A survey on the involvement of accident and emergency doctors in medicolegal work in Hong Kong

An Observational Study on the Management of Medico-Legal Maxillofacial Trauma Cases by General Practitioners

Maxillofacial trauma, as seen from a medico-legal point of view, is an integral part of medical practice in emergency departments. Therefore, general practitioners should have sufficient knowledge about their roles and responsibilities in managing these cases. This study aimed to assess general practitioners' knowledge, practices, and attitudes regarding managing medico-legal cases (MLCs).

MATERIAL AND METHOD

This study included 113 general practitioners from St. Spiridon Hospital in Iasi, Romania. Participants completed a self-administered structured questionnaire assessing the knowledge, attitudes, and practices of general practitioners regarding the handling of medico-legal cases.

RESULTS

The scores obtained for the level of knowledge, attitudes, and practices indicate a good level of knowledge on the part of the responding doctors, with the average value being 38, in a range from 0 to 49 (min. value 28-max wave. 47). The score regarding the attitudes of doctors related to the management of medico-legal cases is modest, with the average value being 37 points out of a maximum of 60 points (min. 14-max. 51). The same situation is recorded in the case of practices regarding the management of medico-legal cases, with the average value being 68 out of a maximum value of 90 (min. 38-max. 84).

CONCLUSION

This study's results revealed the absence of a well-defined protocol for the recognition and handling of medico-legal cases among general practitioners from Iasi and the need to improve the level of attitudes and practices regarding the management of medico-legal cases. The limitations of this study included the relatively small sample from a single hospital and the use of a methodology based on self-administered questionnaires, which may be subjective. Accordingly, future studies should involve larger and more diverse samples to monitor changes in knowledge and practices over time and qualitative methodologies to gain deeper physician-related insights into medical case management.

Characteristics of acute sexual assault care in New England emergency departments

Objective

Interventions such as written protocols and sexual assault nurse examiner programs improve outcomes for patients who have experienced acute sexual assault. How widely and in what ways such interventions have been implemented is largely unknown. We sought to characterize the current state of acute sexual assault care in New England.

Methods

We conducted a cross-sectional survey of individuals acute with knowledge of emergency department (ED) operations in relation to sexual assault care at New England adult EDs. Our primary outcomes included the availability and coverage of dedicated and non-dedicated sexual assault forensic examiners in EDs. Secondary outcomes included frequency of and reasons for patient transfer; treatment before transfer; availability of written sexual assault protocols; characteristics and scope of practice of dedicated and non-dedicated sexual assault forensic examiners (SAFEs), provision of care in SAFEs' absence; availability, coverage, and characteristics of victim advocacy and follow-up resources; and barriers to and facilitators of care.

Results

We approached all 186 distinct adult EDs in New England to recruit participants; 92 (49.5%) individuals participated, most commonly physician medical directors (n = 34, 44.1%). Two thirds of participants reported they at times have access to a dedicated (n = 52, 65%, 95% confidence interval [CI], 54.5%-75.5%) or non-dedicated (n = 50, 64.1%; 95% CI, 53.5%-74.7%) SAFE, but fewer reported always having this access (n = 9, 17.3%; 95% CI, 7%-27.6%; n = 13, 26%; 95% CI, 13.8%-38.2%). We describe in detail findings related to our secondary outcomes.

Conclusions

Although SAFEs are recognized as a strategy to provide high-quality acute sexual assault care, their availability and coverage is limited.

Emergency Physicians' Awareness of Medico-Legal Case Management: A Cross-Sectional Study from Saudi Arabia

Background

Emergency department physicians often encounter medico-legal cases when patients initially present to the hospital, and thus there is a strong need for them to have robust medico-legal management and reporting knowledge.

Objective

To assess the awareness of emergency department physicians of two major hospitals in the Eastern Province of Saudi Arabia in managing medico-legal cases.

Methods

This descriptive cross-sectional survey-based study included all adult and pediatric emergency physicians working at King Fahd Hospital of the University and King Fahd Specialist Hospital, two major government hospitals in the Eastern Province of Saudi Arabia. The questionnaire included questions about demographic information, the workload in the emergency department, previous medico-legal training, and information about physicians' perspectives regarding medico-legal situations.

Results

A total of 85 physicians completed the questionnaire, with most being Saudis (78.8%) and consultants (44.7%). Most participants (84.7%) immediately notified the police authority through the official procedure on suspicion of a case being criminal. However, only 28.2% of the participants were aware of how to complete the medico-legal report, and the majority (82.4%) had not received any specific training or attended specific courses in writing medico-legal reports. Most participants (91.8%) expressed the need for additional medico-legal case training programs, with continuous education (29.4%) being the preferred mode. In addition, 60% of the consultants were dissatisfied with the current medico-legal reporting and management workflow in their hospital. About half of the participants did not obtain photographs in medico-legal cases and did not know if their workplace provided a protocol for collecting evidentiary material such as clothes, swabs, bullets, remnants of foreign bodies, etc.

Conclusions

The results of the present study indicate the necessity to consider periodical continuing medical education programs and workshops for emergency department physicians in the Eastern Province of Saudi Arabia to help them in appropriately handling medico-legal cases.

Study of handling of medico-legal cases in governmental hospitals in Cairo

Medico-legal case (MLC) represents an integral part of medical practice in the emergency departments and causalities. Therefore, the physicians should have the sufficient knowledge of their roles and responsibilities while handling these cases to aid legal justice. This study on the physicians working in governmental hospitals in Cairo aimed to assess physicians' knowledge, practice and attitude regarding handling of MLCs. The study included 452 physicians working in 7 governmental hospitals in Cairo. There were non-significant differences in physicians' knowledge, practice and attitude scores according to their age groups, gender, job titles or duration of work experience. Physicians working in the day surgery centre had the lowest knowledge and attitude scores. Daily rate of confrontation with MLCs was reported by 42% the participants (190 physicians) and weekly rate was reported by 21.7% (98 physicians). Writing ML report was found as the most frequently encountered difficulty faced the participants during handling of MLCs (67.1%), followed by dealing with the patients' relatives. In conclusion, this study revealed absence of a well defined protocol for recognition and handling of MLCs in all included governmental hospitals in Cairo.

Forensic emergency medicine: old wine in new barrels

Emergency and forensic physicians may find themselves sometimes on the same medical battleground but with different primary aims and hence often ignore or do not recognize each other's needs. The emergency physician interacts with law enforcement agencies with greater frequency than any other hospital physician and hence needs expertise with legal issues. Awareness of the forensic relevance of certain medical observations by emergency physicians, knowledge of emergency medicine methodology and techniques and of resuscitation-related injuries by forensic physicians may lead to a higher standard in both forensic and emergency medicine, a better serving of the criminal justice system, and most importantly safeguarding the rights of victims of criminal assault. It is this achievable mutual symbiosis that we would like to refer to as the concept of 'forensic emergency medicine'.

Specific training in clinical forensic medicine is useful to ACEM trainees

OBJECTIVE

To assess the effectiveness of a 6-month rotation in forensic medicine in developing medicolegal and forensic skills for doctors training for a fellowship with the Australasian College for Emergency Medicine (ACEM).

METHODS

Over a period of 6 years 12 trainees undertook a 6-month rotation with the Victorian Institute of Forensic Medicine (VIFM) as a clinical forensic registrar. These 12 trainees were surveyed and asked structured questions regarding their perception of the usefulness of the training and the impact of the rotation on their professional development.

RESULTS

Twelve replies were received (100% response rate). All respondents felt that the term had a major positive influence on their ability to examine victims of physical and sexual assault, obtain forensic specimens and prepare a medicolegal report.

CONCLUSIONS

A 6-month rotation in clinical forensic medicine improves ACEM trainees perceived ability to perform a number of medicolegal tasks without interfering with other areas of professional development.