To assess the knowledge, attitude, and practice patterns (KAPP) of Indian ophthalmologists regarding medicolegal issues using an initial survey. METHODS An online form was circulated among Indian ophthalmologists of all ages over social media and email by the Young Ophthalmologists Society of India (YOSI) and its medicolegal working group. Anonymous responses were obtained and analyzed for each question. The questionnaire comprised questions about demographic details, KAPP of medicolegal issues including how to deal with medicolegal issues (if faced), medical indemnity insurance, deviation from the recommended minimum sum assured (Rs. 1 crore for Indian ophthalmologists), and legal service providers. RESULTS A total of 109 responses were obtained. The majority of the respondents were male (60, 55%). More than 50% of respondents (58, 53.2%) were younger than 35 years. More than one-fourth of the respondents were private practitioners (29, 27%), and the majority were of senior consultant designation (45, 41%). Around 80% of respondents (89, 81.6%) were aware of professional indemnity insurance; however, only 54% (n = 59) bought the insurance cover. A majority of the respondents (38, 64.4%) had an indemnity cover of a maximum of Rs. 50 lacs. Only 20% of respondents were aware of the expert body at the state/national level that deals with medicolegal cases. Thirty percent of respondents recommended the ideal cover amount to be more than Rs. 1 crore. CONCLUSION The current survey highlights the dismally low rate of awareness of medicolegal issues among ophthalmologists. Specifically, a majority of Indian ophthalmologists surveyed did not have recommended minimum insured cover for professional indemnity insurance. Larger studies are needed to further explore KAPP of Indian ophthalmologists in various medicolegal issues.
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Affiliation(s)
- Deepanshu Agrawal
- Department of Ophthalmology, Choithram Netralaya, Indore, Madhya Pradesh, India
| | - Aarti Heda
- Department of Ophthalmology, National Institute of Ophthalmology, Pune, Maharashtra, India
| | - Sayantan Ghosh
- Department of Ophthalmology, Calcutta National Medical College, Kolkata, West Bengal, India
| | - Sonal Kalia
- Department of Ophthalmology, SMS Medical College, Jaipur, Rajasthan, India
| | - Karan Bhatia
- Department of Ophthalmology, Manaktala Eye and Maternity Home, Meerut, Uttar Pradesh, India
| | - Nilesh Kumar
- Department of Ophthalmology, Madhavi Netralaya, Ara, Bihar, India
| | - Koushik Tripathy
- Department of Ophthalmology, ASG Eye Hospital, Kolkata, West Bengal, India
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Pai SN. Arthroscopy in India Through the Medicolegal Lens: A Comprehensive Review. Indian J Orthop 2023; 57:1984-1992. [PMID: 38009181 PMCID: PMC10673772 DOI: 10.1007/s43465-023-01011-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 09/26/2023] [Indexed: 11/28/2023]
Abstract
Introduction With the increasing number of Arthroscopic surgeries, comes with it, the undesirable problem of litigation associated with it. Arthroscopy does possess certain unique aspects which need to be understood from the legal point of view as well. Materials and Methods We obtained information on specific medico-legal cases involving arthroscopy from books and websites containing collections of medico-legal judgments in Indian legal courts, consumer dispute redressal forums at the state and national levels, and state medical councils.. Results We assimilated and analysed all this information, combined it with our experience in the field of medical law, and have provided practical, enforceable ways to decrease the medicolegal risk for arthroscopy surgeons. Conclusion This review provides a comprehensive overview of pressing issues in relation to the medicolegal aspects of arthroscopic surgery.
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Affiliation(s)
- Satvik N. Pai
- Department of Orthopaedic Surgery, Aster RV Hospital, J P Nagar, Bangalore, India
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Jones M, Elrifay A, Amer N, Awad H. Con: Limitations of POCUS Examination: Be Aware of Overdiagnosis and Undertreatment. J Cardiothorac Vasc Anesth 2023; 37:2366-2369. [PMID: 36707381 DOI: 10.1053/j.jvca.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 01/02/2023] [Indexed: 01/09/2023]
Affiliation(s)
- Mikayla Jones
- The Ohio State University College of Medicine, Columbus, OH
| | - Amr Elrifay
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Nourhan Amer
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Hamdy Awad
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH.
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Kachhawa G, Kaundal A, Kulshrestha V, Sethi D, Kriplani A, Sreeniwas V, Agarwal N. Awareness Regarding Medicolegal Aspects of Medical Services Among Reproductive Age Women: A Population-Based Cross-Sectional Study. Cureus 2023; 15:e49360. [PMID: 38143698 PMCID: PMC10749207 DOI: 10.7759/cureus.49360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2023] [Indexed: 12/26/2023] Open
Abstract
INTRODUCTION The government has implemented various laws to regulate medical practice and improve the quality of health care services. This study evaluated the general population's awareness of various medicolegal aspects related to the medical profession. Methods: A cross-sectional study was conducted. Knowledge of laws and ethics related to medical practice was assessed based on a well-structured questionnaire including 25 items. Women were categorized based on their score into low (below 50th percentile), medium (50th -75th percentile), and high (above 75th percentile) awareness. Results: A total of 334 women were recruited. The mean age of the women in the study was 30.29±6.58 SD years; most women were between 20-30 (56.28%). Most women were graduates (33.23%), followed by postgraduates (29.04%). The majority of women were unemployed (housewives: 64.67%, students: 4.49%), followed by skilled workers (22.75%), semi-professional, and professionals (8.08%). High awareness about the various medicolegal aspects was seen in 25.1% of women, while 29.04% had medium awareness and 45.80% had low awareness. It was also seen that the women with higher education(p=0.002) and those employed (0.001) had better knowledge. Further, graduate housewives had better awareness than non-graduate housewives. Conclusion: Education and self-independence significantly affected awareness of medicolegal issues among our women. Assuring the right to education and empowering women with self-independence will go a long way in ensuring active participation in medical decision-making.
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Affiliation(s)
- Garima Kachhawa
- Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, IND
| | - Asmita Kaundal
- Obstetrics and Gynaecology, AIl India Institute of Medical Sciences, Bilaspur, IND
| | - Vidushi Kulshrestha
- Obstetrics and Gynaecology, AIl India Institute of Medical Sciences, New Delhi, IND
| | - Divya Sethi
- Biostatistics, All India Institute of Medical Sciences, New Delhi, IND
| | - Alka Kriplani
- Obstetrics and Gynecology, Paras Hospitals, Gurgaon, IND
| | - V Sreeniwas
- Biostatistics, All India Institute of Medical Sciences, New Delhi, IND
| | - Nutan Agarwal
- Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, IND
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10
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Ainsworth MJG, Cook TM. Pre-operative information, shared decision-making and consent for anaesthesia: time for a rethink. Anaesthesia 2023; 78:1187-1190. [PMID: 37203398 DOI: 10.1111/anae.16053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2023] [Indexed: 05/20/2023]
Affiliation(s)
- M J G Ainsworth
- Department of Anaesthesia and Intensive Care Medicine, Royal United Hospitals Bath, Bath, UK
| | - T M Cook
- Department of Anaesthesia and Intensive Care Medicine, Royal United Hospitals Bath, Bath, UK
- University of Bristol, Bristol, UK
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11
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Pai SN, Jeyaraman N, Jeyaraman M, Shyam A. Osteoporosis - An Imminent Ethical and Legal Debacle? J Orthop Case Rep 2023; 13:1-3. [PMID: 37753139 PMCID: PMC10519322 DOI: 10.13107/jocr.2023.v13.i09.3852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 07/18/2023] [Indexed: 09/28/2023] Open
Abstract
Osteoporosis is a condition characterized by a decrease in bone density. Its prevalence is on the rise and is only going to continue to rise further. Fragility fractures such as neck of femur fracture fractures and intertrochanteric fractures are among the most common fractures encountered by orthopedic surgeons today. Yet, the management of these fragility fractures has unfortunately fallen short of addressing the etiology behind the fracture. Orthopedic surgeons routinely perform arthroplasty or osteosynthesis for stabilization of these fractures, but rarely do they address the coexisting osteoporosis. We explore the factors, leading to this scenario, the practical hurdles faced, the ethical and legal considerations on the matter, and the road ahead. We believe that this is a topic which should be discussed further among orthopedic surgeons to arrive at practical solutions and change in perspectives. The aim of this article was to encourage a debate on the matter, increase awareness about the current situation, and help change the trend in the management of osteoporosis in developing countries like India.
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Affiliation(s)
- Satvik N Pai
- Department of Orthopaedic Surgery, HOSMAT Hospital, Bengaluru, Karnataka, India
| | - Naveen Jeyaraman
- Department of Orthopaedics, ACS Medical College and Hospital, Dr. MGR Educational and Research Institute, Chennai, Tamil Nadu, India
| | - Madhan Jeyaraman
- Department of Orthopaedics, ACS Medical College and Hospital, Dr. MGR Educational and Research Institute, Chennai, Tamil Nadu, India
| | - Ashok Shyam
- Department of Orthopaedics, Sancheti Institute for Orthopedics and Rehabilitation, Pune, Maharashtra, India
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Pai SN, Jeyaraman M, Jeyaraman N, Nallakumarasamy A, Yadav S. In the Hands of a Robot, From the Operating Room to the Courtroom: The Medicolegal Considerations of Robotic Surgery. Cureus 2023; 15:e43634. [PMID: 37719624 PMCID: PMC10504870 DOI: 10.7759/cureus.43634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2023] [Indexed: 09/19/2023] Open
Abstract
Robotic surgery has rapidly evolved as a groundbreaking field in medicine, revolutionizing surgical practices across various specialties. Despite its numerous benefits, the adoption of robotic surgery faces significant medicolegal challenges. This article delves into the underexplored legal implications of robotic surgery and identifies three distinct medicolegal problems. First, the lack of standardized training and credentialing for robotic surgery poses potential risks to patient safety and surgeon competence. Second, informed consent processes require additional considerations to ensure patients are fully aware of the technology's capabilities and potential risks. Finally, the issue of legal liability becomes complex due to the involvement of multiple stakeholders in the functioning of robotic systems. The article highlights the need for comprehensive guidelines, regulations, and training programs to navigate the medicolegal aspects of robotic surgery effectively, thereby unlocking its full potential for the future..
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Affiliation(s)
- Satvik N Pai
- Orthopaedic Surgery, Hospital for Orthopedics, Sports Medicine, Arthritis, and Trauma (HOSMAT) Hospital, Bangalore, IND
| | - Madhan Jeyaraman
- Orthopaedics, ACS Medical College and Hospital, Dr. MGR Educational and Research Institute, Chennai, IND
| | - Naveen Jeyaraman
- Orthopaedics, ACS Medical College and Hospital, Dr. MGR Educational and Research Institute, Chennai, IND
| | - Arulkumar Nallakumarasamy
- Orthopaedics, ACS Medical College and Hospital, Dr. MGR Educational and Research Institute, Chennai, IND
| | - Sankalp Yadav
- Medicine, Shri Madan Lal Khurana Chest Clinic, New Delhi, IND
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Patil A, Chawathey S, Malim A. Adequacy of Informed Consent in Elective Surgical Procedures: A Study in a Navi Mumbai Tertiary Care Centre. Cureus 2023; 15:e41777. [PMID: 37449289 PMCID: PMC10337701 DOI: 10.7759/cureus.41777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2023] [Indexed: 07/18/2023] Open
Abstract
Background Informed consent (IC) is a voluntary authorisation given by a patient or research subject after fully comprehending the risks involved in various procedures and treatments. Though a patient may fulfill all the aspects of consent by completing an informed consent form (ICF), research indicates poor execution of the IC process by ill-informed patients with little comprehension. The present study was done on patients to assess their understanding and involvement in the consenting process, thereby providing insight into the adequacy and sufficiency of the IC process. Materials and methodology Patients undergoing elective surgical procedures were surveyed using a questionnaire to study whether the written informed consent (IC) process was adequately used in elective surgeries and to assess the patient's understanding of the IC and whether the informed consent forms (ICF) used met the ethical and legal standards for this purpose. The questionnaire was administered to the patients by two surveyors. As per the inclusion/exclusion criteria, data was collected from 221 admitted patients who were planned to undergo or recently underwent various elective surgical/operative procedures. Descriptive analysis using frequency and percentages of the positive and negative responses was used to analyse the data. Results In 219 (99%) of the cases, informed consent was taken. Two hundred-eight patients (94.1%) understood the knowledgeable consent information, while 13 (5.9%) did not. Of the total 221 patients, more than 90% of patients were informed about the nature and indication of the surgery. The expected benefits were told to 83.25% of patients, while possible complications of the procedure were reported to 91 patients (41.2%). Of the total, 58.37 % of patients knew the type of anaesthesia used for elective surgery. Two hundred and sixteen (97.73%) patients favoured the informed consent process, and 213 (96.38%) were satisfied with the information provided in the consent form. The education status of the patient varied, with nearly 15.5% being illiterate while 35.3% being educated till high school. Patients undergoing surgical procedures must be explained the nature and indication of the proposed surgical treatment, including its benefits and risks. About 208 (94.1%) of the patients stated that they understood all the information provided in the ICF, and 213 patients (96.3%) were satisfied with it. Most patients (88.7%) exercised autonomy in deciding to undergo surgery. Ninety-seven percent of patients favoured the IC process, of which 38.46% believed informed consent has a medicolegal significance. Conclusion The present study revealed that a better understanding of the informed consent by the patients is a vital component of the process as it helps exercise autonomy in the decision-making process. However, the lack of information in the informed consent forms critically affects the quality and adequacy of the IC, thus posing ethical and legal challenges to genuinely informed consent.
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Affiliation(s)
- Amit Patil
- Forensic Medicine and Toxicology, All India Institute of Medical Sciences, Patna, Patna, IND
| | - Shreyas Chawathey
- Anaesthesiology, Critical Care and Pain, Homi Bhabha National Institute, Tata Memorial Hospital, Mumbai, IND
| | - Adel Malim
- College of Medicine, Dr D Y Patil Medical College, Hospital, and Research Centre, Navi Mumbai, IND
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Pai SN, Jeyaraman M, Jeyaraman N, Yadav S. Understanding the Medico-Legal Aspects of Telemedicine in India. Cureus 2023; 15:e42431. [PMID: 37637663 PMCID: PMC10448835 DOI: 10.7759/cureus.42431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2023] [Indexed: 08/29/2023] Open
Abstract
Telemedicine has brought a new dimension to healthcare and has been gaining popularity worldwide. However, the medico-legal aspects of the practice of telemedicine in India remain ambiguous to most doctors and administrators. We have therefore provided a concise overview of the legal aspects of telemedicine, which will enable doctors and administrators to provide better telemedicine services while safeguarding themselves from possible litigation.
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Affiliation(s)
- Satvik N Pai
- Orthopaedic Surgery, HOSMAT Hospital, Bangalore, IND
- Orthopaedic Surgery, Sri Ramachandra Institute of Higher Education and Research, Chennai, IND
| | - Madhan Jeyaraman
- Orthopaedics, South Texas Orthopaedic Research Institute (STORI), Laredo, USA
- Orthopaedics, ACS Medical College and Hospital, Dr MGR Educational and Research Institute, Chennai, IND
| | - Naveen Jeyaraman
- Orthopaedics, ACS Medical College and Hospital, Dr MGR Educational and Research Institute, Chennai, IND
| | - Sankalp Yadav
- Medicine, Shri Madan Lal Khurana Chest Clinic, New Delhi, IND
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Parikh PM. Ayurvedic Doctors Cannot Prescribe Allopathic Medicines-National Consumer Dispute Redressal Commission Judgement. South Asian J Cancer 2023; 12:100-103. [PMID: 37969682 PMCID: PMC10635757 DOI: 10.1055/s-0043-1772678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2023] Open
Abstract
Purvish M. ParikhWe describe the facts of the matter and the court's decision in a case of an Ayurveda, Yoga & Naturopathy, Unani, Siddha, and Homeopathy (AYUSH) doctor being found guilty of deficiency of service by prescribing allopathic medicines that were associated with known complications. The case details include the allegation, the defense, and the court's judgement. Details of the concerned acts, circulars, and regulations, as well as court case laws, are described. The regulations allow AYUSH doctors to prescribe allopathic medicines under certain circumstances, which were not adhered to in this case.
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Affiliation(s)
- Purvish M. Parikh
- Department of Clinical Hematology, Mahatma Gandhi University of Medical Sciences and Technology, Jaipur, Rajasthan, India
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Gong JH, Soliman L, Sobti N, Mehrzad R, Woo AS. Medical Malpractice Litigations Involving Infant Craniosynostosis and Deformational Plagiocephaly in the United States. Cleft Palate Craniofac J 2023:10556656231165591. [PMID: 36935634 DOI: 10.1177/10556656231165591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2023] Open
Abstract
OBJECTIVE To identify characteristics of malpractice litigations involving skull deformity in infants (craniosynostosis and deformational plagiocephaly). DESIGN Retrospective review of all lawsuits with jury verdicts or settlements involving infant skull deformity as the primary diagnosis using the Westlaw Legal Database. SETTING United States. PATIENTS, PARTICIPANTS Plaintiffs with skull deformity as the primary diagnosis. MAIN OUTCOME MEASURES Litigation outcome and indemnity payment amount. RESULTS From 1990 to 2019, 9 cases involving infant skull deformity met our inclusion/exclusion criteria. Among these cases, 8 (88.9%) cases resulted in indemnity payments to plaintiffs, totaling $30,430,000. Failure to diagnose (n = 4, 44.4%) and surgical negligence (n = 3, 33.3%) were the most common reasons for litigations. CONCLUSIONS There were a small number of malpractice lawsuits involving infant skull deformity over three decades. When cases go to court, physicians and hospitals have a high likelihood of judgment against them, frequently resulting in high indemnity payments.
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Affiliation(s)
- Jung Ho Gong
- Division of Plastic and Reconstructive Surgery, The Warren Alpert Medical School of Brown University, Providence, RI 02903, USA
| | - Luke Soliman
- Division of Plastic and Reconstructive Surgery, The Warren Alpert Medical School of Brown University, Providence, RI 02903, USA
| | - Nikhil Sobti
- Division of Plastic and Reconstructive Surgery, The Warren Alpert Medical School of Brown University, Providence, RI 02903, USA
| | - Raman Mehrzad
- Division of Plastic and Reconstructive Surgery, The Warren Alpert Medical School of Brown University, Providence, RI 02903, USA
| | - Albert S Woo
- Division of Plastic and Reconstructive Surgery, The Warren Alpert Medical School of Brown University, Providence, RI 02903, USA
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17
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Bright MR, White LD, Concha Blamey SI, Endlich Y, Culwick MD. Perioperative corneal abrasions: A report of 42 cases from the webAIRS database. Anaesth Intensive Care 2023; 51:63-71. [PMID: 36065127 DOI: 10.1177/0310057x221099032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Corneal abrasions are an uncommon complication of anaesthesia. The aim of this study was to identify potential risk factors, treatment and outcomes associated with corneal abrasions reported to the web-based anaesthesia incident reporting system (webAIRS), a voluntary de-identified anaesthesia incident reporting system in Australia and New Zealand, from 2009 to 2021. There were 43 such cases of corneal abrasions reported to webAIRS over this period. The most common postoperative finding was a painful eye. Common features included older patients, individuals with pre-existing eye conditions, general anaesthesia and procedures longer than 60 minutes. Most cases were treated with a combination of lubricating eye drops or aqueous antibiotic eye drops. The findings indicate that patients who sustain a perioperative corneal abrasion can be reassured that in many cases it will heal within 48 hours, but they should seek earlier review if symptoms persist or deteriorate. None of the cases in this series resulted in permanent harm. Well established eye protective measures are important to utilise throughout the perioperative period, including the time until the patient has recovered in the post-anaesthesia care unit.
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Affiliation(s)
- Matthew R Bright
- Department of Anaesthesia, Royal Brisbane and Women's Hospital, Herston, Australia
- Faculty of Medicine, University of Queensland, Australia
| | - Leigh D White
- Department of Anaesthesia and Perioperative Medicine, Sunshine Coast Hospital and Health Service, Birtinya, Australia
| | - Sandra I Concha Blamey
- Department of Anaesthesia, Royal Brisbane and Women's Hospital, Herston, Australia
- Faculty of Medicine, University of Queensland, Australia
| | - Yasmin Endlich
- Department of Anaesthesia, 1062Royal Adelaide Hospital, Adelaide, Australia
- Faculty of Medicine, The University of Adelaide, Adelaide, Australia
| | - Martin D Culwick
- Department of Anaesthesia, Royal Brisbane and Women's Hospital, Herston, Australia
- Faculty of Medicine, University of Queensland, Australia
- Australian and New Zealand Tripartite Anaesthesia Data Committee, Melbourne, Australia
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18
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Deora H, Yagnick NS, Gupta A, Tripathi M, Gupta SK, Mohindra S, Ganapathy K. The Legal Void Outside Brain Death in India: The Legislative Need of 'DNR' in Brain Death. Neurol India 2023; 71:20-27. [PMID: 36861568 DOI: 10.4103/0028-3886.370453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
Objective The legal definitions of brain death are tantamount for legal dogmas and sometimes criminal intimidation of the treating doctors. The tests for brain death are only applicable to patients planned for organ transplantation. We intend to discuss the necessity of the "Do Not Resuscitate (DNR)" legislature in cases of brain death patients and applicability of tests for brain death irrespective of the intention for organ donation. Methods A comprehensive review of the literature was performed till May 31, 2020 from the MEDLINE (1966 to July 2019) and Web of Science (1900 to July 2019). Search criteria included all publications with the MESH terms: "Brain Death/legislation and jurisprudence"[Mesh] OR "Brain Death/organization and administration"[Mesh] AND "India" [Mesh]. We also discuss the different opinions and implications of brain death versus brain stem death in India with the senior author (KG) who was responsible for South Asia's first multi-organ transplant after certifying brain death. Additionally, a hypothetical scenario of a DNR case is discussed in the current legal paradigm of India. Results The systematic search yielded only five articles reporting a series of brain stem death cases with an acceptance rate of organ transplant among brain stem deaths being 34.8%. The most common solid organs transplanted were the kidney (73%) and liver (21%). A hypothetical scenario of a DNR and possible legal implications of the same under the current 'Transplantation of Human Organs Act (THOA)' of India remains unclear. A comparison of brain death laws in most Asian countries shows a similar pattern regarding the declaration of brain death and the lack of knowledge or legislature regarding DNR cases. Conclusion After the determination of brain death, discontinuation of organ support requires the consent of the family. The lack of education and the lack of awareness have been major impediments in this medico-legal battle. There is also an urgent need to make laws for cases that do not qualify for brain death. This would help in not only realistic realization but also better triage of the health care resources while legally safeguarding the medical fraternity.
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Affiliation(s)
- Harsh Deora
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Nishant S Yagnick
- Department of Neurosurgery, Paras Hospitals, Gurugram, Haryana, India
| | - Ayan Gupta
- Student at Law, National Law University, Delhi, India
| | - Manjul Tripathi
- Department of Neurosurgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Sandeep Mohindra
- Department of Neurosurgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Muacevic A, Adler JR, Alfandi HA, AlDahan HA, Almadan HM, AlSaif HH, Menezes RG. Iatrogenic Causes of Cardiac Tamponade Resulting From Surgical Procedures: An Overview. Cureus 2023; 15:e33773. [PMID: 36655159 PMCID: PMC9840527 DOI: 10.7759/cureus.33773] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2023] [Indexed: 01/15/2023] Open
Abstract
Cardiac tamponade is one of the most severely life-threatening emergencies encountered, mainly because of its significant impact on the pumping capacity of the heart by compressing the cardiac chambers due to the rapid accumulation of blood, fluid, pus, or clots in the pericardial sac. These accumulations may be collected following traumas, malignancies, uremia, and many other medical conditions as well as surgical procedures. Numerous errors and medicolegal aspects have been identified in diagnosing and treating cardiac tamponade associated with cardiac-related procedures such as valve replacement surgeries, cardiac pacemaker implantation, pericardiocentesis, and other non-cardiac related procedures such as peri-hiatal surgeries. Patients taking anticoagulants or anticancer medications are especially susceptible to developing cardiac tamponade when undergoing surgical procedures, raising the question of preoperative screening to avoid errors. Misdiagnosis, treatment delay or failure to deliver the utmost quality of treatment, lack of complication screening and follow-ups for those at risk, surgeons rushing to complete cases, burnout, and other human factors are predispositions to the development of cardiac tamponade. Fortunately, most of these errors occurring within healthcare settings are avoidable and must be prevented for eliminating any risks to reduce the incidence and mortality of cardiac tamponade cases resulting from iatrogenic etiology. It is an intricate condition where precision and caution are crucial.
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Cohen EB, Gordon IK. First, do no harm. Ethical and legal issues of artificial intelligence and machine learning in veterinary radiology and radiation oncology. Vet Radiol Ultrasound 2022; 63 Suppl 1:840-850. [PMID: 36514231 PMCID: PMC10107688 DOI: 10.1111/vru.13171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 09/23/2022] [Accepted: 09/29/2022] [Indexed: 12/15/2022] Open
Abstract
Artificial Intelligence and machine learning are novel technologies that will change the way veterinary medicine is practiced. Exactly how this change will occur is yet to be determined, and, as is the nature with disruptive technologies, will be difficult to predict. Ushering in this new tool in a conscientious way will require knowledge of the terminology and types of AI as well as forward thinking regarding the ethical and legal implications within the profession. Developers as well as end users will need to consider the ethical and legal components alongside functional creation of algorithms in order to foster acceptance and adoption, and most importantly to prevent patient harm. There are key differences in deployment of these technologies in veterinary medicine relative to human healthcare, namely our ability to perform euthanasia, and the lack of regulatory validation to bring these technologies to market. These differences along with others create a much different landscape than AI use in human medicine, and necessitate proactive planning in order to prevent catastrophic outcomes, encourage development and adoption, and protect the profession from unnecessary liability. The authors offer that deploying these technologies prior to considering the larger ethical and legal implications and without stringent validation is putting the AI cart before the horse, and risks putting patients and the profession in harm's way.
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Affiliation(s)
- Eli B Cohen
- Department of Molecular and Biomedical Sciences, North Carolina State University College of Veterinary Medicine, Cary, North Carolina, USA
| | - Ira K Gordon
- The Oncology Service by United Veterinary Care, Knoxville, Tennessee, USA
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21
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Abstract
Violently-injured individuals presenting to the emergency department (ED) have an elevated risk of repeat injury after being discharged from acute care settings and a high rate of unaddressed mental health and social needs. While there is a growing body of programmatic interventions to address these needs, including hospital-based violence intervention programs, there is a lack of data regarding physician perspectives of current practice for this patient population. Understanding current practice is critical for integrating new programs into workflow and developing evidence-based medical education to improve care. The aim of this study is to elucidate current trauma-informed care practices of emergency medicine and general surgery trainee physicians to inform future curriculum development surrounding care of violently injured patients. In this study, emergency medicine and surgical trainees with at least one year of residency experience participated in simulation-primed interviews in pairs or small groups. Interviews garnered perspectives on the physician role in treating violently injured youth, using simulation as a priming event focused on previously known patient concerns. Qualitative themes that emerged were participants (1) perceived their role as managing medical/surgical concerns and seek others to build trust and manage psychosocial and legal concerns, (2) had a high level of knowledge of ED stressors and de-escalation strategies, (3) perceived that patient distrust can negatively impact their ability to provide care, and (4) perceived that law enforcement can negatively impact care and are sometimes uncertain about how to interact with law enforcement. These findings support that medical education for providers should focus on medicolegal issues, particularly managing law enforcement presence in the ED, structural and interpersonal causes of distrust of medical providers and the medical system, and addressing postdischarge mental health and social needs.
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22
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Eze UO, Ojifinni KA. Trauma Forensics in Blunt and Sharp Force Injuries. J West Afr Coll Surg 2022; 12:94-101. [PMID: 36590782 PMCID: PMC9802595 DOI: 10.4103/jwas.jwas_190_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 10/03/2022] [Indexed: 01/03/2023]
Abstract
Trauma forensics is the concept of examining trauma from a medicolegal standpoint in a given jurisdiction. Blunt and sharp force traumas are classified based on the different mechanisms of causation, which have a medicolegal significance. Adopting a standard approach to the medical evaluation of such injuries in patients would serve both the purposes of rendering appropriate treatment and the documentation and preservation of medical evidence. However, most trauma cases are seen by medical practitioners with very limited forensic knowledge and skills, and they are still expected to meet the needs of the court or the judicial mechanism in subsequent legal proceedings. Therefore, some measures, including 10 practical considerations, which are applicable in attending to blunt and sharp force traumas, would limit the risk a clinician faces in the crossfire of medicine and law.
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Affiliation(s)
- Uwom Okereke Eze
- Department of Pathology, University College Hospital (UCH), Ibadan, Oyo State, Nigeria
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23
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Rabe M. Telehealth in South Africa: A guide for healthcare practitioners in primary care. S Afr Fam Pract (2004) 2022; 64:e1-e6. [PMID: 35792625 PMCID: PMC9257714 DOI: 10.4102/safp.v64i1.5533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 04/24/2022] [Accepted: 04/28/2022] [Indexed: 11/25/2022] Open
Abstract
The use of telehealth is becoming a prevalent feature in clinical practice worldwide, partly because of advances in medical and telecommunications technology. The coronavirus disease 2019 (COVID-19) pandemic has been a key driver in justifying the accelerated use of telehealth, leading to healthcare practitioners (HCPs) utilising virtual consultations more avidly. Although challenges remain, recent data have shown that remote consultations are feasible, safe and effective in South Africa (SA) and that HCPs should become proficient in conducting telehealth, virtual or remote consultations. These guidelines are based on the revised Health Professions Council of South Africa (HPCSA) General Ethical Guidelines for Good Practice in Telehealth (Booklet 10) and guidelines on remote or video consultations from the University of Oxford, the Royal Australian College of General Practitioners and the Royal College of Psychiatrists. These guidelines aim to equip HCPs with the basic knowledge and skills pertaining to medicolegal, communication and practical aspects of telehealth and how to practise telehealth safely and effectively in primary care settings in SA during the COVID-19 pandemic and beyond.
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Affiliation(s)
- Mareike Rabe
- Family Physician, Locum in Public and Private Practice, Cape Town.
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24
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Vilanilam GC, Gohil J. Medicolegal Priorities for a Neurosurgeon/Neurologist in the COVID Era. Neurol India 2022; 70:845-848. [PMID: 35864607 DOI: 10.4103/0028-3886.349678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Vulnerable moments, panic, and uncertainties are the hallmarks of pandemic outbreaks. Medicolegal challenges add further injury to the public health chaos. Although containing the pandemic is of prime concern, medicolegal and ethical uncertainties further complicate ideal standards of medical care. Constraints in the provision of medical care, resource limitations, infectivity risks, burgeoning costs, and pandemic control laws, create extremely precarious medicolegal situations. Ethics and medical negligence laws may, at times, be trampled upon by the overwhelming urgencies of the pandemic. Hence, we attempt to review basic ethical and medicolegal principles that are put to test by pandemic urgencies. We aim to study these vulnerable medicolegal moments in neurosurgeons'/neurologists' clinical and research practices during the COVID-19 times from our own practice and contemporary literature on COVID practices, medicolegal sciences, and pandemic healthcare directives. We also review supportive measures and safeguards to brace these vulnerable moments effectively. We compile medicolegally sound and ideal practice parameters, including the basic principles for a restructured informed surgical consent ensuring a medicolegally and ethically sound practice. Several ethical and medicolegal exigencies are part of medical practice during a pandemic. Special care should be taken to avoid violations of medicolegal and ethical proprieties during the urgencies of medical care and research. Restructuring of contracts like the informed consent would also count as an ideal practice modification in a pandemic.
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Affiliation(s)
- George C Vilanilam
- Department of Neurosurgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Jaypalsinh Gohil
- Department of Neurosurgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
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25
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D'Sa A, Griffiths R. Medicolegal claims: a way to learn from our mistakes? Anaesthesia 2022; 77:507-509. [PMID: 35355245 DOI: 10.1111/anae.15729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 03/16/2022] [Accepted: 03/18/2022] [Indexed: 11/28/2022]
Affiliation(s)
- A D'Sa
- Department of Anaesthesia and Intensive Care, Addenbrooke's Hospital, Cambridge, UK
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26
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Fairley R, Emanuel T, Goettl B. Staff Augmentation during Disaster Response. Prehosp Disaster Med 2022;:1-3. [PMID: 35039111 DOI: 10.1017/S1049023X22000024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
This article outlines a disaster medicine team response to the Texas-Mexico border during a coronavirus disease 2019 (COVID-19) surge. The team consisted of emergency medicine attending providers, as well as a nurse practitioner and a physician assistant, who were asked to work in the intensive care unit (ICU) under the guidance of an intensivist. The article highlights the medicolegal and ethical implications of providers working outside of their designated scope of practice. A framework for future staff augmentation during a disaster is explained.
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Alghamdi SA, Alfayez LS, Alnojaidi TF, Aljaffer MA. Knowledge and attitudes of physicians toward forensic psychiatry in Saudi Arabia. Saudi Med J 2022; 43:98-104. [PMID: 35022290 PMCID: PMC9280551 DOI: 10.15537/smj.2022.43.1.20210669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 11/23/2021] [Indexed: 11/16/2022] Open
Abstract
Objectives: To assess the knowledge and attitudes of physicians of different specialties, including psychiatrists, regarding forensic psychiatry to determine whether further modification or training is needed in the psychiatry residency program. Methods: This cross-sectional study was carried out using a 3-page, 3-section questionnaire containing 21 questions disseminated randomly online via Google forms using social media platforms. The 482 participants were residents, specialists, and consultants of various specialties. The study was conducted between September 2020 and August 2021 in various tertiary hospitals across Saudi Arabia. Results: A total of 482 physicians were recruited. The most common age group was 25-35 years, comprising mostly Saudis (62.4%). Based on the results, “poor” and “good” knowledge of forensic psychiatry was identified in 89% and 11% of the physicians, while “negative” and “positive” attitudes were identified in 16.4% and 83.6% of the physicians. Conclusion: Although the perspective of physicians regarding forensic psychiatry was found to be positive, their knowledge of the topic seems to be lacking.
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Affiliation(s)
- Saleh A. Alghamdi
- From the Department of Clinical Neurosciences (Alghamdi); from the College of Medicine (Alfayez, Alnojaidi), Imam Mohammad Ibn Saud Islamic University, and from the Department of Psychiatry (Aljaffer), College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia.
- Address correspondence and reprint request to: Dr. Saleh A. Alghamdi, Department of Clinical Neurosciences, College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, Kingdom of Saudi Arabia. E-mail: ORCID ID: https://orcid.org/0000-0003-3264-7397
| | - Lujain S. Alfayez
- From the Department of Clinical Neurosciences (Alghamdi); from the College of Medicine (Alfayez, Alnojaidi), Imam Mohammad Ibn Saud Islamic University, and from the Department of Psychiatry (Aljaffer), College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia.
| | - Taif F. Alnojaidi
- From the Department of Clinical Neurosciences (Alghamdi); from the College of Medicine (Alfayez, Alnojaidi), Imam Mohammad Ibn Saud Islamic University, and from the Department of Psychiatry (Aljaffer), College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia.
| | - Mohammed A. Aljaffer
- From the Department of Clinical Neurosciences (Alghamdi); from the College of Medicine (Alfayez, Alnojaidi), Imam Mohammad Ibn Saud Islamic University, and from the Department of Psychiatry (Aljaffer), College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia.
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28
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Leech RL, Selfe J, Ball S, Greenhalgh S, Hogan G, Holway J, Willis E, Yeowell G. A scoping review protocol: Investigating the extent and legal process of cauda equina syndrome claims for UK physiotherapists. Musculoskeletal Care 2021; 19:457-461. [PMID: 34904357 DOI: 10.1002/msc.1550] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 02/19/2021] [Accepted: 02/20/2021] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Cauda equina syndrome (CES) is a condition where early identification and treatment is crucial to avoid potentially devastating effects. There is a high number of litigation cases linked with CES given it is a relatively rare condition. This scoping review protocol proposes to explore the extent and process of CES litigation in UK healthcare context cases amongst UK physiotherapists. METHODS AND ANALYSIS The methodological framework recommended by Arksey and O'Malley, Levac et al. and the Joanna Briggs Institute will be used throughout this review to aid reporting and transparency. A patient and public involvement (PPI) group meeting was convened at the beginning of the review process in order to provide knowledge exchange to inform the search strategy and propose resources to be used during the scoping review. Two reviewers will independently review the literature in order to apply the inclusion and exclusion criteria. Once the studies to be included have been identified, the data from these studies will be extracted and charted. Results will show quantitative data of the studies included in the review and a narrative synthesis of the literature. DISSEMINATION This scoping review will evaluate the existing knowledge relating to CES and litigation and will map the key concepts around this topic. Results will be disseminated to practitioners and policy-makers through peer-reviewed publications, conferences, reports and social media. This method may prove helpful to others who are investigating extent and processes relating to medicolegal cases involving healthcare practitioners. REGISTRATION The current paper is registered with OSF registries (DOI 10.17605/OSF.IO/MP6Y3).
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Affiliation(s)
- Rachel L Leech
- Department of Health Professions, Faculty Health, Psychology and Social Care, Manchester Metropolitan University, Manchester, UK
| | - James Selfe
- Department of Health Professions, Faculty Health, Psychology and Social Care, Manchester Metropolitan University, Manchester, UK
| | - Suzanne Ball
- Department of Health Professions, Faculty Health, Psychology and Social Care, Manchester Metropolitan University, Manchester, UK
| | - Susan Greenhalgh
- Department of Health Professions, Faculty Health, Psychology and Social Care, Manchester Metropolitan University, Manchester, UK.,Bolton NHS Foundation Trust, Bolton, UK
| | - Gareth Hogan
- Department of Health Professions, Faculty Health, Psychology and Social Care, Manchester Metropolitan University, Manchester, UK
| | - Janene Holway
- Department of Health Professions, Faculty Health, Psychology and Social Care, Manchester Metropolitan University, Manchester, UK
| | - Emma Willis
- Department of Health Professions, Faculty Health, Psychology and Social Care, Manchester Metropolitan University, Manchester, UK
| | - Gillian Yeowell
- Department of Health Professions, Faculty Health, Psychology and Social Care, Manchester Metropolitan University, Manchester, UK
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Abstract
INTRODUCTION The syndromes of mild cognitive impairment (MCI) or mild neurocognitive disorder (MiND), often prodromal to dementia (Major Neurocognitive Disorder), are characterized by acquired clinically significant changes in one or more cognitive domains despite preserved independence. Mild impairment has significant medicolegal consequences for an affected person and their care system. We review the more common etiologies of MiND and provide a systematic review of its medicolegal implications. METHODS We conducted a systematic review of the peer-reviewed English literature on medicolegal aspects of MCI or MiND using comprehensive search terms and expanding our review to include sources cited by these reports. RESULTS Impairment of memory, executive function, social cognition, judgment, insight or abstraction can alter an individual's abilities in a variety of areas that include decision making, informed consent, designation of a surrogate decision-maker such as a health care proxy, understanding and management of financial affairs, execution of a will, or safe driving. CONCLUSION Even mild cognitive impairment can have significant behavioral consequences. Clinicians can assist care partners and persons with MCI or MiND by alerting them to the medicolegal concerns that often accompany cognitive decline. Early recognition and discussion can help a care system manage medicolegal risk more effectively and promote thoughtful advance planning.
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Affiliation(s)
- Anca Bejenaru
- Department of Psychiatry and Behavioral Health, Christiana Care, Wilmington, DE, USA
| | - James M Ellison
- Department of Psychiatry and Behavioral Health, Christiana Care, Wilmington, DE, USA.,Department of Family and Community Medicine, Christiana Care, Wilmington, DE, USA.,Department of Psychiatry & Human Behavior, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
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30
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Edwards PJ, Bennett-Britton I, Ridd MJ, Booker M, Barnes RK. Factors affecting the documentation of spoken safety-netting advice in routine GP consultations: a cross-sectional study. Br J Gen Pract 2021; 71:e869-e876. [PMID: 34489251 PMCID: PMC8436774 DOI: 10.3399/bjgp.2021.0195] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 06/18/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Previous studies have reported how often safety-netting is documented in medical records, but it is not known how this compares with what is verbalised and what factors might influence the consistency of documentation. AIM To compare spoken and documented safety-netting advice and to explore factors associated with documentation. DESIGN AND SETTING A cross-sectional study, using an existing GP consultations archive. METHOD Observational coding involving classifying and quantifying medical record entries and comparison with spoken safety-netting advice in 295 video-/audio-recorded consultations. Associations were tested using logistic regression. RESULTS Two-thirds of consultations (192/295) contained spoken safety-netting advice that applied to less than half of the problems assessed (242/516). Only one-third of consultations (94/295) had documented safety-netting advice, which covered 20.3% of problems (105/516). The practice of GPs varied widely, from those that did not document their safety-netting advice to those that nearly always did so (86.7%). GPs were more likely to document their safety-netting advice for new problems (P = 0.030), when only a single problem was discussed in a consultation (P = 0.040), and when they gave specific rather than generic safety-netting advice (P = 0.007). In consultations where multiple problems were assessed (n = 139), the frequency of spoken and documented safety-netting advice decreased the later a problem was assessed. CONCLUSION GPs frequently do not document the safety-netting advice they have given to patients, which may have medicolegal implications in the event of an untoward incident. GPs should consider how safely they can assess and document more than one problem in a single consultation and this risk should be shared with patients to help manage expectations.
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Affiliation(s)
- Peter J Edwards
- Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol
| | - Ian Bennett-Britton
- Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol
| | - Matthew J Ridd
- Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol
| | - Matthew Booker
- Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol
| | - Rebecca K Barnes
- Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol; senior qualitative researcher, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford
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Madadin M, Al-Abdulrahman R, Alahmed S, Alabdulqader R, Alshehri L, Alkathery N. Desert Related Death. Int J Environ Res Public Health 2021; 18:11272. [PMID: 34769789 DOI: 10.3390/ijerph182111272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 10/16/2021] [Accepted: 10/23/2021] [Indexed: 12/03/2022]
Abstract
Introduction: Desert death is defined as any death that occurs in the desert and could be attributed to a list of causes including environmental, animal related, undetermined, and other causes. Death in the desert seems to be obscure and little discussed in the field of forensic medicine, despite its importance, and there is only limited literature available on this broad topic. This narrative review aims to identify the most common causes of desert death and its medicolegal implications. Desert death causes: Environmental causes of death could be a result of temperature and lightening-related causes. Moreover, a variety of animals found in deserts are considered to be threatening and fatal, in addition to other and undetermined causes. Medicolegal implications of desert death: Likely to arise from the difficulties faced in finding the cause of death are the identification of the victim and the postmortem injuries that occur. Conclusion: Desert death is a broad topic with great medicolegal significance. More information and case reports need to be added in the literature. Guidelines for people about the danger of going to deserts in specific weather conditions should be implemented. Safety regulations must be taken into account at all times.
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Bavarian R, Schatman ME, Keith DA. Persistent Pain Following Proplast-Teflon Implants of the Temporomandibular Joint: A Case Report and 35-Year Management Perspective. J Pain Res 2021; 14:3033-3046. [PMID: 34611434 PMCID: PMC8486010 DOI: 10.2147/jpr.s329123] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 09/16/2021] [Indexed: 01/03/2023] Open
Abstract
Over three decades ago, hundreds of predominantly young women with temporomandibular joint pain and other symptoms were implanted with a prosthetic device composed of Proplast-Teflon that subsequently caused considerable harm, with patients developing chronic pain, dysfunction, and disability. This perspective review presents such a patient who suffered for decades with severe pain despite extensive pharmacotherapy, injection therapy, multiple surgeries, and behavioral health interventions. The details of the origin and subsequent events regarding the use of Proplast-Teflon interpositional implants in the temporomandibular joint are described with resources from several different perspectives. The lessons learned demonstrate failures at the federal, professional, and individual level.
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Affiliation(s)
- Roxanne Bavarian
- Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Boston, MA, USA.,Department of Oral and Maxillofacial Surgery, Harvard School of Dental Medicine, Boston, Ma, USA
| | - Michael E Schatman
- Department of Anesthesiology, Perioperative Care, & Pain Medicine, NYU School of Medicine, New York, NY, USA.,School of Social Work, North Carolina State University, Raleigh, NC, USA
| | - David A Keith
- Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Boston, MA, USA.,Department of Oral and Maxillofacial Surgery, Harvard School of Dental Medicine, Boston, Ma, USA
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33
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Lam CL, Siu BWM, Yau VCK. Advancement in the medicolegal requirement for testamentary capacity assessment in older adults: the dilemmas in Hong Kong. Psychiatr Psychol Law 2021; 29:563-576. [PMID: 35903500 PMCID: PMC9318259 DOI: 10.1080/13218719.2021.1956381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Medical and legal professionals are increasingly involved in probate disputes in which the validity of a will due to a lack of testamentary capacity in older adults is frequently challenged. The legal test for testamentary capacity under common-law jurisdiction was established in the famous case of Banks v Goodfellow (1870). The High Court of Hong Kong recently issued new practice guidance for legal professionals on the preparation of a will for older adults. This paper discusses the dilemmas and competing issues among different parties on this medicolegal interface based on recent literature and local examples. We recommend a risk-based pragmatic framework for legal and medical professionals to minimise potential disputes in testamentary capacity assessment.
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Affiliation(s)
- Chi-Leung Lam
- The Medical Centre for Cognition and Emotion (HK), Hong Kong, China
| | - Bonnie W. M. Siu
- Department of Forensic Psychiatry, Castle Peak Hospital, Hong Kong, China
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Mitchell M. Medicolegal Considerations in the Management of Opioid Use Disorder With Buprenorphine in the Correctional Setting. J Correct Health Care 2021; 27:210-214. [PMID: 34388040 DOI: 10.1089/jchc.19.06.0054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Buprenorphine-based medication-assisted treatment is a long-term strategy for individuals with opioid use disorder (OUD), a condition observed at disproportionate rates among incarcerated populations. Individuals with OUD are also at higher risk of overdose and death upon community reentry, necessitating effective interventions and care modalities targeted at this high-risk population. As support for buprenorphine in correctional health care increases, so do concerns surrounding personal liability for prescribers. This article seeks to identify problematic events related to prescribing buprenorphine to incarcerated individuals, clarify medicolegal implications, and provide recommendations for safe prescribing and administration within this unique setting.
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Affiliation(s)
- Megann Mitchell
- Division of Emergency Medicine, UW Medicine, Harborview Medical Center, Seattle, Washington, USA
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35
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Young K, Koshi EJ, Mostales JC, Saha B, Burgess LP. Medicolegal Considerations Regarding Steroid Use in Otolaryngology: A Review of the Literature. Ann Otol Rhinol Laryngol 2021; 131:544-550. [PMID: 34151596 DOI: 10.1177/00034894211026737] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To review the literature on corticosteroid use and provide recommendations on patient counseling and/or consent to promote judicious prescribing and reduce the incidence of corticosteroid-related lawsuits. METHOD A conventional literature search of PubMed on corticosteroid-related medicolegal cases was undertaken. Search terms included "medicolegal," "otolaryngology," and "adrenocorticosteroids." A medical subjects headings search with the keywords "adrenal cortex hormones" and "jurisprudence" was also performed. RESULTS Corticosteroids have been reported as the third most frequent medication involved in malpractice claims, oftentimes leading to disproportionately costly payments. The most common specialties found to be involved in corticosteroid related medicolegal cases included dermatology (12%), primary care (10%), and neurologists or neurosurgeons (6%). The most common complications encountered were avascular necrosis (39%), changes in mood (16%), infection (14%), and vision changes (14%). Only a few cases corticosteroid-related litigation regarding otolaryngologists were identified. More frequent causes for otolaryngology claims were intraoperative complications, deficits in diagnoses, and failures or delays in treatment. Three medicolegal pitfalls regarding corticosteroid use were identified from this review included: (1) insufficient advising, (2) lack of or incomplete informed consent, and (3) the significance of the patient-physician relationship. CONCLUSION Despite the scarcity of corticosteroid-related medicolegal literature pertaining to otolaryngologists, corticosteroids are one of the most widely prescribed medications in the field of otolaryngology and have been shown to have a high rate of medical malpractice claims in medicine. Counseling and consenting the patient, as well as developing a strong physician-patient relationship, are integral processes in addressing any adverse effects occurring during therapy, and may also help to decrease the incidence and success of litigation against otolaryngologists.
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Affiliation(s)
- Kurtis Young
- John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, USA
| | - Elliott J Koshi
- John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, USA
| | - Joshua C Mostales
- John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, USA
| | - Bibek Saha
- John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, USA
| | - Lawrence P Burgess
- John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, USA
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Dugral E, Sanli A, Can İO. Medicolegal Evaluation of Long-Term Respiratory Functions in Patients Injured Due to Traffic Accidents. Cureus 2021; 13:e15642. [PMID: 34306852 PMCID: PMC8279099 DOI: 10.7759/cureus.15642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2021] [Indexed: 11/07/2022] Open
Abstract
Aim Blunt chest trauma is a frequent injury in developing countries, with motor vehicle accidents being the most common cause. Most studies about the effects of post-traumatic injuries on pulmonary functions are related to the acute phase. The aim of this study is to compare the effect of injury type on pulmonary function tests as a long-term disability in patients with severe chest trauma due to traffic accidents. Methods In our study, 53 patients were admitted to the Forensic Expert Council with the aim of determining the disability ratio at least six months after the traffic accident. All patients who had a respiratory function test because of respiratory symptoms and whose reporting period was completed were appreciated. A retrospective examination of the forensic committee reports, types of injuries, and current pulmonary function test results were analyzed and the data were evaluated by using the Statistical Package for the Social Sciences (SPSS) 22.0 program (IBM Corp, Armonk, NY). Results Thirty-two (32) of the patients were male while 21 were female. Their average age was 39.88 ± 15.29. Sixty-six percent (66%; n: 35) of the cases were injured due to in-vehicle traffic accidents, 18.9% (n: 10) due to motorcycle accidents, 15.1% (n: 8) due to non-vehicle traffic accidents. The number of cases with costa fractures was 47 and 74.4% of these cases had three or more rib fractures. The mean forced expiratory volume in 1 second/forced vital capacity ratio (FEV1/FVC-Tiffeneau-Pinelli index) was calculated as 85.3% ± 9.45, and the average FVC was 84.3 ± 14.98%. The average number of rib fractures in all patients was 3.41 ± 2.24. It was observed that tube thoracostomy was performed in seven of 12 cases with FEV1/FVC below 80%, and the average number of rib fractures was 3.75. In 20 cases where the FVC average was below 80%, the mean number of rib fractures was 3.8, and tube thoracostomy was performed in 10 of these cases. The highest FEV1 value was 116%, and the lowest FEV1 value was 35%. The FEV1 value of 23 cases was between 75% and 95%. The highest FEV1/FVC value was 113% and the lowest FEV1/FVC value was 50%. The FEV1/FVC values of 38 cases were between 80% and 100%. Conclusions In our study, most patients achieve near-complete recovery in pulmonary function tests; the impact of pre-existing pulmonary compromise on recovery is less known. The number of rib fractures can reflect the severity of the blunt trauma but it would not necessarily predict the resulting pulmonary function. These results are consistent with the previous studies. Further larger prospective studies are required to investigate different factors affecting prognosis.
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Affiliation(s)
- Esra Dugral
- Department of Pulmonology, Dokuz Eylul University, Faculty of Medicine, İzmir, TUR
| | - Aydin Sanli
- Department of Thorax Surgery, Dokuz Eylul University, Faculty of Medicine, İzmir, TUR
| | - İsmail Ozgur Can
- Department of Forensic Medicine, Dokuz Eylul University, Faculty of Medicine, İzmir, TUR
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Abstract
STUDY DESIGN Narrative review. OBJECTIVE The aim of this narrative review is to examine trends in malpractice litigation arising from spine surgery. We also hope to detail mitigation strategies that surgeons can employ to decrease their risk of a claim. METHODS A review of the relevant literature examining the prevalence, risks, and outcomes of malpractice litigation following spine surgery was conducted using the MEDLINE and Embase databases. RESULTS Combined queries identified 1140 potentially relevant articles. After eliminating duplicate articles and screening by title and abstract, 38 articles underwent full-text review. Of these, 22 were deemed relevant to the research questions posed. Evaluation of references identified 1 additional relevant article. Spine surgery represents one of the most litigious specialties in the United States health care system. The available literature points to a consistent pattern of common allegations leading to litigation following spine surgery. While a majority of filed lawsuits end in the surgeon's favor, these cases carry high monetary and time expenditures regardless of outcome. Furthermore, the threat of a malpractice lawsuit motivates many surgeons to practice defensive medicine by utilizing unnecessary or unindicated tests and studies. CONCLUSION Through the examination of trends in malpractice claims and case outcomes, surgeons may be able to adapt practices to minimize their risk of litigation. These changes can include, but are not limited to, identification of those procedures that are most litigious and a more thorough discussion of the informed consent process to include operative and nonoperative treatments prior to all procedures. More important, however, spine surgeons can potentially serve as advocates for change.
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Affiliation(s)
- Keith L. Jackson
- Dwight David Eisenhower Army Medical Center, Fort Gordon, GA, USA
| | | | - Matthew Griffith
- Dwight David Eisenhower Army Medical Center, Fort Gordon, GA, USA
,Matthew Griffith, Department of Orthopaedic Surgery, Dwight David Eisenhower Army Medical Center, Fort Gordon, GA 30905, USA.
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38
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Todd NV. Spinal reperfusion syndrome. A literature review and medicolegal implications. Br J Neurosurg 2021; 35:541-546. [PMID: 33754912 DOI: 10.1080/02688697.2021.1900539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Aim. To consider the diagnosis of spinal reperfusion syndrome (SRS) and its medicolegal implications.Materials and Methods. . A PRISMA guided PubMed search was performed to identify cases of possible SRS following spinal surgery.Result. Fourteen papers suggested that SRS might be the cause of neurological deterioration. In patients undergoing surgery for cervical degenerative disorders there were 7 patients who had new deficits immediately on awakening from the anaesthetic. There were 6 patients who had no new deficit immediately post-surgery with new deficits occurring within hours, or up to 3 days post-surgery.Conclusion. There is no agreed clinical definition of the SRS and the radiological abnormalities are not defined. The diagnosis of SRS can potentially be made by exclusion or inclusion. If there is a known cause of new neurological deficits intra- or immediately post-operatively, such as for example intraoperative cord injury, inadequate decompression or a haematoma, that is the probable diagnosis, not SRS. If a patient awakes with new deficits the most likely cause (if no other cause is identified) is intraoperative injury to the cord. If there is delayed deterioration with no cause identified SRS is a possible explanation. New deficits occur in 0.5 to 1.0% of patients undergoing anterior cervical spine surgery i.e. overall this is common whereas SRS is rare. The medicolegal implications are discussed.
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Affiliation(s)
- N V Todd
- Newcastle Nuffield Hospital, Newcastle upon Tyne, United Kingdom of Great Britain and Northern Ireland
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Abstract
BACKGROUND Despite studies showing most patients significantly improve their nasal congestion with surgical management of nasal turbinates, not all achieve acceptable results. Rarely, patients report substantial worsening of symptoms leading to litigation risk. OBJECTIVE Document the United States medicolegal environment for nasal turbinate surgery. METHODS We searched the Westlaw database for turbinate related terms for 1987- July 2019, recording demographics, claims, legal arguments, and outcomes in legal cases related to nasal turbinate surgery. We assessed prevalence and correlations with case outcomes. RESULTS Of the 39 cases identified, the most common complaint was nose/facial pain (53.8% of cases). Surgeons prevailed in 87.2% of cases, with total liabilities of $3,224,606 [mean $97,715.3, ±$283,900.8]. Surgeons had statistically significant favorable outcomes when patients claimed dryness, headache, congestion, crusting, breathing problems, and disfigurement (all p < 0.05). Revision surgery was indicated in 23.1% of cases and was claimed in 40.0% of patient awards. Surgical negligence was claimed in 40.0% of patient awards versus 67.9% of surgeon awards (p = 0.333). Lack of informed consent was claimed in 20.0% of patient awards versus 32.1% of surgeon awards (p = 0.601). CONCLUSIONS There are inherent litigation risks for surgeons when performing nasal turbinate surgery. Most claims against surgeons, are resolved in favor of the surgeon. Understanding the types of claims and legal arguments that are made by patients could help assessing the risks of a proposed litigation. Documenting clear indications for surgery and written informed consent may reduce litigations against surgeons.
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Affiliation(s)
- Steven M Coppess
- University of Washington Department of Emergency Medicine, Seattle, Washington
| | | | - Greg E Davis
- University of Washington Department of Emergency Medicine, Seattle, Washington.,Proliance Surgeons, Seattle, Washington
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40
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Kelly AM, Cockburn T, Madden B. When patients behave badly: Consent, breach of the duty of care and the law. Emerg Med Australas 2020; 33:172-174. [PMID: 33269498 DOI: 10.1111/1742-6723.13692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 11/18/2020] [Indexed: 11/29/2022]
Abstract
Patients who are abusive or aggressive in ED raise special clinical and legal challenges. These include what steps clinicians should take to exclude serious illness/injury as the cause of the behaviour and when investigations or treatments can be imposed on these patients without their consent. Using a case illustration, this paper discusses legal issues which arise in this context, including how the standard of care owed by clinicians is determined and what may constitute a breach of duty; such patients' right to consent to (or decline) tests and treatment; and when clinicians may lawfully act without consent and/or control the patient's behaviour.
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Affiliation(s)
- Anne-Maree Kelly
- Joseph Epstein Centre for Emergency Medicine Research, Sunshine Hospital, Melbourne, Victoria, Australia.,Australian Centre for Health Law Research, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Tina Cockburn
- Australian Centre for Health Law Research, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Bill Madden
- Australian Centre for Health Law Research, Queensland University of Technology, Brisbane, Queensland, Australia
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41
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Johnson RJ, MacKenzie D. Medicolegal considerations of radiology report writing in the new pjmirodigm of artificial intelligence. J Med Imaging Radiat Oncol 2020; 65:67-69. [PMID: 33217781 DOI: 10.1111/1754-9485.13126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 10/21/2020] [Indexed: 11/29/2022]
Affiliation(s)
| | - Don MacKenzie
- Brisbane Courthouse, Coroners Court of Queensland, Brisbane, Queensland, Australia
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42
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LeFever D, Demand A, Kandregula S, Vega A, Hobley B, Paterson S, Trosclair K, Menger R, Kosty J, Guthikonda B. Status of current medicolegal reform in the United States: a neurosurgical perspective. Neurosurg Focus 2020; 49:E5. [PMID: 33130614 DOI: 10.3171/2020.8.focus20616] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 08/24/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE There are approximately 85,000 lawsuits filed against medical practitioners every year in the US. Among these lawsuits, neurosurgery has been identified as a "high-risk specialty" with exceptional chance of having medical malpractice suits filed. Major issues affecting the overall medicolegal environment include tort reform, the formation of medical review panels, the increasing practice of defensive medicine, and the rising costs of medical insurance. In this study, the authors provide a concise update of the current medicolegal environments of the 50 states and provide a general guide to favorable and unfavorable states in which to practice neurosurgery. METHODS Data were acquired related to state-by-state medical review panel status, noneconomic damage caps, economic damage caps, and civil suit filing fees. States were placed into 5 categories based on the status of their current medicolegal environment. RESULTS Of the 50 states in the US, 18 have established a medical review panel process. Fifteen states have a mandatory medical review process, whereas 3 states rely on a voluntary process. Thirty-five states have tort reform and have placed a cap on noneconomic damages. These caps range from $250,000 to $2,350,000, with the median cap of $465,900. Only 8 states have placed a cap on total economic damages. These caps range from $500,000 to $2,350,000, with the median cap of $1,050,000. All states have a filing fee for a medical malpractice lawsuit. These costs range from $37 to $884, with the median cost for filing of $335. CONCLUSIONS Medicolegal healthcare reform will continue to play a vital role in physicians' lives. It will dictate if physicians may practice proactively or be forced to act defensively. With medicolegal reform varying greatly among states, it will ultimately dictate if physicians move into or away from certain states and thus guide the availability of healthcare services. A desirable legal system for neurosurgeons, including caps on economic and noneconomic damages and availability of medical review panels, can lead to safer practice.
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Affiliation(s)
- Devon LeFever
- 1Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana; and
| | - Audrey Demand
- 1Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana; and
| | - Sandeep Kandregula
- 1Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana; and
| | - Alexis Vega
- 1Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana; and
| | - Breydon Hobley
- 1Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana; and
| | - Soleil Paterson
- 1Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana; and
| | - Krystle Trosclair
- 1Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana; and
| | - Richard Menger
- 2Department of Neurosurgery Specialists, University of South Alabama, Mobile, Alabama
| | - Jennifer Kosty
- 1Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana; and
| | - Bharat Guthikonda
- 1Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana; and
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Bass DI, Lee A, Browd SR, Ellenbogen RG, Hauptman JS. Medicolegal issues in abusive head trauma for the pediatric neurosurgeon. Neurosurg Focus 2020; 49:E23. [PMID: 33130608 DOI: 10.3171/2020.8.focus20599] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 08/18/2020] [Indexed: 11/06/2022]
Abstract
The purpose of this article is to serve as a rational guide for the pediatric neurosurgeon in navigating common medicolegal issues that arise in the management of abusive head trauma (AHT). Many of these issues may be unfamiliar or unpleasant to surgeons focused on addressing disease. The authors begin with a brief history on the origins of the diagnosis of AHT and the controversy surrounding it, highlighting some of the facets of the diagnosis that make it particularly unique in pediatric neurosurgery. They then review some special medical considerations in these patients through the perspective of the neurosurgeon and provide several examples as illustration. The authors discuss how to appropriately document these cases in the medical record for expected legal review, and last, they provide an overview of the legal process through which the neurosurgeon may be called to provide testimony.
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Affiliation(s)
- David I Bass
- 1Department of Neurological Surgery, University of Washington; and
| | - Amy Lee
- 1Department of Neurological Surgery, University of Washington; and.,2Department of Neurosurgery, Seattle Children's Hospital, Seattle, Washington
| | - Samuel R Browd
- 1Department of Neurological Surgery, University of Washington; and.,2Department of Neurosurgery, Seattle Children's Hospital, Seattle, Washington
| | - Richard G Ellenbogen
- 1Department of Neurological Surgery, University of Washington; and.,2Department of Neurosurgery, Seattle Children's Hospital, Seattle, Washington
| | - Jason S Hauptman
- 1Department of Neurological Surgery, University of Washington; and.,2Department of Neurosurgery, Seattle Children's Hospital, Seattle, Washington
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44
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Sankey EW, Mehta VA, Wang TY, Than TT, Goodwin CR, Karikari IO, Shaffrey CI, Abd-El-Barr MM, Than KD. The medicolegal impact of misplaced pedicle and lateral mass screws on spine surgery in the United States. Neurosurg Focus 2020; 49:E20. [PMID: 33130620 DOI: 10.3171/2020.8.focus20600] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 08/24/2020] [Indexed: 11/06/2022]
Abstract
Spine surgery has been disproportionately impacted by medical liability and malpractice litigation, with the majority of claims and payouts related to procedural error. One common area for the potential avoidance of malpractice claims and subsequent payouts involves misplaced pedicle and/or lateral mass instrumentation. However, the medicolegal impact of misplaced screws on spine surgery has not been directly reported in the literature. The authors of the current study aimed to describe this impact in the United States, as well as to suggest a potential method for mitigating the problem.This retrospective analysis of 68 closed medicolegal cases related to misplaced screws in spine surgery showed that neurosurgeons and orthopedic spine surgeons were equally named as the defendant (n = 32 and 31, respectively), and cases were most commonly due to misplaced lumbar pedicle screws (n = 41, 60.3%). Litigation resulted in average payouts of $1,204,422 ± $753,832 between 1995 and 2019, when adjusted for inflation. The median time to case closure was 56.3 (35.2-67.2) months when ruled in favor of the plaintiff (i.e., patient) compared to 61.5 (51.4-77.2) months for defendant (surgeon) verdicts (p = 0.117).
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Affiliation(s)
- Eric W Sankey
- 1Department of Neurosurgery, Spine Division, Duke University Medical Center, Durham, North Carolina; and
| | - Vikram A Mehta
- 1Department of Neurosurgery, Spine Division, Duke University Medical Center, Durham, North Carolina; and
| | - Timothy Y Wang
- 1Department of Neurosurgery, Spine Division, Duke University Medical Center, Durham, North Carolina; and
| | | | - C Rory Goodwin
- 1Department of Neurosurgery, Spine Division, Duke University Medical Center, Durham, North Carolina; and
| | - Isaac O Karikari
- 1Department of Neurosurgery, Spine Division, Duke University Medical Center, Durham, North Carolina; and
| | - Christopher I Shaffrey
- 1Department of Neurosurgery, Spine Division, Duke University Medical Center, Durham, North Carolina; and
| | - Muhammad M Abd-El-Barr
- 1Department of Neurosurgery, Spine Division, Duke University Medical Center, Durham, North Carolina; and
| | - Khoi D Than
- 1Department of Neurosurgery, Spine Division, Duke University Medical Center, Durham, North Carolina; and
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45
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Abstract
OBJECTIVE Informed consent has served as a main principle of medical ethics and laws in the United States. The 1986 American Association of Neurological Surgeons Code of Ethics implied medicolegal liability for the failure to obtain informed consent without providing practical guidance regarding the application of informed consent to individual patient encounters in a medicolegal environment. Here, the authors aimed to identify baseline patient recall after discussions with neurosurgeons and their capacity to provide informed consent, describe the effects of interventions to improve patient comprehension, and elucidate the role of informed consent in malpractice litigation in neurosurgery. Their findings may guide neurosurgeons in discussions to properly inform patients and reduce the risk of litigation. METHODS A systematic review was conducted to explore informed consent within neurosurgery and its application to medicolegal liability using the PubMed, Embase, and Scopus databases. Titles and abstracts from articles identified in the search were read and selected for full-text review. Studies meeting prespecified inclusion criteria were reviewed in full and analyzed for study design, aim, population, interventions, and outcomes. RESULTS Of 1428 resultant articles, 21 were included in the review. Baseline patient recall was low, particularly for risks and alternatives of treatments, and even decreased over time. Cognitive impairment was noted as a factor limiting the ability to provide informed consent. Interventions incorporating a combination of modalities in informed consent discussions, a specialized consent form with points for neurosurgeons to check off upon discussion, interactive websites, question prompt lists, and illustrations were found to be effective in improving patient knowledge. Lack of informed consent was a common factor for malpractice litigation. Spine surgery was particularly prone to costly lawsuits. Payments were generally greater for plaintiff verdicts than for settlements. CONCLUSIONS The application of informed consent to patient encounters is an important facet of clinical practice. Neurosurgeons have a duty to provide patients with all pertinent information to allow them to make decisions about their care. The authors examined baseline patient comprehension and capacity, interventions to improve informed consent, and malpractice litigation; it appears that determining the proper capacity to provide informed consent and considering informed consent as a process that depends on the setting are important. There is room to improve the informed consent process centered on baseline patient health literacy and understanding as well as clear communication using multiple modalities.
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Affiliation(s)
- Nathan A Shlobin
- 1Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Division of Pediatric Neurosurgery, Anne and Robert H. Lurie Children's Hospital, Chicago
| | - Mark Sheldon
- 2Department of Philosophy, Northwestern University, Evanston; and.,3Center for Bioethics and Medical Humanities, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Sandi Lam
- 1Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Division of Pediatric Neurosurgery, Anne and Robert H. Lurie Children's Hospital, Chicago
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Garg K, Sharma R, Raheja A, Tandon V, Katiyar V, Dash C, Bhatnagar R, Khullar MK, Raju B, Nanda A, Kale SS. Perceptions of Indian neurosurgeons about medicolegal issues and malpractice suits. Neurosurg Focus 2020; 49:E10. [PMID: 33130628 DOI: 10.3171/2020.8.focus20592] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 08/19/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Despite the rising trend of medicolegal challenges in India, there is an absolute dearth of literature from India on this issue. The authors conducted a survey, to their knowledge a first of its kind, to assess the perceptions of Indian neurosurgeons about the medicolegal challenges faced in everyday practice. METHODS An anonymous online survey performed using Google Forms was widely circulated among neurosurgeons practicing in India via email and social media platforms. The questionnaire consisted of 38 questions covering the various aspects of medicolegal issues involved in neurosurgery practice. RESULTS A total of 221 survey responses were received, out of which 214 responses were included in the final analysis, barring 7 responders who had no work experience in India. The respondents were categorized according to their working arrangements and work experience. Out of all of the respondents, 20 (9.3%) had ≥ 1 malpractice suits filed against them. More than 90% of the respondents believed that malpractice suits are on the rise in India. Almost half of the respondents believed the advent of teleconsultation is further compounding the risk of malpractice suits, and 66.4% of respondents felt that they were inadequately trained during residency to deal with medicolegal issues. Most respondents (88.8%) felt that neurosurgeons working in the government sector had lesser chances of facing litigations in comparison to those working in the private sector. The practice of obtaining video proof of consent was more commonly reported by respondents working in freelancing and private settings (45.1%) and those with multiple affiliations (61.3%) compared to respondents practicing in government settings (22.8%) (p < 0.001). Neurosurgeons working in the private sector were more likely to alter management and refer sick patients to higher-volume treatment centers to avoid malpractice suits than their government counterparts (p = 0.043 and 0.006, respectively). The practices pertaining to legal preparedness were also found to be significantly higher among the respondents from the private sector (p < 0.001). CONCLUSIONS This survey highlights the apprehensions of neurosurgeons in India with regard to rising malpractice suits and the subsequent increase of defensive neurosurgical practices, especially in the private sector. A stronger legal framework for providing for quick redress of patient complaints, while deterring frivolous malpractice suits, can go a long way to allay these fears. There is a dire need for systematic training of neurosurgeons regarding legal preparedness, which should begin during residency.
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Affiliation(s)
- Kanwaljeet Garg
- 1Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi
| | - Ravi Sharma
- 1Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi
| | - Amol Raheja
- 1Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi
| | - Vivek Tandon
- 1Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi
| | - Varidh Katiyar
- 1Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi
| | - Chinmaya Dash
- 2Department of Neurosurgery, All India Institute of Medical Sciences, Bhubaneswar
| | - Rishi Bhatnagar
- 3Naveen Law Firm, Advocates Supreme Court of India, New Delhi, India
| | | | - Bharath Raju
- 4Department of Neurosurgery, Rutgers New Jersey Medical School, Newark; and
| | - Anil Nanda
- 4Department of Neurosurgery, Rutgers New Jersey Medical School, Newark; and.,5Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Shashank S Kale
- 1Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi
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Dhadwal AS, Sibanda L, Blum IR. Awareness and Understanding of Decision-Making Capacity and Its Relationship to Legally Valid Consent for Older Patients in Dentistry. Prim Dent J 2020; 9:59-63. [PMID: 32940592 DOI: 10.1177/2050168420943979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
With a growing ageing population and increased life expectancy in the UK, oral healthcare professionals will be exposed to a greater number of patients with health conditions which may affect cognitive function, communication and capacity to consent to treatment. This often gives rise to a conundrum which clinicians may face when considering capacity, consent and the legal implications and frameworks surrounding this. Assessing patient capacity is encountered routinely in dental practice and so oral healthcare professionals should be well informed of their responsibilities in this context. This article summarises and introduces readers to key concepts regarding consent and capacity with reference to relevant cross-jurisdictional legislation.
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Affiliation(s)
- Amardeep Singh Dhadwal
- Dental Core Trainee, Birmingham Dental Hospital and School of Dentistry & Birmingham Community Healthcare Trust
| | - Lwazi Sibanda
- Dental Core Trainee, Birmingham Dental Hospital and School of Dentistry & Birmingham Community Healthcare Trust
| | - Igor R Blum
- Reader in Primary Dental Care & Advanced General Dental Practice Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, UK Consultant & Specialist in Restorative Dentistry, King's College Hospital Dental Institute
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Jayadev C, Mahendradas P, Vinekar A, Kemmanu V, Gupta R, Pradhan ZS, D'Souza S, Aroor CD, Kaweri L, Shetty R, Honavar SG, Shetty B. Tele-consultations in the wake of COVID-19 - Suggested guidelines for clinical ophthalmology. Indian J Ophthalmol 2020; 68:1316-1327. [PMID: 32587157 PMCID: PMC7574118 DOI: 10.4103/ijo.ijo_1509_20] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
While telemedicine has been around for a few decades, it has taken great importance and prominence in recent times. With the fear of the virus being transmitted, patients and physicians across specialties are using consultation via a telephone call or video from the safety of their homes. Though tele-ophthalmology has been popular for screening, there are no clear guidelines on how to comprehensively manage patients seeking advice and treatment for a particular eye condition. Some major barriers to diagnosis and management are compromised detailed examination, no measurement of the visual acuity or intraocular pressure and a retinal evaluation not being feasible. Despite these limitations, we do need to help those patients who need immediate care or attention. Hence, this article has put together some guidelines to follow during such consultations. They are important and timely due to the medicolegal and financial implications.
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Affiliation(s)
- Chaitra Jayadev
- Narayana Nethralaya Eye Institute, 121/C, Chord Road, Rajajinagar, Bengaluru, Karnataka, India
| | - Padmamalini Mahendradas
- Narayana Nethralaya Eye Institute, 121/C, Chord Road, Rajajinagar, Bengaluru, Karnataka, India
| | - Anand Vinekar
- Narayana Nethralaya Eye Institute, 121/C, Chord Road, Rajajinagar, Bengaluru, Karnataka, India
| | - Vasudha Kemmanu
- Narayana Nethralaya Eye Institute, 121/C, Chord Road, Rajajinagar, Bengaluru, Karnataka, India
| | - Roshmi Gupta
- Narayana Nethralaya Eye Institute, 121/C, Chord Road, Rajajinagar, Bengaluru, Karnataka, India
| | - Zia S Pradhan
- Narayana Nethralaya Eye Institute, 121/C, Chord Road, Rajajinagar, Bengaluru, Karnataka, India
| | - Sharon D'Souza
- Narayana Nethralaya Eye Institute, 121/C, Chord Road, Rajajinagar, Bengaluru, Karnataka, India
| | - Chaithra D Aroor
- Narayana Nethralaya Eye Institute, 121/C, Chord Road, Rajajinagar, Bengaluru, Karnataka, India
| | - Luci Kaweri
- Narayana Nethralaya Eye Institute, 121/C, Chord Road, Rajajinagar, Bengaluru, Karnataka, India
| | - Rohit Shetty
- Narayana Nethralaya Eye Institute, 121/C, Chord Road, Rajajinagar, Bengaluru, Karnataka, India
| | - Santosh G Honavar
- Narayana Nethralaya Eye Institute, 121/C, Chord Road, Rajajinagar, Bengaluru, Karnataka, India
| | - Bhujang Shetty
- Narayana Nethralaya Eye Institute, 121/C, Chord Road, Rajajinagar, Bengaluru, Karnataka, India
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49
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Parkinson R, Eardley I, Reynard J. The meaning of words - closing the gap in understanding between doctors and patients in 21st century consent. BJU Int 2020; 126:411-415. [PMID: 32649792 DOI: 10.1111/bju.15167] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 06/23/2020] [Accepted: 07/03/2020] [Indexed: 11/28/2022]
Abstract
'When I use a word' Humpty Dumpty said, in a rather scornful tone, 'it means just what I choose it to mean, neither more nor less'. 'The question is' said Alice 'whether you can make words mean so many different things'. Through the Looking-Glass, Lewis Carroll, 1872.
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Affiliation(s)
- Richard Parkinson
- Department of Urology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Ian Eardley
- Department of Urology, Leeds Teaching Hospital Trust, Leeds, UK
| | - John Reynard
- Department of Urology, Oxford University NHS Hospitals Trust, Oxford, UK.,Nuffield Department of Surgical Sciences, Oxford University NHS Hospitals Trust, Oxford, UK
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50
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Abstract
COVID‐19 has massively changed the health landscape around the world. Wide‐ranging changes to healthcare delivery have occurred, especially in hospitals and EDs. Health services have made local decisions about care pathways, in some cases deviating from what would, until recently, have been considered widely accepted care. These changes bring with them new medicolegal risk for clinicians. In Australia, civil liability Acts provide protection for professionals when the criterion of having undertaken ‘competent’ practice that would be ‘widely accepted’ ‘in the circumstances’ is met. There is doubt how courts, and the medical experts who advise them, will evaluate clinical care provided during the pandemic when health services have developed local care pathways and there is no nationally accepted standard.
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Affiliation(s)
- Anne-Maree Kelly
- Joseph Epstein Centre for Emergency Medicine Research, Western Health, Melbourne, Victoria, Australia.,Department of Medicine, Melbourne Medical School - Western Precinct, The University of Melbourne, Melbourne, Victoria, Australia
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