Informed consent in urology.

Appropriate professional practice includes the diagnostic and treatment process of urologic pathology, as well as patient information and respect for patient autonomy in decision making. Informed consent is the gradual process of providing information to the patient and their subsequent decision making. The informed consent document (ICD), when required, demonstrates that information has been provided sufficiently in advance to allow for the patient's deliberation. The dual need for simple yet complete documents make the preparation of adequate ICDs extremely difficult. If the information process is not carried out properly, the professional may incur a medical malpractice liability that is treated as a loss of opportunity. To avoid such situations, the work of scientific societies in the preparation, accessibility, and dissemination of ICD models is fundamental.

Management of testicular torsion in the ER: lessons learned from medical professional liability claims.

OBJECTIVE: To evaluate emergency care for testicular torsion (TT) in medical professional liability (MPL) claims. METHODS: Claims related to TT from 2000 to 2018 were located. The assistance provided and the association with MPL were analyzed. RESULTS: Eighty complaints were identified, testicular pain was reported in 83.75% of first consultations, with a mean evolution time of 15.5 h. The mean time to diagnosis was 7.98 days. The first consultation was at the hospital in 75.1% of cases, but an ultrasound was performed only in 7.5%. When TT diagnosis was performed, 97.3% had undergone ancillary tests. The MPL was significantly associated with non-criminal proceedings and with less than 6 h of symptoms' evolution, and, within this subgroup, without undergoing an ultrasound scan. CONCLUSIONS: Late consultations, wrong diagnosis and late diagnosis are claimed. When MPL are claimed by means of non-criminal law, the existence of responsibility is frequently considered, even more in those cases when the consultation took place before 6 h of evolution with no ancillary tests having been performed.

Medicolegal Aspects of Teledermatology. / Aspectos médico-legales de la teledermatología.

Teledermatology has facilitated specialist care during the crisis caused by the coronavirus disease 2019 pandemic, eliminating unnecessary office visits and the possible exposure of patients or dermatologists. However, teledermatology brings forward certain ethical and medicolegal questions. A medical consultation in which the patient is not physically present is still a medical act, to which all the usual ethical and medicolegal considerations and consequences apply. The patient's right to autonomy and privacy, confidentiality, and data protection must be guaranteed. The patient must agree to remote consultation by giving informed consent, for which a safeguard clause should be included. Well-defined practice guidelines and uniform legislation are required to preserve the highest level of safety for transferred data. Adequate training is also needed to prevent circumstances involving what might be termed «telemalpractice¼.

Medical malpractice liability and its consequences. / Encuesta a los urólogos sobre responsabilidad profesional médica y sus consecuencias.

INTRODUCTION: Urology is a specialty of medium risk of claim. Receiving a claim for medical professional liability is a stressful experience with significant repercussions. The objective of this study was to assess the impact of these claims on Spanish urologists. METHODOLOGY: A survey on medical professional liability in urology was designed. The Spanish Association of Urology and the Urological Research Foundation approved the questionnaire, generated by the PIEM online tool. RESULTS: The total number of responses obtained was 202 (11.6% rate), of which 25.24% reported having been claimed, 88% reported mood changes after being claimed, 100% in criminal proceedings. The level of emotional involvement reported was the highest at the beginning of the process and progressively decreasing until its resolution. An affected doctor-patient relationship was considered in 67.9% of cases and 71.4% acknowledged increased defensive medicine in their professional practice. A percentage of 6.7% considered leaving the profession. DISCUSSION: The response rate obtained and the medical acts motivating the claims were comparable to those obtained in a similar survey conducted in the United States. The fact that claims are perceived as very stressful situations and may give rise to the phenomenon of the second victim or to the clinical judicial syndrome is clear, so efforts should be devoted to develop training in this matter and programs that address the consequences derived from these situations.

Use of Photography in Dermatology: Ethical and Legal Implications. / Implicaciones bioéticas y médico-legales del uso de la fotografía en dermatología.

Photographs are necessary in the clinical practice of dermatology, but there are ethical implications to consider. Moreover, dermatologists must be aware of and comply with certain legal requirements affecting the use of photographs. The main ethical principles are respect for patient autonomy and the physician's obligation to do no harm. The law differentiates between 2 bases for protection: one concerns the photographed person's rights over the image and the other protects personal data. Recent legislation places restrictions on taking photographs and exhibiting them. Photographs taken to be stored with a medical history have not been called into question, but the physician is recommended to inform the patient that they exist. When a photograph is exhibited for the purpose of teaching or illustrating concepts, it is necessary to determine whether or not the patient can be identified. If the answer is yes, the patient must give explicit permission. Caution should be exercised when publishing medical photographs on social media.

[Unexpected death due to eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome)]. / Muerte inesperada debida a granulomatosis eosinofílica con poliangeítis (síndrome de Churg-Strauss).

Eosinophilic granulomatosis with polyangiitis (EGPA), or Churg-Strauss syndrome, is a rare disease characterized by disseminated necrotizing vasculitis with extravascular granulomas occurring among patients with asthma and tissue eosinophilia. Clinically, it presents in various ways and progresses in three phases: prodromic (asthma and rhino-sinusitis), eosinophilic (peripheral eosinophilia and organ involvement), and vasculitic (clinical manifestations due to small vessel vasculitis). The differential diagnosis of EGPA principally includes eosinophilic and vasculitic disorders, early treatment is needed to avoid a fatal outcome. We present the case report of a 38-year-old male with a history of asthma. After a month-and-a-half of progressive weakness, no fever, diarrhea, vomiting and abdominal pain associated with weight loss, he was diagnosed of intestinal parasitosis. He later died of a massive myocardial necrosis due to EGPA with multiple organs affected.

Medical Malpractice Issues in Dermatology: Clinical Safety and the Dermatologist. / La dermatología y sus aspectos médico-legales: seguridad clínica y dermatología.

Clinical safety and medical liability are first-order concerns in today's medical practice. It is important to understand the circumstances under which medical acts fail to live up to the accepted standard of care and to recognize the impact that malpractice claims have on physicians. Practitioners must also grasp the concept of medical error, studying malpractice claims in order to identify the areas where improvement is needed. The risk of accusations of malpractice in dermatology is comparatively low, both in Spain and worldwide. However, a great variety of clinical scenarios in dermatology can potentially give rise to a claim, and malignant melanoma is most susceptible to risk. Dermatologists should know which actions during clinical consultation merit particular attention and care. Clinical practice carries inherent risk of malpractice claims, but taking certain recommended precautions can prevent them.

Physicians as second victims after a malpractice claim: An important issue in need of attention.

OBJECTIVE: Being sued for malpractice is extremely stressful and potentially traumatizing. We aim to identify claims' consequences on the physicians' well-being and medical practice. MATERIAL AND METHODS: We administered a confidential telephonic survey to those physicians with a claim closed during 2014, among those insured by the main professional liability insurance company in the region. The questionnaire addressed several topics: symptoms and well-being changes, needs, impairments and practice changes. We used descriptive statistics as well as Chi-square and T-Student tests. RESULTS: A total of 99 physicians responded to the questionnaire (response rate of 64.7%). Most of them (80.8%) acknowledged having suffered a significant emotional distress, no matter the claim's outcome (p=0.958) or the kind of procedure (p=0.928). Anger and mood cluster of symptoms were frequent, and the experience frequently affected their personal, family or social life and professional conduct. Practice changes correlated significantly and positively with the number of symptoms reported (p=0.010), but not with the outcome of the claim (p=0.338) or the kind of procedure (p=0.552). CONCLUSIONS: Most claimed physicians suffer a significant emotional distress after a malpractice claim, which affects their professional performance. According to our results, they should be assessed and assisted in order to minimize the negative consequences on their well-being and their praxis.

[Analysis of claims for wrong-site surgery (1986-2017)]. / Reclamaciones por cirugía en sitio erróneo (1986- 2017).

BACKGROUND: Wrong site surgery (WSS) is a potentially preventable adverse event in healthcare. METHODS: We performed a retrospective analysis of the 9,129 claims managed by the Professional Liability Service of the Catalonian's Colleges of Physicians from 1986 to 2017. RESULTS: We identified 57 claims for WSS (1.78 per year), with an increase in the final ten years (0.92 to 3.83). One patient identification error corresponded to the anesthetic procedure; surgery involving fingers (17.5%), backbone (15.8%), knee (12.3%) and teeth (12.3%) was predominant. Orthopedic Surgery and Traumatology was the specialty most involved (54.4%), being tooth extraction, vertebral disc prolapsed surgery and finger bone resection the most frequent procedures with seven cases each (12.3%). Claims followed criminal (16 cases, 28.1%) or civil proceedings (9 cases, 15.8%), with two guilty verdicts on a civil basis. The frequency of claims leading to compensation was 59.6%, averaged 9,210.23 euros per claim, resolved through extrajudicial (65.6%) or judicial channels (50.0%). CONCLUSION: WSS events cannot be overlooked and shows high incidence of claims liability rates, which highlights the need to increase efforts to ensure patient safety in this area.

Malpractice risk at the physician level: Claim-prone physicians.

Professional liability and patient safety are worldwide concerns and efforts to identify claimed physicians' characteristics cross borders. Interventions with "at risk populations" would help to better address the underlying problems that lead to many claims. We analyzed physicians' characteristics of every paid claim between 2005 and 2014 in Catalonia region (Spain). We identified 808 physicians involved in 725 paid claims. A total of 12.38% physicians had at least two paid claims over the study period. Physicians' risk of future paid claims was increased if they had more than one previous paid claim (hazard ratio, 1.87; 95% confidence interval [CI], 1.67-2,1). More than half the claims were accounted for by physicians in four specialty groups: obstetrics and gynecology (20.4%), traumatology and orthopedic Surgery (17.5%), plastic surgery (10%) and general surgery (9.7%). The risk of recurrence was higher among surgery-related specialties than among non-surgery-related specialties. Specialty is a particularly strong determinant of claim incidence, so the risk issue may not be so individually determined, but conditioned by the kind of medicine or procedures we practice. Nevertheless, physicians' risk of future paid-claims increases after the second claim. Management systems should take advantage of this information, in order to prevent patient safety events and malpractice claims. Our results support both specialty-based interventions in high-risk specialties, such us Plastic Surgery, as well as interventions at a physician level in those physicians with more than one paid claim.

Clinical safety and professional liability claims in Ophthalmology. / Seguridad clínica y reclamaciones por responsabilidad profesional en Oftalmología.

INTRODUCTION: Patient safety is an international public health priority. Ophthalmology scientific societies and organisations have intensified their efforts in this field. As a tool to learn from errors, these efforts have been linked to the management of medical professional liability insurance through the analysis of claims. MATERIAL AND METHODS: A review is performed on the improvements in patient safety, as well as professional liability issues in Ophthalmology. RESULTS: There is a high frequency of claims and risk of economic reparation of damage in the event of a claim in Ophthalmology. Special complaints, such as wrong surgery or lack of information, have a high risk of financial compensation and need strong efforts to prevent these potentially avoidable events. Studies focused on pathologies or specific procedures provide information of special interest to sub-specialists. The specialist in Ophthalmology, like any other doctor, is subject to the current legal provisions and appropriate mandatory training in the medical-legal aspects of health care is essential. CONCLUSIONS: Professionals must be aware of the fundamental aspects of medical professional liability, as well as specific aspects, such as defensive medicine and clinical safety. The understanding of these medical-legal aspects in the routine clinical practice can help to pave the way towards a satisfactory and safe professional career, and help in increasing patient safety. The aim of this review is to contribute to this training, for the benefit of professionals and patients.

Medical professional responsibility for postvasectomy pregnancy. / Responsabilidad profesional médica en embarazo posvasectomía.

BACKGROUND: The follow-up of patients postvasectomy is frequently limited to a seminogram at 3months if azoospermia is observed. This study evaluates a series of cases of complaints for postvasectomy pregnancy to establish follow-up recommendations that increase the clinical safety and reduce the risk of complaints. MATERIAL AND METHODS: We reviewed the database of the Department of Professional Responsibility of the Council of the College of Physicians of Catalonia, finding 28 complaints for postvasectomy pregnancy between 1992 and 2011. We analysed the clinical and legal variables of the cases. RESULTS: A total of 13 extrajudicial complaints (46.43%), 13 civil lawsuits (46.43%) and 2 criminal lawsuits (7.14%) were recorded. Only 10 cases had a signed document of informed consent specific to vasectomy. In 26 cases, the data from the spermogram was available. A single spermogram was conducted in 20 cases (76.92%), 2 spermograms were conducted in 4 cases (15.38%) and none were performed in 2 cases (7.69%). For 9 of the cases (45%) where only a single spermogram was performed, the test was performed before 3months postvasectomy. In 17 cases (65.38%), the result of the last spermogram was azoospermia, and 3 cases had oligospermia (11.54%). There were 2 failures of interpretation of the spermogram (7.69%) and 2 of normospermia (7.69%). In 2 cases, a spermogram was not performed (7.69%). Pregnancy occurred between 4 and 50 months after the intervention. In 12 cases (42.86%), it was considered that the practitioner was responsible. DISCUSSION: It is recommended that physicians emphasise (during the patient information stage) the possibility of spontaneous recanalisation and to request 2 spermograms, whose result should be azoospermia. Performing the test in the 3months after vasectomy is risky, as is basing the waiting time on the number of ejaculations.