Under the microscope: doctors, lawyers, and melanocytic neoplasms

Misdiagnosed melanoma remains one of the most common causes of lawsuits in histopathology. Reasons for this are discussed in conjunction with relevant literature, common errors in diagnosis, and strategies to avoid them.

Dermatology and the Americans With Disabilities Act: a review of the case law

The Americans With Disabilities Act (ADA) defines disability as a physical or mental impairment that substantially limits one or more major life activities. Although dermatology has received relatively little attention in the context of disability law, dermatologic diseases are properly covered by the ADA and are subject to the same criteria as other medical conditions. A Lexis-Nexis search of federal court decisions covering the ADA produced 23 cases dealing with dermatologic impairments as disabilities. In Cehrs v Northeast Ohio Alzheimer Research Center, a federal appeals court held that psoriasis constituted a disability under the Act. Skin diseases not only cause physical and mental impairments, but they are also visible to others. Persons with skin diseases may be "regarded as" disabled, and this can constitute discrimination under the law.

Medicolegal issues for the dermatologist

Medicolegal issues for the dermatologist cannot be ignored. Appropriate legal advice from an attorney with such expertise may represent an unwanted office expense. However, the value of this advice in an increasingly hostile health care environment cannot be underestimated. Legal consultation, an insurance policy against the vagaries of health care law, has become a necessity in our litigious society.

The legal and risk management conundrum of telemedicine

A store-and-forward teledermatology service was established between two general practices and the department of plastic surgery at Derriford Hospital in Plymouth. An academic lawyer and an expert in risk management made an assessment of the service. They looked at the following issues: medicolegal problems; security; confidentiality; and risk. None of them was considered insoluble and there is no reason why such issues should prevent the National Health Service from developing telemedicine services. All organizations considering telemedicine need to ensure that the proposed telemedicine service satisfies the issues raised in this study.

Does the location of the surgery or the specialty of the physician affect malpractice claims in liposuction?

BACKGROUND

There is increasing national dialogue on who should perform liposuction and where it should be performed.

OBJECTIVE

To determine the effect of the location of liposuction surgery and the specialty of the physician on the incidence of malpractice claims.

METHODS

Physicians Insurance Association of America malpractice data from 1995-1997 was analyzed.

RESULTS

Hospital-based liposuction had more than 3 times the rate of malpractice settlements than office-based liposuction. Dermatologists accounted for less than 1% of malpractice claim settlements in liposuction.

CONCLUSION

Dermatologic liposuction education has emphasized small volume cases performed under local anesthesia using the tumescent technique. The safety of this approach appears to be validated in terms of decreased malpractice settlements.

Informed consent and informed refusal

BACKGROUND

This article continues our medicolegal series that addresses issues affecting current dermatology practice. Informed consent and informed refusal have become cornerstones of modern American healthcare, and can serve to facilitate communication and trust between physician and patient.

METHODS

A format with an initial discussion of legal concepts is followed by hypothetical problems and a review of actual cases to illustrate the principles of informed consent and informed refusal.

RESULTS

A valid informed consent from a competent patient should be obtained before initiating most dermatologic treatment. When a competent patient refuses a recommended medical test or procedure, the physician should make sure the patient understands the potential negative consequences of refusal. Some form of written documentation in the medical record is advised in either situation.

CONCLUSION

Failure to obtain a patient's informed consent prior to beginning treatment or failing to obtain an informed refusal before accepting a patient's decision to forego a test or procedure may subject the dermatologist to multiple later allegations, most commonly negligence.

Quality in the dermatological contract. A report from the Workshop on Quality Issues in Dermatological contracting of the British Association of Dermatologists

This document is a summary of the most important points from a meeting convened by the audit sub-committee of the British Association of Dermatologists (BAD) and the research unit of the Royal College of Physicians on 16 May 1994. Participants represented the views of district general and teaching hospital dermatologists, a fundholding general practitioner, a health commissioning agent and patient support groups. The meeting was preceded by a workshop on 6 April 1994, involving 16 patient support groups chaired by Consumers Association from which a discussion paper was presented by two representatives. This report is intended for dermatologists, contract managers and purchasers.