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Phua R, Mandrusiak A, Singh L, Martin R, Forbes R. Identifying and navigating suspected serious pathologies: New-graduate physiotherapists' perspectives and developmental needs. Musculoskelet Sci Pract 2024; 71:102944. [PMID: 38520877 DOI: 10.1016/j.msksp.2024.102944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 02/28/2024] [Accepted: 03/17/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND Physiotherapists in Australia play a vital first-contact role in identifying suspected serious pathologies and navigating their management pathways. Current literature highlights challenges faced by physiotherapists including implications of ineffective identification and management of suspected serious pathologies, yet the perspectives of new-graduate physiotherapists related to this area of practice remain unknown. OBJECTIVE The aim of this study was to explore new-graduate physiotherapists' perspectives and developmental needs related to identifying suspected serious pathologies and navigating their management pathways in patients with musculoskeletal complaints. DESIGN and Method: A qualitative study using a reflexive thematic analytical approach was undertaken. Eighteen semi-structured interviews were conducted. Thematic analysis was utilized on the interview data. RESULTS Four key themes were generated: (1) Physiotherapists as advocates; (2) Navigating uncertainties and complexities; (3) Safe and accessible workplace support builds confidence; and (4) Importance of direct learning opportunities. CONCLUSION New-graduate physiotherapists recognize their imperative role as first-contact practitioners in identifying and navigating suspected serious pathologies yet also experience significant uncertainties. The findings highlight key developmental needs, including supportive workplaces, established referral frameworks and direct learning opportunities during pre-professional training.
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Affiliation(s)
- Rachel Phua
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia.
| | - Allison Mandrusiak
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia.
| | - Lakhvir Singh
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia.
| | - Romany Martin
- School of Health Sciences, The University of Tasmania, Launceston, Australia.
| | - Roma Forbes
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia.
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Iqbal J, Shafique MA, Mustafa MS, Covell MM, Fatima A, Saboor HA, Nadeem A, Iqbal A, Iqbal MF, Rangwala BS, Hafeez MH, Bowers CA. Neurosurgical Malpractice Litigation: A Systematic Review and Meta-Analysis. World Neurosurg 2024; 188:55-67. [PMID: 38685351 DOI: 10.1016/j.wneu.2024.04.112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Revised: 04/16/2024] [Accepted: 04/17/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND Neurosurgery has 1 of the highest risks for medical malpractice claims. We reviewed the factors associated with neurosurgical malpractice claims and litigation in the United States and reported the outcomes through a systematic review of the literature. METHODS We conducted a systematic review of the literature according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines using the Medline, Embase, Cochrane, PubMed, and Google Scholar databases. We sought to identify pertinent studies containing information about medical malpractice claims and outcomes involving neurosurgeons in the United States. RESULTS We identified 15 retrospective studies spanning from 2002 to 2023 that reviewed over 7890 malpractice claims involving practicing neurosurgeons in the United States. Disparities were evident in neurosurgical litigation, with 474 cases linked to brain-related surgeries and a larger proportion, 1926 cases, tied to spine surgeries. The most commonly filed claims were intraprocedural errors (37.4%), delayed diagnoses (32.1%), and failure to treat (28.8%). Less frequently filed claims included misdiagnosis or choice of incorrect procedure (18.4%), occurrence of death (17.3%), test misinterpretation (14.4%), failure to appropriately refer patients for evaluation/treatment (14.3%), unnecessary surgical procedures (13.3%), and lack of informed consent (8.3%). The defendant was favored in 44.3% of claims, while in 31.3% of lawsuits were dropped, 17.7% of verdicts favored the plaintiff, and 16.6% reached an out of court settlement. Only 3.5% of lawsuits found both parties liable. CONCLUSION Neurosurgery is a high-risk specialty with 1 of the highest rates of malpractice claims. Spine claims had a significantly higher rate of filed malpractice claims, while cranial malpractice claims were associated with higher litigation compensation. Predictably, spinal cord injuries play a crucial role in predicting litigation. Importantly, nonsurgical treatments are also a common source of liability in neurosurgical practice.
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Affiliation(s)
- Javed Iqbal
- Department of Neurosurgery, King Edward Medical University, Lahore, Pakistan.
| | | | | | - Michael M Covell
- Department of Neurosurgery, Georgetown University School of Medicine Washington, Washington, District of Columbia, USA
| | - Afia Fatima
- Department of Neurosurgery, Jinnah Sindh Medical University, Karachi, Pakistan
| | - Hafiz Abdus Saboor
- Department of Neurosurgery, King Edward Medical University, Lahore, Pakistan
| | - Abdullah Nadeem
- Department of Neurosurgery, Dow University of Health Sciences, Karachi, Pakistan
| | - Ather Iqbal
- Department of Neurosurgery, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
| | | | | | | | - Christian A Bowers
- Department of Neurosurgery, Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Albuquerque, New Mexico, USA
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Garattini L, Badinella Martini M. Modeling European health systems: an ideal chain of services. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2024; 25:189-192. [PMID: 38095820 DOI: 10.1007/s10198-023-01651-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/15/2023] [Indexed: 02/12/2024]
Affiliation(s)
- Livio Garattini
- Department of Health Policy, Institute for Pharmacological Research Mario Negri IRCCS, Milan, Italy.
| | - Marco Badinella Martini
- Department of Health Policy, Institute for Pharmacological Research Mario Negri IRCCS, Milan, Italy
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Yavorkovsky LL. Aggressive B-Cell Lymphoma with Metastatic Spinal Cord Compression: Treat the Patient, Not the Disease. Oncol Res Treat 2024; 47:287-295. [PMID: 38432228 DOI: 10.1159/000538104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 02/24/2024] [Indexed: 03/05/2024]
Abstract
INTRODUCTION The management of metastatic spinal cord compression (mSCC) is a demanding task. The main challenges of mSCC include various manifestations and unpredictable outcomes with indiscriminate treatment recommendations. Because of attendant urgency with potentially devastating health consequences, the SCC is an emotionally disturbing experience whose management could take an impulsive rather than rational approach. The treatment strategy is particularly problematic when mSCC is caused by a malignant lymphoma with its protean attributes. CASE REPORT A 68-year-old female presented with generalized body pain and weight loss. Imaging studies revealed a vast bulk of the disease involving lymph nodes, spleen, visceral organs, musculature, marrow, and bones including vertebrae with extension into the spinal canal. A biopsy of the chest wall mass showed high-grade diffuse large B-cell lymphoma. A magnetic resonance imaging (MRI) of the spine demonstrated diffuse marrow replacement by the tumor of the thoracic and lumbar spine with compression of the cord. The prompt treatment with corticosteroids and immunochemotherapy (ICT) was recommended, but the patient elected to seek a second opinion. After two doses of radiation therapy, the patient's general condition rapidly deteriorated and she was hospitalized for systemic ICT. Despite the treatment, her condition continued to deteriorate, and she died 3 weeks after the presentation. CONCLUSION The presented case demonstrates some hitherto unaddressed challenges in evaluation and treatment of mSCC caused by aggressive non-Hodgkin lymphoma (LSSC). The case scrutinizes the role of MRI in uncommon clinical situations. The case has also exposed some ethical issues associated with the proper management of LSCC.
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Affiliation(s)
- Leonid L Yavorkovsky
- Oncology Division, Kaiser Permanente San Jose Medical Center, San Jose, California, USA
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5
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Goetz K, Oldenburg D, Strobel CJ, Steinhäuser J. The influence of fears of perceived legal consequences on general practitioners' practice in relation to defensive medicine - a cross-sectional survey in Germany. BMC PRIMARY CARE 2024; 25:23. [PMID: 38216861 PMCID: PMC10785451 DOI: 10.1186/s12875-024-02267-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 01/04/2024] [Indexed: 01/14/2024]
Abstract
BACKGROUND Medical decisions are influenced by a variety of factors also by legal requirements and feelings of uncertainty, which results in the term defensive medicine. The aim of the study was to evaluate the influence of fears of perceived legal consequences on the practice of defensive medicine from the perspective of German general practitioners (GPs). METHODS A cross-sectional study was performed from April to May 2022. GPs were invited via an e-mail newsletter of the Institute for Continuing Education in Family Medicine in the German Association of General Practitioners and via an online platform of the German College of General Practitioners and Family Physicians. The evaluation of legal fears, the general assessment of defensive medicine and reasons for and the frequency of defensive medical measures were surveyed in this study. Beside descriptive analyses, a stepwise linear regression analysis was used to explore potential associations between for the primary outcome variable 'fears of legal consequences' on the practice of defensive medicine. RESULTS 413 general practitioners with an average age of 50 years (51% female) responded. The majority rated their fears of legal consequences as low to average whereas for almost a third (27%, n = 113) the fears were strong to very strong. Regarding legal fears, the physician-patient-relationship played a fairly to very large role for 48% (n = 198) of the respondents. One third estimated the probability of being sued civilly in the next 10 years as rather high to very high. 47% (n = 193) of the participants assumed that the risk of being sued could mostly to very much be reduced by defensive medicine. Legal self-protection was for 38% of the responders (n = 157) quite frequently to very frequently a reason for acting defensively. Consequently, half of the respondents stated that they performed unnecessary laboratory tests at least once per week and 40% indicated that they referred patients for radiological diagnostics without medical indication once per month. CONCLUSIONS As legal fears have an influence on medical practice and legal self-protection being a frequent reason for defensive behaviour, understanding and knowledge of the law should be improved by legal education at university and further training of post-graduate trainees and practicing physicians should be implemented. Additionally, a more in-depth enlightenment of society about the phenomenon of Protective and Defensive Medicine and its consequences could be a possibility to decrease the perceived fears of legal consequences on the physicians' side.
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Affiliation(s)
- Katja Goetz
- Institute of Family Medicine, University Medical Center Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany.
| | - Dorothee Oldenburg
- Institute of Family Medicine, University Medical Center Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Christina Jana Strobel
- Institute of Family Medicine, University Medical Center Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Jost Steinhäuser
- Institute of Family Medicine, University Medical Center Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
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Arafa A, Negida A, Elsheikh M, Emadeldin M, Hegazi H, Senosy S. Defensive medicine practices as a result of malpractice claims and workplace physical violence: a cross-sectional study from Egypt. Sci Rep 2023; 13:22371. [PMID: 38102200 PMCID: PMC10724153 DOI: 10.1038/s41598-023-47720-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 11/17/2023] [Indexed: 12/17/2023] Open
Abstract
Defensive medicine refers to practices motivated mainly by legal rather than medical purposes. Increased healthcare costs, overutilization of medical services, and potential harm to patients from unnecessary procedures are among its drawbacks. We performed this study to assess the prevalence of defensive medicine practices in Egypt and their associations with experiencing malpractice claims and workplace physical violence. We investigated 1797 physicians (68.1% male), with an average age of 36.8 ± 9.1 years, practicing in Egypt between January 14th and February 23rd, 2023. SPSS was used for statistical analysis. The majority reported engaging in defensive medicine practices. Specifically, 89.6% acknowledged avoiding high-risk procedures, 87.8% refrained from treating high-risk patients, 86.8% admitted to making unnecessary referrals, 84.9% acknowledged ordering unnecessary tests, 61.4% reported performing unnecessary procedures, and 56.4% disclosed prescribing unnecessary medications. Obstetricians and surgeons exhibited the highest rates of defensive medicine. Using linear regression analysis adjusted for age and sex, malpractice claims and workplace physical violence were associated with defensive medicine score (zero-100): βs (95% CIs) = 5.05 (3.10, 6.99) and 5.60 (3.50, 7.71), respectively, (p values < 0.001). In conclusion, defensive medicine is deeply ingrained in the clinical routines of Egyptian physicians. Establishing a comprehensive national medical liability framework is required.
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Affiliation(s)
- Ahmed Arafa
- Department of Public Health and Community Medicine, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt.
| | - Ahmed Negida
- Department of Neurology, Virginia Commonwealth University, Richmond, VA, USA
- Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Mohamed Elsheikh
- Department of Health Informatics, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
- Department of Emergency Medicine and Traumatology, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Mohamed Emadeldin
- Department of Urology, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
| | - Hesham Hegazi
- Wirral University Teaching Hospital NHS Foundation Trust, Wirral, UK
| | - Shaimaa Senosy
- Department of Public Health and Community Medicine, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
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Pischedda G, Marinò L, Corsi K. Defensive medicine through the lens of the managerial perspective: a literature review. BMC Health Serv Res 2023; 23:1104. [PMID: 37848915 PMCID: PMC10580549 DOI: 10.1186/s12913-023-10089-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 09/29/2023] [Indexed: 10/19/2023] Open
Abstract
PURPOSE Several studies have been carried out on defensive medicine, but research from the managerial viewpoint is still scarce. Therefore, the aim of the present study is to conduct a literature review to better understand defensive medicine from a managerial perspective. DESIGN/METHODOLOGY/APPROACH A literature review was conducted of studies focusing on the organisational (meso) level of healthcare providers and managerial practices. A final sample of 28 studies was processed. FINDINGS Defensive medicine has mainly been studied in the USA, and scholars have principally used quantitative surveys. High-risk specialities have been a critical field of investigation, and a large portion of the papers are published in journals that cover medicine, health policy, education and law fields. The analysis showed that operations and the organisation of staffing were the most discussed managerial practices. No study considered planning and budgeting aspects. ORIGINALITY/VALUE The review confirmed that the managerial aspect of defensive medicine has not been fully addressed. Stimulated by this gap, this study analyses the managerial background of the defensive medicine phenomenon and shows which managerial practices have been most analysed. This paper also contributes to developing the literature on defensive medicine from the managerial side. Areas for future research include qualitative studies to investigate the behaviour of managers of healthcare companies to give a different perspective on defensive medicine and organisations' decision-making. RESEARCH LIMITATIONS/IMPLICATIONS Some important publications might have been missed in this work because of the choice of only two databases. A further limit could be imposed by the use of the English language as an inclusion criterion.
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Affiliation(s)
- Gianfranco Pischedda
- Department of Economics and Business, University of Sassari, Via Muroni, 25, 07100, Sassari, Italy.
| | - Ludovico Marinò
- Department of Economics and Business, University of Sassari, Via Muroni, 25, 07100, Sassari, Italy
| | - Katia Corsi
- Department of Economics and Business, University of Sassari, Via Muroni, 25, 07100, Sassari, Italy
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Ingram S, Stenner R, May S. The experiences of uncertainty amongst musculoskeletal physiotherapists in first contact practitioner roles within primary care. Musculoskeletal Care 2023; 21:644-654. [PMID: 36683250 DOI: 10.1002/msc.1735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 01/09/2023] [Accepted: 01/10/2023] [Indexed: 01/24/2023]
Abstract
AIM The aim of this research was to explore the experiences of uncertainty amongst Musculoskeletal First Contact Practitioners working in primary care. BACKGROUND The Musculoskeletal First Contact Practitioner role involves advanced physiotherapists providing an alternative to the GP by acting as first point of contact for people presenting to primary care with musculoskeletal conditions. Limited research into the role exists but the first-contact aspect, clinical complexity and time pressures are deemed to contribute to uncertainty within the role. METHOD A qualitative research design was undertaken using a hermeneutic interpretative phenomenological approach. Data was collected using semi-structured interviews with subsequent thematic analysis of the data. FINDINGS Eight participants working as Musculoskeletal First Contact Practitioners across England were recruited using purposive sampling. Five themes were identified: (1) Role clarity within primary care, (2) Burden of responsibility, (3) Preparedness for the primary care environment, (4) 'I'm not really sure how long I am going to stay in this role', (5) Mitigating uncertainty. CONCLUSION This study demonstrates the multifaceted phenomenon of uncertainty amongst Musculoskeletal First Contact Practitioners. Uncertainty appeared to be influenced by the primary care environment, preparedness for the role and perceived burden of responsibility. Diagnostic uncertainty was prevalent with concerns of missing serious pathology evident. The impact of uncertainty on wellbeing was linked to possible burnout and retention issues. Consultation approaches, access to support networks and a cultural shift in tolerating uncertainty were reported to mitigate uncertainty. Further research into possible differences in experiences related to employment models appears warranted.
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Affiliation(s)
- Simon Ingram
- Somerset NHS Foundation Trust, Musgrove Park Hospital, Taunton, Somerset, UK
| | - Rob Stenner
- Somerset NHS Foundation Trust, Musgrove Park Hospital, Taunton, Somerset, UK
| | - Sue May
- School of Health Professions, Peninsula Allied Health Centre, University of Plymouth, Plymouth, Devon, UK
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Rueda MA, Carrascal-Penaranda D, Ortegón JDC, Barón JDG. Decision Making in Radiology: Beyond Clinical Perspective. Acad Radiol 2023; 30:1766. [PMID: 35933284 DOI: 10.1016/j.acra.2022.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 07/06/2022] [Accepted: 07/07/2022] [Indexed: 11/09/2022]
Affiliation(s)
- Maria Alejandra Rueda
- Department of diagnostic imaging, Fundación Santa Fe de Bogotá, Bogotá, Colombia 110111
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Cernega A, Meleșcanu Imre M, Ripszky Totan A, Arsene AL, Dimitriu B, Radoi D, Ilie MI, Pițuru SM. Collateral Victims of Defensive Medical Practice. Healthcare (Basel) 2023; 11:healthcare11071007. [PMID: 37046933 PMCID: PMC10094659 DOI: 10.3390/healthcare11071007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 03/29/2023] [Accepted: 03/30/2023] [Indexed: 04/05/2023] Open
Abstract
This paper analyzes the phenomenon of defensive medical practice, starting from the doctor–patient relationship, and the behavioral and professional factors that can influence the proper functioning of this relationship and the healthcare system. We analyze medical malpractice, given the increase in the number of accusations, as an essential factor in triggering the defensive behavior of doctors, together with other complementary factors that emphasize the need for protection and safety of doctors. The possible consequences for the doctor–patient relationship that defensive practice can generate are presented and identified by analyzing the determining role of the type of health system (fault and no-fault). At the same time, we investigate the context in which overspecialization of medical personnel can generate a form of defensive practice as a result of the limiting effect on the performance of a certain category of operations and procedures. The increase in the number of malpractice accusations impacts the medical community—“the stress syndrome induced by medical malpractice”—turning doctors into collateral victims who, under the pressure of diminishing their reputational safety, practice defensively to protect themselves from future accusations. This type of defensive behavior puts pressure on the entire healthcare system by continuously increasing costs and unresolved cases, which impact patients by limiting access to medical services in the public and private sectors.
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Affiliation(s)
- Ana Cernega
- Department of Organization, Professional Legislation and Management of the Dental Office, Faculty of Dental Medicine, “Carol Davila” University of Medicine and Pharmacy, 17-23 Plevnei Street, 020021 Bucharest, Romania
| | - Marina Meleșcanu Imre
- Department of Prosthodontics, Faculty of Dental Medicine, “Carol Davila” University of Medicine and Pharmacy, 17-23 Calea Plevnei, 010221 Bucharest, Romania
| | - Alexandra Ripszky Totan
- Department of Biochemistry, Faculty of Dental Medicine, “Carol Davila” University of Medicine and Pharmacy, 17-23 Plevnei Street, 020021 Bucharest, Romania
| | - Andreea Letiția Arsene
- Department of General and Pharmaceutical Microbiology, Faculty of Pharmacy, “Carol Davila” University of Medicine and Pharmacy, 6 Traian Vuia Street, 020956 Bucharest, Romania
| | - Bogdan Dimitriu
- Department of Endodontics, Faculty of Dental Medicine, “Carol Davila” University of Medicine and Pharmacy, 17-23 Plevnei Street, 020021 Bucharest, Romania
| | - Delia Radoi
- Department of Organization, Professional Legislation and Management of the Dental Office, Faculty of Dental Medicine, “Carol Davila” University of Medicine and Pharmacy, 17-23 Plevnei Street, 020021 Bucharest, Romania
| | - Marina-Ionela Ilie
- Department of General and Pharmaceutical Microbiology, Faculty of Pharmacy, “Carol Davila” University of Medicine and Pharmacy, 6 Traian Vuia Street, 020956 Bucharest, Romania
| | - Silviu-Mirel Pițuru
- Department of Organization, Professional Legislation and Management of the Dental Office, Faculty of Dental Medicine, “Carol Davila” University of Medicine and Pharmacy, 17-23 Plevnei Street, 020021 Bucharest, Romania
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Strobel CJ, Oldenburg D, Steinhäuser J. Factors influencing defensive medicine-based decision-making in primary care: A scoping review. J Eval Clin Pract 2023; 29:529-538. [PMID: 36433885 DOI: 10.1111/jep.13799] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 10/26/2022] [Accepted: 11/01/2022] [Indexed: 11/28/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES Medical decision-making processes in primary care are influenced by defensive medical practice. This involves a high possibility for negative consequences on many levels, for example, patient's health, health care system costs and a crisis of trust in the patient-doctor relationship. Aim of this review was to identify factors of defensive medicine-based decision-making in primary care. METHODS This scoping review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping reviews (PRISMA-ScR) guidelines and included systematic research on MEDLINE, Google Scholar and two German databases for additional grey literature. References provided further literature. Articles in English and German published from 1 January 1982 to 15 June 2022 were assessed. RESULTS From 911 publications screened, 13 publications [6 qualitative studies and 7 quantitative (3 cross-sectional) studies] were included. In these, four main categories of factors influencing defensive medical practice were identified: (social) media, patients adopting a consumer attitude, health care system based working conditions and physician's tolerance for uncertainty. Pressure deriving from these four different sources is exerted on the general practitioner and may result in a defensive medical decision behaviour. CONCLUSIONS Four categories on influencing factors of defensive medicine could be identified. Strategies to tolerate uncertainty should be trained in under- and postgraduate training.
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Affiliation(s)
- Christina J Strobel
- Institute of Family Medicine, University Medical Center Schleswig Holstein, Lübeck, Germany
| | - Dorothee Oldenburg
- Institute of Family Medicine, University Medical Center Schleswig Holstein, Lübeck, Germany
| | - Jost Steinhäuser
- Institute of Family Medicine, University Medical Center Schleswig Holstein, Lübeck, Germany
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12
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Ghinea N. Do doctors have a responsibility to help patients import medicines from abroad? JOURNAL OF MEDICAL ETHICS 2023; 49:131-135. [PMID: 35246498 DOI: 10.1136/medethics-2021-108027] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 02/15/2022] [Indexed: 06/14/2023]
Abstract
Almost any medicine can be purchased online from abroad. Many high-income countries permit individuals to import medicines for their personal use. However, those who import medicines face the risk of purchasing poor-quality products that may not work, or that may even harm them. Many people are willing to accept this risk for the opportunity to purchase more affordable medicines. This is especially true of individuals from low socioeconomic backgrounds who already struggle to afford the medicines they need if they are not subsidised by insurers or if copayments are high. As medicine prices and out-of-pocket healthcare spending continue to climb, the online marketplace provides an important alternative for individuals in high-income countries to source medicines. In this article, I argue that doctors have a responsibility to help patients access medicines online and I propose a framework that can be used to facilitate responsible personal importation.
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Affiliation(s)
- Narcyz Ghinea
- Philosophy Department, Faculty of Arts, Centre for Agency, Values and Ethics, Macquarie University, North Ryde, NSW, Australia
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Chaudhary A, Barwal VK. Defensive Medicine in the Context of the Indian Health System. Indian Pediatr 2022; 59:882-884. [PMID: 36370018 PMCID: PMC9748894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
Abstract
Defensive medicine; although a recent concept, is slowly beginning to cement its place in the Indian health system. An interaction of multiple factors has paved way for this form of practice. Need for certainty of the diagnosis, lack of hierarchy in medical care, exponential growth of micro/super specializations and private/corporate health institutions, incentive-based practice, increasing incidences of violence against health personnel, rising trend of defamation suites against doctors, bad publicity by media, and interference by elected representatives have jeopardized the situation. This has led to decline in practice of clinical medicine, increased burden of investigations, especially in already compromised public facilities, and high out-of-pocket health expenditure. As much as ethical medical practice, standard patient management protocols, strict protection of interest of medical practitioners by law, responsible role of media and elected representatives are the need of the hour; we need to find ways to accept and incorporate defensive medicine into the modern medicine. Different stakeholders are required to come together and take substantial steps to understand the phenomenon and preserve the art and science of practicing medicine in its true form.
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Affiliation(s)
- Ankit Chaudhary
- Department of Community Medicine, Dr Rajendra Prasad Government Medical College, Kangra, Himachal Pradesh
| | - Vijay Kumar Barwal
- Department of Community Medicine, Indira Gandhi Medical College, Shimla; Himachal Pradesh. Correspondence to, Dr Vijay Kumar Barwal, Assistant professor, Department of Community Medicine, Indira Gandhi Medical College, Shimla, Himachal Pradesh.
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14
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Chaudhary A, Barwal VK. Defensive Medicine in the Context of the Indian Health System. Indian Pediatr 2022. [PMCID: PMC9748894 DOI: 10.1007/s13312-022-2649-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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15
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Finucane LM, Greenhalgh SM, Mercer C, Selfe J. Defensive medicine: A symptom of uncertainty? Musculoskelet Sci Pract 2022; 60:102558. [PMID: 35367770 DOI: 10.1016/j.msksp.2022.102558] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 03/16/2022] [Accepted: 03/19/2022] [Indexed: 11/30/2022]
Abstract
Defensive medicine is a well-documented phenomenon and refers to the practice of over-cautious management of patients, leading to excessive clinical activity such as over-investigation, unnecessary appointments and additional interventions. Adopting this approach is not in the best interest of patients and can lead to clinical reasoning being replaced by lists, guidelines and algorithms which do not consider the complexity of a patients presentation or the reasoning inherent in good clinical judgement. The drivers of defensive medicine are varied and include a high level of uncertainty alongside other factors including clinical experience with past cases, system pressures and patient expectations. This paper explores these drivers and considers strategies on how best to avoid a defensive medicine approach. It reinforces the need to adopt a patient centred focus and use sound clinical reasoning to support the management of patients.
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Affiliation(s)
- Laura M Finucane
- Sussex MSK Partnership, Brighton, UK; Department of Health, Social Care and Education, St Georges University London, UK.
| | - Susan M Greenhalgh
- Bolton NHS Foundation Trust, UK; Department of Health Professions, Manchester Metropolitan University, UK
| | - Christopher Mercer
- Western Sussex Hospitals NHS Trust, Chichester, UK; University Hospitals Sussex NHS Trust, UK
| | - James Selfe
- Department of Health Professions, Manchester Metropolitan University, UK; Physiotherapy Department, Satakunta University of Applied Sciences, Pori, Finland
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Martins Teixeira L, Santos Junior LA, Franco RS. Perfil de denúncias éticas contra médicos em um estado brasileiro, de 2001 a 2016. REVISTA IBEROAMERICANA DE BIOÉTICA 2022. [DOI: 10.14422/rib.i19.y2022.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Nas últimas décadas, a Medicina convive com o aumento de denúncias éticas e processos judiciais. Este artigo avaliou as sindicâncias apreciadas pelo Conselho Regional de Medicina do Piauí, de 2001 a 2016. Foram incluídas 1011 sindicâncias, totalizando 1073 médicos implicados. Houve significativo crescimento da quantidade de médicos denunciados em função do tempo (p<0,001). O principal denunciante foi o próprio paciente ou seu familiar/representante legal (54,15%), com a queixa principal de negligência (31,87%). Os denunciados mais frequentes foram do sexo masculino (77,45%). O artigo discute fatores associados ao crescimento das denúncias, como distanciamento da relação médico-paciente e represálias ao erro médico.
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17
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Hurley DJ, Neary S. An analysis of the conditions referred to an eye emergency department. EXPERT REVIEW OF OPHTHALMOLOGY 2022. [DOI: 10.1080/17469899.2022.2079496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Daire J Hurley
- Department of Ophthalmology, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Dublin, Ireland
| | - Simon Neary
- Department of Ophthalmology, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Dublin, Ireland
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18
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Teixeira C, Antão C, Anes E, Gomes MJ, Versos A, Tomé C. Use of Cervical Cancer Screening among Patients of Primary Healthcare Services: Northeast Portugal. PORTUGUESE JOURNAL OF PUBLIC HEALTH 2022. [DOI: 10.1159/000522666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
<b><i>Background:</i></b> Understanding the overuse and underuse of cervical cancer (CC) screening plays a role in preventing such behaviours, allowing to maximize the CC screening uptake. <b><i>Aim:</i></b> To assess the predictors of being over-screened and never/under-screened in CC screening in Northeast Portugal. <b><i>Methods:</i></b> This is a part of a larger cross-sectional survey carried out in two public health centres in Northeast Portugal (October 2017 to June 2018). Data collection was based on a face-to-face interview. This analysis included 764 women (aged 25–60 years) classified according to the use of CC screening into guideline-consistent screened, over-screened and unscreened/under-screened. Multivariate logistic regression models were conducted to assess predictors of being over-screened and never/under-screened. Adjusted odds ratio (OR) and respective 95% confidence interval (95% CI) were obtained. <b><i>Results:</i></b> One-fourth (<i>n</i> = 197) of participants were unscreened/under-screened and 50.0% (<i>n</i> = 382) of them were classified as over-screened. Regular visits with primary care physicians (OR = 0.44; 95% CI: 0.26–0.76) and higher age (OR = 0.98; 95% CI: 0.96–1.00) reduced the odds of being unscreened/under-screened. Women who received prescription/recommendation for CC screening from primary care physician (OR = 1.89; 95% CI: 1.09–3.29) or both primary care physician and nurse (OR = 2.62; 95% CI: 1.10–6.22) were more likely to be over-screened. Higher level of CC health literacy decreases the odds of being over-screened (OR = 0.95; 95% CI: 0.90–1.00) and unscreened/under-screened (OR = 0.87; 95% CI: 0.82–0.92). The majority of over-screened (52.2%) and of under-screened (44.2%) women reported that their screening frequency was based on healthcare provider prescription. Among never-screened women, 60.2% reported that no one prescribed screening. <b><i>Conclusion:</i></b> The increase in CC health literacy can maximize CC screening uptake. Primary healthcare providers could play a role in preventing the overuse and underuse of CC screening.
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Tracing the missteps of stepped care: Improving the implementation of stepped care through contextual behavioral science. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2022. [DOI: 10.1016/j.jcbs.2022.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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20
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Andersen MK, Hvidt EA, Pedersen KM, Lykkegaard J, Waldorff FB, Munck AP, Pedersen LB. Defensive medicine in Danish general practice. Types of defensive actions and reasons for practicing defensively. Scand J Prim Health Care 2021; 39:413-418. [PMID: 34463601 PMCID: PMC8725848 DOI: 10.1080/02813432.2021.1970945] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE To examine the occurrence of and types of defensive medicine (DM), and the reasons for practicing DM in general practice. DESIGN Prospective survey registration of consecutive consultations regarding defensive medicine defined as: Actions that are not professionally well founded but are carried out due to demands and pressure. The GPs registered the degree of defensiveness, the type(s) of defensive action(s) and the reason(s) for acting defensively. SETTING Danish general practice. SUBJECTS A total of 26 GPs registered a total of 1,758 consultations. MAIN OUTCOME MEASURES Defensive medical actions. RESULTS Defensive actions were performed in 12% (210/1749) of all consultations. A fifth (46/210) of the defensive actions were characterised by the GPs as 'moderately' or 'highly' defensive. Frequent types of defensive actions were: blood tests, point-of-care-tests (POCTs) and referrals. Common reasons for defensive actions were: Influence from patients, 37% (78/210), concerns of overlooking severe disease, 32% (67/210) and influence from patient relatives, 12% (25/210). CONCLUSION Danish GPs registered self-perceived defensive actions in a prospective survey. DM was carried out in one out of eight consultations, most often due to patient influence. The most frequent defensive actions were blood tests, POCTs and referrals.
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Affiliation(s)
- Merethe K. Andersen
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
- CONTACT Merethe K. Andersen , Research unit of General Practice, Department of Public Health, University of Southern Denmark, J. B. Winsløwsvej 9A, Odense5000, Denmark
| | - Elisabeth Assing Hvidt
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
- Department for the Study of Culture, University of Southern Denmark, Odense, Denmark
| | - Kjeld M. Pedersen
- Department of Business and Economics, University of Southern Denmark, Odense, Denmark
| | - Jesper Lykkegaard
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Frans B. Waldorff
- Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Anders P. Munck
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Line B. Pedersen
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
- DaCHE – Danish Centre for Health Economics, Department of Public Health, University of Southern Denmark, Odense, Denmark
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21
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Defensive pharmacy practice: a gap in our understanding. Int J Clin Pharm 2021; 43:1718-1721. [PMID: 34121158 PMCID: PMC8642327 DOI: 10.1007/s11096-021-01285-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 05/15/2021] [Indexed: 11/09/2022]
Abstract
Defensive practice is prevalent across healthcare disciplines and much study has been performed on this behaviour in medicine and nursing. However, little research has been carried out on defensive practice in pharmacy, despite its potential to increase healthcare costs, reduce quality of care and affect pharmacist job satisfaction. With a more litigious society emerging and greater level of regulation, the pharmacy profession shares many of the influences of defensive practice identified in other healthcare professions. As a result, pharmacists too may engage in defensive practice behaviours in order to protect themselves from the perceived risk of litigation. Research in this area is necessary to identify how this phenomenon affects the profession and to develop methods of improving pharmacy practice. While this type of research would not be without challenges, it could form the basis for policy change and greater professional representation, ultimately improving quality of care for patients.
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22
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Ahmed A, McGoldrick DM, Elledge R. Clinical negligence claims in oral and maxillofacial surgery over the last 10 years. Br J Oral Maxillofac Surg 2021; 59:1259-1263. [PMID: 34364713 DOI: 10.1016/j.bjoms.2021.05.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 05/14/2021] [Indexed: 11/24/2022]
Abstract
According to NHS Resolution, the cost of harm from clinical activity in the last year was £8.3 billion. The steady increase in litigation within the National Health Service (NHS) has led to concerns being raised regarding the sustainability of the NHS, the increasing practice of defensive medicine, and the psychological impact on healthcare professionals. To our knowledge, litigation within oral and maxillofacial surgery has not been investigated in the UK since 2010, therefore our aims were to identify the trends within our specialty and the common reasons for negligence claims over the last 10 years. A freedom of information request was made to NHS Resolution for all clinical negligence claims from 2010 to 2020. A total of 1,122 claims were registered and the total for damages paid was £32,631,131. The claims were categorised by the primary injury and further divided into groups of cause codes. Four types of primary injury comprised 65.4% (n = 734) of all negligence claims and were as follows: additional or unnecessary operations (n = 313, 27.9%), unnecessary pain (n = 156, 13.9%), nerve damage (n = 139, 12.4%), and dental damage (n = 126, 11.2%). The damages associated with nerve damage were the costliest, with a total of £8,033,737 being paid. The significant increase in the number and cost of clinical negligence claims is concerning. The lessons from these claims must be shared and implemented to reduce the burden on the NHS, and ensure that we are providing a high quality of care with improved patient outcomes.
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Affiliation(s)
- A Ahmed
- Department of Maxillofacial Surgery, University Hospitals Birmingham, Mindelsohn Way, Birmingham, B15 2TH.
| | - D M McGoldrick
- Department of Maxillofacial Surgery, University Hospitals Birmingham, Mindelsohn Way, Birmingham, B15 2TH.
| | - R Elledge
- Department of Maxillofacial Surgery, University Hospitals Birmingham, Mindelsohn Way, Birmingham, B15 2TH.
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Glechner A, Rabady S, Bachler H, Dachs C, Flamm M, Glehr R, Hoffmann K, Hoffmann-Dorninger R, Kamenski G, Lutz M, Poggenburg S, Tschiggerl W, Horvath K. A Choosing Wisely top-5 list to support general practitioners in Austria. Wien Med Wochenschr 2021; 171:293-300. [PMID: 33970380 PMCID: PMC8484253 DOI: 10.1007/s10354-021-00846-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 04/06/2021] [Indexed: 11/25/2022]
Abstract
From a pool of 147 reliable recommendations, ten experts from the Austrian Society of General Practice and Family Medicine selected 21 relevant recommendations as the basis for the Delphi process. In two Delphi rounds, eleven experts established a top‑5 list of recommendations designed for Austrian family practice to reduce medical overuse. Three of the chosen recommendations address the issue of antibiotic usage in patients with viral upper respiratory tract infections, in children with mild otitis media, and in patients with asymptomatic bacteriuria. The other two “do not do” recommendations concern imaging studies for nonspecific low back pain and routine screening to detect prostate cancer. A subsequent survey identified the reasons for selecting these top‑5 recommendations: the frequency of the issue, potential harms, costs, and patients’ expectations. Experts hope the campaign will save time in educating patients and provide legal protection for omitting measures.
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Affiliation(s)
- Anna Glechner
- Department for Evidence-based Medicine and Clinical Epidemiology, Cochrane Austria, Danube University Krems, Dr.-Karl-Dorrek Straße 30, 3500, Krems a.d. Donau, Austria.
| | - Susanne Rabady
- Department of General Medicine and Family Practice, Karl Landsteiner University of Health Sciences, Krems, Austria
| | - Herbert Bachler
- General Medicine and Family Medicine, Medical University Innsbruck, Innsbruck, Austria
| | - Christoph Dachs
- Institute of General Practice, Family Medicine and Preventive Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Maria Flamm
- Institute of General Practice, Family Medicine and Preventive Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Reinhold Glehr
- Institute of General Practice and Evidence-Based Health Research, Medical University Graz, Graz, Austria
| | - Kathryn Hoffmann
- Department for General Medicine and Family Practice, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | - Renate Hoffmann-Dorninger
- Department for General Medicine and Family Practice, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | - Gustav Kamenski
- Department of General Medicine and Family Practice, Karl Landsteiner University of Health Sciences, Krems, Austria.,Karl Landsteiner Institute for Systematics in General Medicine, Angern, Austria
| | - Matthias Lutz
- General Medicine and Family Medicine, Medical University Innsbruck, Innsbruck, Austria
| | - Stephanie Poggenburg
- Institute of General Practice and Evidence-Based Health Research, Medical University Graz, Graz, Austria
| | | | - Karl Horvath
- Institute of General Practice and Evidence-Based Health Research, Medical University Graz, Graz, Austria
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24
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Williams PL, Williams JP, Williams BR. The fine line of defensive medicine. J Forensic Leg Med 2021; 80:102170. [PMID: 33878590 DOI: 10.1016/j.jflm.2021.102170] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 03/27/2021] [Accepted: 04/07/2021] [Indexed: 11/25/2022]
Abstract
Defensive medicine is a practice that has been utilized by clinicians in efforts of preventing patient dissatisfaction and malpractice claims and may be done through either omission or commission. As much as 57% of physicians have disclosed that they practice defensive medicine. However, this practice does not necessarily prevent malpractice claims and more importantly, neither does it equate to good medical practice, with some leading to poor outcomes. Unfortunately, there is a high percentage of malpractice claims lodged against clinicians in both primary care and hospital settings. Specialists such as surgeons, obstetricians, and gynecologists face the highest claims. In particular, during the SARS CoV-2 pandemic, with new challenges and limited treatment algorithms, there is an even greater concern for possible bourgeoning claims. Counteracting defensive medicine can be accomplished through decriminalizing malpractice claims, leaving physician oversight up to state medical boards and hospital claims management committees. Additional tort reform measures must also be taken such as caps on noneconomic damages to ensure emphasis on beneficence and nonmaleficence. Once these are in place, it may well serve to increase clinician-patient trust and improve patient independence in the shared decision-making process of their treatment, allowing clinicians to practice their full scope of practice without feeling wary of potential malpractice claims.
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Affiliation(s)
- Preston L Williams
- University of Lynchburg, Doctor of Medical Science Program, 1501 Lakeside Drive, Lynchburg, VA, 24501, USA.
| | - Joanna P Williams
- Eisenhower Health, 39000 Bob Hope Drive, Rancho Mirage, CA, 92270, USA
| | - Bryce R Williams
- Palm Desert High School, 74910 Aztec Road, Palm Desert, CA, 92260, USA
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25
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Biloglav Z, Medaković P, Vrkić D, Brkljačić B, Padjen I, Ćurić J, Žuvela F, Ivanac G. Geographical and Temporal Distribution of Radiologists, Computed Tomography and Magnetic Resonance Scanners in Croatia. INQUIRY: THE JOURNAL OF HEALTH CARE ORGANIZATION, PROVISION, AND FINANCING 2021; 58:469580211060295. [PMID: 34807799 PMCID: PMC8613895 DOI: 10.1177/00469580211060295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
The aim of the study was to analyse the temporal and geographic distribution of radiologists, computed tomography and magnetic resonance scanners in Croatia. In this observational study we estimated radiologists’ number per 100,000 population for 1997, 2006, and 2017 and compared private and public CT and MR scanners between 2011 and 2018. We analyzed the availability of radiologists and scanners, and the relationship between the radiological workforce and economic strength among counties. The workforce increased significantly from 1997 to 2017 and was associated with economic strength categories in 2017. In 2018, there were more CT scanners in the public sector, while MR scanners were distributed evenly. In 2011, there was similar distribution of CT and MR between sectors, while in 2018 there were significantly more public CT scanners. Counties with a medical school had significantly more radiologists and MR scanners. The high-to-low ratios per CT and MR were 11 and 8.2, suggesting inequality of health care. Croatia significantly increased its radiological workforce; however, cross-county inequality remained. Counties with higher economic strength and medical schools have better availability of radiologists and equipment. To ensure the sustainable activity of the health care system, a precise estimate of supply and demand of radiology services is needed.
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Affiliation(s)
- Zrinka Biloglav
- Department of Medical Statistics, Epidemiology and Medical Informatics, School of Public Health Andrija Štampar, University of Zagreb School of Medicine, Zagreb, Croatia
| | - Petar Medaković
- Department of Radiology, Special Hospital Agram, Zagreb, Croatia
| | - Dina Vrkić
- Central Medical Library, University of Zagreb School of Medicine, Zagreb, Croatia
| | - Boris Brkljačić
- University of Zagreb School of Medicine, Zagreb, Croatia
- Department of Diagnostic and Interventional Radiology, University Hospital Dubrava, Zagreb, Croatia
| | - Ivan Padjen
- University of Zagreb School of Medicine, Zagreb, Croatia
- Division of Clinical Immunology and Rheumatology, Department of Internal Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Josip Ćurić
- Department of Diagnostic and Interventional Radiology, University Hospital Dubrava, Zagreb, Croatia
| | - Franko Žuvela
- Department of Radiology, General Hospital Varaždin, Varaždin, Croatia
| | - Gordana Ivanac
- University of Zagreb School of Medicine, Zagreb, Croatia
- Department of Diagnostic and Interventional Radiology, University Hospital Dubrava, Zagreb, Croatia
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26
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Palaniappan A, Sellke F. A review of medical malpractice cases in congenital cardiac surgery in the Westlaw database in the United States from 1994 to 2019. J Card Surg 2020; 36:134-142. [PMID: 33131138 DOI: 10.1111/jocs.15109] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 09/11/2020] [Indexed: 01/16/2023]
Abstract
BACKGROUND Medical malpractice litigations are common for cardiac surgeons, and congenital cardiac surgeons are uniquely held accountable by patients, who are minors, and their families. Therefore, it is imperative for physicians to be cognizant of clinically effective and legally tenable practices. METHODS The Westlaw legal research service was utilized to collect medical malpractice litigations from 1994 to 2019 pertaining to congenital cardiac surgery, inclusive, in the United States. Court documents were manually screened, with 177 litigations satisfying criteria for inclusion. Data collection included patient demographics, verdict and litigation characteristics, and clinical data. Fisher's exact test was used to assess the significance of association. RESULTS Across the 177 litigations, 44% had defendant verdicts, 30% had plaintiff verdicts, and 26% had settlements. The average plaintiff award was $9,363,710, and the average settlement was $4,141,825. Patient mortality occurred in 87 cases (49.2%), and wrongful death claims were argued in 71 cases (40%). The most common reason for litigation were procedural errors (79 cases, 45%). The most frequent clinical event was cardiac arrest (95 cases, 54%). California recorded the most litigations (34 cases, 19.2%). Defendant verdicts were significantly associated with cardiac arrest, procedural errors, and permanent neurological injury (p < .05). CONCLUSIONS Defendant's verdicts were more common in cases with patient mortality, which had lower average plaintiff awards and settlements, since future healthcare expenses are inapplicable to this cohort. Future litigations can be minimized with an emphasis on reducing procedural errors, treating and diagnosing patients timely, and monitoring patients sufficiently.
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Affiliation(s)
- Ashwin Palaniappan
- Alpert Medical School, Brown University, Providence, Rhode Island, USA.,Division of Cardiothoracic Surgery, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Frank Sellke
- Alpert Medical School, Brown University, Providence, Rhode Island, USA.,Division of Cardiothoracic Surgery, Rhode Island Hospital, Providence, Rhode Island, USA
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Milner TD, Hilmi O, Marshall J, MacKenzie K. Pan‐Scotland tonsillectomy outcomes: A national cross‐sectional study. Clin Otolaryngol 2020; 46:138-145. [DOI: 10.1111/coa.13608] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 06/08/2020] [Accepted: 06/14/2020] [Indexed: 01/06/2023]
Affiliation(s)
- Thomas D. Milner
- Queen Elizabeth University Hospital Glasgow UK
- University of Glasgow Glasgow UK
| | - Omar Hilmi
- Queen Elizabeth University Hospital Glasgow UK
| | | | - Kenneth MacKenzie
- Queen Elizabeth University Hospital Glasgow UK
- University of Strathclyde Glasgow UK
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Bester JC. Defensive practice is indefensible: how defensive medicine runs counter to the ethical and professional obligations of clinicians. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2020; 23:413-420. [PMID: 32303983 DOI: 10.1007/s11019-020-09950-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Defensive medicine has become pervasive. Defensive medicine is often thought of as a systems issue, the inevitable result of an adversarial malpractice environment, with consequent focus on system-responses and tort reform. But defensive medicine also has ethical and professionalism implications that should be considered beyond the need for tort reform. This article examines defensive medicine from an ethics and professionalism perspective, showing how defensive medicine is deeply problematic. First, a definition of defensive medicine is offered that describes the essence of defensive practice: clinical actions with the goal of protecting the clinician against litigation or some adverse outcome. Ethical arguments against defensive medicine are considered: (1) defensive medicine is deceptive and undermines patient autonomy; (2) defensive medicine subjugates patient interests to physician interests and violate fiduciary obligations; (3) defensive medicine exposes patients to harm without benefit; (4) defensive medicine undermines trust in the profession; and (5) defensive medicine violates obligations of justice. Possible arguments in favor of defensive medicine are considered and refuted. Defensive practice is therefore unethical and unprofessional, and should be viewed as a challenge for medical ethics and professionalism.
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29
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Garattini L, Padula A. Defensive medicine in Europe: a 'full circle'? THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2020; 21:477-482. [PMID: 31919702 DOI: 10.1007/s10198-019-01151-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Livio Garattini
- CESAV, Centre for Health Economics, Institute for Pharmacological Research Mario Negri IRCCS, 24020, Ranica, Italy.
| | - Anna Padula
- CESAV, Centre for Health Economics, Institute for Pharmacological Research Mario Negri IRCCS, 24020, Ranica, Italy
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30
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Garattini L, Padula A, Mannucci PM. Defensive medicine: Everything and its opposite. Eur J Intern Med 2020; 74:117-118. [PMID: 32001095 DOI: 10.1016/j.ejim.2020.01.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 01/14/2020] [Accepted: 01/20/2020] [Indexed: 11/15/2022]
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31
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Garattini L, Padula A. Defensive medicine in Europe: a 'full circle'? THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2020; 21:165-170. [PMID: 31879861 DOI: 10.1007/s10198-019-01144-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Accepted: 12/03/2019] [Indexed: 05/24/2023]
Affiliation(s)
- Livio Garattini
- CESAV, Centre for Health Economics, Institute for Pharmacological Research Mario Negri IRCCS, 24020, Ranica, Italy.
| | - Anna Padula
- CESAV, Centre for Health Economics, Institute for Pharmacological Research Mario Negri IRCCS, 24020, Ranica, Italy
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32
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Kwee RM, Kwee TC. Medical disciplinary jurisprudence in alleged malpractice in radiology: 10-year Dutch experience. Eur Radiol 2020; 30:3507-3515. [PMID: 32064563 PMCID: PMC7248030 DOI: 10.1007/s00330-020-06685-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 01/09/2020] [Accepted: 01/28/2020] [Indexed: 11/09/2022]
Abstract
PURPOSE To systematically investigate the frequency and types of allegations related to radiology practice handled by the Dutch Medical Disciplinary Court in the past 10 years. METHODS The Dutch Medical Disciplinary Court database was searched for verdicts concerning radiology practice between 2010 and 2019. The association between the number of verdicts and time (years) was assessed by Spearman's rho. Other data were summarized using descriptive statistics. RESULTS There were 48 verdicts (mean 4.8 per year). There was no significant association between the number of verdicts and time (Spearman's rho < 0.001, p = 0.99). Most allegations were in breast imaging and musculoskeletal radiology (each 18.8%), followed by interventional radiology, head and neck imaging, and abdominal imaging (each 12.5%), neuroradiology and vascular imaging (each 10.4%), and chest imaging (4.2%). There were 46 allegations against radiologists (95.8%) and 2 against residents (4.2%). The most common allegation (37.5%) was error in diagnosis. In 20.8% of verdicts, the allegation was judged (partially) founded; disciplinary measures were warnings (n = 8) and reprimands (n = 2). An appeal was submitted by the patient in 11 cases and by the radiologist in 3 cases. All appeals by patients were rejected, whereas 2 of the 3 appeals by radiologists were granted and previously imposed disciplinary measures were reversed. CONCLUSION Allegations against radiologists at the Dutch Medical Disciplinary Court are relatively few, their number has remained stable over the past 10 years, and a minority were judged to be (partially) founded. We can learn from the cases presented in this article, which may improve patient care. KEY POINTS • The frequency of allegations against radiologists at the Dutch Medical Disciplinary Court is relatively low and has not exhibited any temporal change over the past 10 years. • These allegations reflect patient dissatisfaction, but this infrequently equals malpractice. • Knowledge of the circumstances under which these allegations have arisen may improve patient care.
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Affiliation(s)
- Robert M Kwee
- Department of Radiology, Zuyderland Medical Center, Heerlen/Sittard/Geleen, The Netherlands
| | - Thomas C Kwee
- Department of Radiology, Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Hanzeplein 1, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands.
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Borgan SM, Romeus L, Rahman S, Asmar A. Internal Medicine Residents and the Practice of Defensive Medicine: A Pilot Study Across Three Internal Medicine Residency Programs. Cureus 2020; 12:e6876. [PMID: 32181105 PMCID: PMC7053673 DOI: 10.7759/cureus.6876] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Background Defensive medicine is becoming increasingly prevalent in the United States and is estimated to cost billions of dollars in excess healthcare spending. There is evidence that the practice of defensive medicine starts early in the medical career. Defensive medicine has been investigated among residents in high medico-legal risk specialties, but there is a paucity of information on its prevalence among internal medicine residents. Objective To examine the prevalence and patterns of defensive medical practices among internal medicine residents. Methods We conducted an online survey among the residents of three internal medicine residency programs in the 2018-2019 academic cycle. We invited all internal medicine residents within the selected programs to participate through email and asked them to complete an electronic survey assessing defensive medical practices. Results A total of 49 out of 143 residents participated in the study (response rate: 34.3%); 55% (n = 27) of the residents who participated considered the risk of being sued during residency to be low, compared to 40.8% (n = 20) who considered it to be moderate and 4.1% (n = 2) who considered it to be high. Defensive medical practices were found to be widely prevalent (40.0-91.3%) among internal medicine residents across all three clinical training stages. Assurance defensive practices were more common than avoidance practices. Conclusion Defensive medical practices, especially of the assurance type, were widely prevalent among our sample of internal medicine residents.
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Affiliation(s)
- Saif M Borgan
- Internal Medicine, University of Central Florida College of Medicine, Orlando, USA
| | - Laniel Romeus
- Internal Medicine, University of Central Florida College of Medicine, Orlando, USA
| | - Saleh Rahman
- Epidemiology and Public Health, University of Central Florida College of Medicine, Orlando, USA
| | - Abdo Asmar
- Internal Medicine, University of Central Florida College of Medicine, Orlando, USA
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Allen TC. Working to Solve the Thyroid Cytopathology Conundrum. Arch Pathol Lab Med 2019; 143:1171-1173. [PMID: 31556707 DOI: 10.5858/arpa.2019-0290-le] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Timothy Craig Allen
- Department of Pathology, University of Mississippi Medical Center, Jackson, Mississippi
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Assing Hvidt E, Bjørnskov Pedersen L, Lykkegaard J, Møller Pedersen K, Andersen MK. A colonized general practice? A critical habermasian analysis of how general practitioners experience defensive medicine in their everyday working life. Health (London) 2019; 25:141-158. [PMID: 31216878 DOI: 10.1177/1363459319857461] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aim of this article is to show how Jürgen Habermas' communicative action theory serves as a useful tool in analysing and interpreting empirical data on how Danish general practitioners experience defensive medicine in their everyday working life. Through six qualitative focus group interviews with a total of 28 general practitioners (14 men and 14 women), the general practitioners' understandings of and experiences with defensive medicine were unfolded and discussed. Traditionally, defensive medicine is understood as physicians' deviation from sound medical practice due to fears of liability claims or lawsuits. In this study, however, a broader understanding of defensive medicine emerged as unnecessary medical actions that are more substantiated by feelings of demands and pressures than meaningful clinical behaviour. As a first analytical step, the data are contextualized drawing on the medical sociological literature that has theorized recent changes within primary health care such as regulation, audit, standardization and consumerism. Using Habermas' theorization to further interpret the general practitioners' experiences, we argue that central areas of the general practitioners' clinical everyday work life can be seen as having become subject to the habermasian social and political processes of 'strategic action' and 'colonization'. It is furthermore shown that the general practitioners share an impulse to resist these colonizing processes, hereby pointing to a need for challenging the increasingly defensive medical culture that seems to pervade the organization of general practice today.
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Sánchez López JD, Cambil Martín J, Villegas Calvo M, Moreno Martín ML. [Actual challenges in the doctor-patient relationship. ¿A change in the quality of health care?]. J Healthc Qual Res 2019; 34:109-110. [PMID: 30922841 DOI: 10.1016/j.jhqr.2018.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 11/24/2018] [Indexed: 06/09/2023]
Affiliation(s)
- J D Sánchez López
- Área de Cirugía Oral y Maxilofacial, Complejo Hospitalario Universitario de Granada, Campus de la Salud, Granada, España.
| | - J Cambil Martín
- Departamento de Enfermería, Facultad de Ciencias de la Salud, Universidad de Granada, Granada, España
| | - M Villegas Calvo
- Departamento de Enfermería, Facultad de Ciencias de la Salud, Universidad de Granada, Granada, España
| | - M L Moreno Martín
- Unidad de Anestesiología y Rehabilitación, Complejo Hospitalario Universitario Granada, Campus de la Salud, Granada, España
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Ozeke O, Ozeke V, Coskun O, Budakoglu II. Second victims in health care: current perspectives. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2019; 10:593-603. [PMID: 31496861 PMCID: PMC6697646 DOI: 10.2147/amep.s185912] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 07/24/2019] [Indexed: 05/13/2023]
Abstract
Medical errors are a serious public health problem and the third-leading cause of death after heart disease and cancer. Every day, the health care professionals (HCPs) practice their skill and knowledge within excessively complex situations and meet unexpected patient outcomes. These unexpected complications and unintentional errors will always be a part of the medical system due to the universal nature of human fallibility and technology. While not all errors are life-threatening, they can significantly compromise a patient's quality of life. However, the victims of medical error reach far beyond the patient. The second victim (SV), which defined for the first time by Albert Wu in his description of the impact of errors on HCPs by both personally and professionally, is a medical emergency equivalent to post-traumatic stress disorder. When the errors occur, it causes a domino effect including the four groups: the patient and family (first victim), the HCP [SV], the hospital reputation (third victim), and patients who are harmed subsequently (fourth victims). The rights of our patients to safe, reliable, and patient-centered care are critical and most important as a primary and utmost aim of medicine. However, we also have to take care of our own (SVs), especially when we have good people who mean to do well and then find themselves in an emotionally complex situation. There is a need to articulate to the public, politicians, and media how system failure leads to medical error even in hand of well-educated and competent HCPs are given an increasing clinical workload. Furthermore, despite several leading institutions in western countries have developed formal support programs that allow HCPs to cope with their emotional distress by obtaining timely support in an emphatic, confidential, non-judgmental environment, we need to raise awareness of this phenomenon and appropriate institutional responses both to harmed patients and their families and HCPs.
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Affiliation(s)
- Ozcan Ozeke
- Health Sciences University, Ankara City Hospital, Department of Cardiology, Ankara, Turkey
- Correspondence: Ozcan OzekeSağlık Bilimleri Üniversitesi, Ankara Şehir Hastanesi, Kardiyoloji Klinigi, Ankara06800, TurkiyeTel +90 505 383 6773Email
| | - Vildan Ozeke
- Gaziosmanpasa University, Department of Computer Education and Instructional Technology, Tokat, Turkey
- Gazi University, Department of Medical Education and Informatics, Ankara, Turkey
| | - Ozlem Coskun
- Gazi University, Department of Medical Education and Informatics, Ankara, Turkey
| | - Isil Irem Budakoglu
- Gazi University, Department of Medical Education and Informatics, Ankara, Turkey
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