What should a suspended doctor do when his actions could save a patient's life?

Suspension from duty is becoming an increasing threat for medical practitioners. While under suspension a doctor may, in extreme circumstances, find themselves in a difficult legal dilemma as to their duty of care towards others. A suspended doctor may risk litigation if they are unaware of the legal ramifications of their unusual circumstances. The following article outlines the legal situation as it applies to England and Wales.

Learning differences, medical students, and the law

To update her article in the June 1999 issue of Academic Medicine, the author addresses the impact of the U.S. Supreme Court's decision in the 2001 Bartlett case on medical students with learning differences. In Bartlett v. the New York State Board of Bar Examiners, the Court ruled that Bartlett was substantially limited in the major life activity of working because of the board's failure to accommodate her reading impairment. The author postulates that the Supreme Court decision in the Bartlett case offers hope to medical students applying for accommodation on medical licensing examinations. If such accommodations are not forthcoming, she suggests that medical schools might ask the question, "Are board examinations a valid measurement of the preparation for the job of a physician?"

Learning disabilities, professionalism, and the practice of medical education

The authors use the interface of learning disabilities (LDs) and medical education to explore several issues relevant to medical professionalism and the training of future physicians. First, they examine arguments given by Little (in the preceding article) that a successful suit for accommodations on a state bar exam is generalizable to LDs and medical education, and suggest ways in which this may not be true. They then explore two frameworks for understanding medical education: (1) as a process of academic achievement linked to degree attainment, and (2) as a process of professional acculturation linked to competencies. Within this dichotomy, they then explore (1) the legitimacy accorded to different types of accommodations, (2) differing meanings of a "level playing field," and (3) the legal standard of "otherwise able." They also examine the use of intermediaries (e.g., a reader) as a "leveling" strategy and how, in clinical settings, this might violate core standards of autonomous decision making. The authors investigate the nature of "technical standards" in training across medicine and nursing and find a number of differences, particularly in the intent and levels of detail of standards. Across these two domains, they observe a status hierarchy, medical hubris, and the emergence of a "right to fail" as one travels down that hierarchy. The authors also examine medicine as an undifferentiated degree and consider arguments that medical school course requirements should be unbundled. They close by insisting that medical schools have a social responsibility to shift their pedagogic gaze from identifying handicaps in individuals to understanding how the education of physicians can become, quite literally, "handicapping."

[The Law of 19 Ventôse, year 21 (10 March 1803): fundamental text and provisional expedient]

During the last years of the Ancien Régime, Fourcroy established the link between Vicq d'Azyr and Colombier who both wore themselves out in order to reform the medical profession, fallen into a state of turmoil. But both died, and henceforth everything was handled by Fourcroy. On 10 March 1803 (19 Ventose an XI) he arranged for the passage of a fundamental law--today is its bi-centennial--reorganising the profession. Henceforth no one could exercise that profession without having been received as a doctor, except in underdeveloped regions where "health officers" (less qualified practitioners) would be accepted.

[Xenophobia and anti-Semitism in the medical milieu during the Occupation as seen through the journal "Concours Médical"]

Analysis of a well-known medical journal, the Concours Médical reveals the attitude among the French medical corps between 1940 and 1944. This journal kept its readers informed of the various stages of xenophobia and anti-Semitism under the Vichy government. It provided the decisions adopted, and the application of measures prohibiting foreign and Jewish physicians to practice, regularly publishing lists. Analysis of the editions published under the occupation clearly shows the xenophobia and anti-Semitism that existed among a certain population of French practitioners.

Achieving the right balance in oversight of physician opioid prescribing for pain: the role of state medical boards

Uncertainty regarding potential disciplinary action may give physicians pause when considering whether to accept a chronic pain patient or how to treat a patient who may require long-term or high doses of opioids. Surveys have shown that physicians fear potential disciplinary acrion for prescribing controlled substances and that physicians will, in some cases, inadequately prescribe opioids due to fear of regulatory scrutiny. Prescribing opioids for long-term pain management, particularly noncancer pain management, has been controversial; and boards have investigated and, in some cases, disciplined physicians for such prescribing. While in virtually all of these cases the disciplinary actions were successfully appealed, news of the success was not often as well-publicized as news of the disciplinary actions, leaving some physicians confused about their potential liability when prescribing opioids for pain. The confusion has perhaps increased as a result of two relatively recent cases, one where a physician was successfully disciplined by a state medical board for undertreatment of his patients’ pain, and another where the physician was successfully sued for inadequate pain treatment.

Medicolegal aspects of imaging and Internet communications

Many facial plastic surgeons have set up their own personal World Wide Web (WWW) pages with an electronic mail link to communicate with and educate prospective patients. The possible dilemma is in that these services are provided without actually meeting patients face to face. Also, despite the growing popularity of computer imaging systems, it is not clear whether the medical and legal advantages of using such a system outweigh the disadvantages. The purpose of this article is to evaluate these aspects and to provide some protective guidelines. An examination of possible causes of actions arising from computer imaging suggests that surgeons who follow a few simple guidelines, and who use computer imaging responsibly and cautiously, minimize their legal liability. Issues surrounding Internet discussion groups, posted medical advice, intellectual property, and the use of an electronic mail link are also discussed.