[Complementary and Alternative Medicine Offers of Teaching Practices for General Medicine]. / Komplementär- und alternativmedizinische Angebote von Lehrpraxen für Allgemeinmedizin.

OBJECTIVE: Germany's new medical licensure act has increased the importance of general practice in academic medical education. This study gives an overview of complementary and alternative medicine in general teaching practices in Germany and their adherence to evidence-based criteria which is required in order to qualify as a teaching practice. METHODS: After a systematic search for German teaching practices, we assessed their diagnostic and therapeutic offers via their websites. We calculated the various frequencies of treatments and differentiated between evidence-based complementary medicine and alternative medicine with little to no evidence. RESULTS: Of 4102 practices, more than half offered complementary and/or alternative treatment. Most of those were treatments approved of by the German medical association. Alternative medicine was offered by 18.2% of the practices. CONCLUSION: Collective terms and conflicting evidence complicate the classification of treatments. Teaching practices offering non-evidence-based treatment raise the question whether recruitment of additional teaching practices stands at odds with the quality of medical education. Explicit offers of alternative treatment should disqualify a teaching practice as such. Controversial treatment may be taught academically and during residency with a focus on evidence-based guidelines and communication skills in order to prepare young medical practitioners for talks with their patients about the subject.

Clínica médica especializada: norma técnica No. 18-2020-DRACES / Specialized medical clinic: technical standard No. 18-2020-DRACES

DRACES [Departamento de Regulación, Acreditación y Control de Establecimientos de Salud] Este documento tiene como objeto: "la regulación, autorización y control de las clínicas médicas especializadas, en concordancia con el Reglamento para la Regulación, Autorización, Acreditación y Control de Establecimientos de Atención para la Salud, Acuerdo Gubernativo 376-2007." Es de carácter obligatorio, por lo que se aplica en todo el territorio nacional. Contiene además, las definiciones de los conceptos relacionados al tema principal, además de la infraestructura que deberá tener cada clínica, incluidos el equipo y recurso humano y técnico.

Clínica médica general: norma técnica No. 17-2020-DRACES / General medical clinic: technical standard No. 17-2020-DRACES

DRACES [Departamento de Regulación, Acreditación y Control de Establecimientos de Salud] Este documento tiene como objeto: "la Regulación, Autorización y Control de las Clínicas Médicas Generales, en concordancia con el Reglamento para la Regulación, Autorización, Acreditación y Control de Establecimientos de Atención para la Salud, Acuerdo Gubernativo 376-2007." Es de carácter obligatorio, por lo que se aplica en todo el territorio nacional. Contiene además, las definiciones de los conceptos relacionados al tema principal, además de la infraestructura que deberá tener cada clínica, incluidos el equipo y recurso humano y técnico.

Supportive networks, healthier doctors and 'just culture': Managing the effects of medico-legal complaints on doctors.

BACKGROUND: When an error leads to possible patient harm and a complaint, the impact on doctors and patients can be profound. Doctors may respond in ways that risk harm to themselves, colleagues and patients, including withdrawing from peers, risk-avoidance practice and even suicidal ideation. OBJECTIVE: This article discusses current research and public discourse on the impact of complaints on doctors' personal and professional lives, as well as the way complaints and the fear of complaints affects doctors' clinical practice. It suggests strategies to ameliorate these effects before a complaint is made. DISCUSSION: When colleagues support one another and collectively reflect on their practice within a culture focused on patient safety, doctors facing complaints or presented with an error are less likely to isolate themselves and fear the worst. Using a common adverse event, the author discusses how analysing minor errors and near-misses can benefit patients, practitioners and practices.

Prevention is better than the cure: Getting privacy compliance right is essential practice management.

BACKGROUND: Ensuring compliance with privacy law is not just a matter of respecting patient confidentiality. The past year has seen the introduction of new legal requirements including data breach notification, and higher penalties for breaches of the Privacy Act 1988 (Cwlth). Disturbingly, the first reporting period shows that the health sector has the highest number of data breaches of any sector. OBJECTIVE: This article outlines the key steps a health practice can take towards managing its privacy compliance. DISCUSSION: The absence of a privacy compliance program can itself be a breach of the Privacy Act, even if no personal information was lost or misused in any way. Health service providers need to place a fresh focus on their legal compliance.

Informal online opinions: Medico-legal considerations in new and social media.

BACKGROUND: Doctors are increasingly discovering that using social media, both via public platforms and closed forums, is a powerful tool to develop a professional presence, share information and network with colleagues. While new technology can open up opportunities to engage, educate and inform, it is important also to recognise that doctors' legal and professional obligations apply equally online. OBJECTIVE: The aim of this article is to raise awareness of and share information about legal and professional obligations when using social media, particularly in the context of seeking peer professional advice or informal input from colleagues. DISCUSSION: While doctors' legal and professional obligations continue to apply online, the technology can create additional complexities. Being aware of these complexities will assist doctors to optimise their use of social media while still complying with those obligations.

General practice location and malpractice litigation.

INTRODUCTION: Healthcare systems in many countries struggle to recruit general practitioners (GPs) for clinics in rural areas leading to less GPs for an increasing number of patients. As a result, fewer resources are available for individual patients, potentially influencing patient satisfaction and the likelihood of malpractice litigation. The aim of this study was to investigate the association between malpractice litigation and local setting characteristics in a Danish national sample of GPs considering rurality, number of patients listed with the GP, as well as levels of local unemployment, education, income and healthcare expenditure. METHOD: This is a register study on Danish complaint files and administrative register data using multivariate logistic regression. RESULTS: No statistical significant association could be established between litigation figures and rurality, occupation with respect to education, and municipality level of healthcare expenditures. However, larger patient list size was associated with higher rates of malpractice litigation (odds ratio (OR) 1.05 per 100 patients). Litigation was less frequent in settings with higher income patient populations (OR 0.65), although where it did occur the criticism seemed much more likely to be justified (OR 6.03). CONCLUSION: Many GPs face an increasing workload in terms of patient lists. This can cause drawbacks in terms of patient dissatisfaction and malpractice litigation even though local factors such as economic wealth apparently interfere. Further research is needed about the role of geographic variations, workload and socioeconomic inequality in malpractice litigation.

The 'elephants in the room' for New Zealand's health system in its 80th anniversary year: general practice charges and ownership models.

The 2018 year signalled the 80th anniversary of the Social Security Act 1938. In order to implement this legislation, a historic compromise between the government and the medical profession created institutional arrangements for the New Zealand health system that endure to this day. The 2018 year also marked the commencement of a Ministerial review of the New Zealand health system. This article considers two intertwined arrangements which stem from the post-1938 compromise that the Ministerial review will need to address if goals of equity and, indeed, the original intent of the 1938 legislation are to be delivered upon: general practice patient charges; and ownership models. It describes the problems patient charges create, and options for ownership that the Ministerial review might contemplate.

Reconfiguring diagnostic work in Danish general practice; regulation, triage and the secretaries as diagnostician.

Health care systems as well as bodies of medical knowledge are dynamic and change as the result of political and social transformations. In recent decades, health care systems have been subjected to a whole assemblage of regulatory practices. The local changes undertaken in Denmark that are being explored here are indicative of a long-term shift that has occurred in many welfare states intended to make public services in the Global North more efficient and transparent. Departing in prolonged field work in Danish general practice and the anthropological literature on audit culture, this paper suggests that the introduction of regulatory practices has enhanced the need for triage as a key organising principle. The term triage literally means separating out and refers to the process of sorting and placing patients in time and space. The paper suggests that an increasing introduction of triage feeds into a reconfiguration of diagnostic work, where the clinical setting is gradually becoming more intertwined with the governing domains of policy, and the work of the secretary is gradually becoming more intertwined with that of the doctor. Finally, the paper argues that an increasing regulation of general practice poses an ethically charged challenge to existing welfare politics of responsibility between the state and the public, as it makes it increasingly difficult to negotiate access to care.

Responsabilidad penal médica: consideraciones en la aplicación del principio del doble efecto / Medical Criminal Liability: considerations in the application of the principle of double effect

La responsabilidad médica en Chile contempla un espacio de discrecionalidad, en situaciones de peligro para la mujer durante el embarazo y en el tratamiento paliativo de pacientes terminales. En estos casos se presentan conceptos jurídicos indeterminados, en el ordenamiento jurídico chileno, que requieren de una propuesta interpretativa en consonancia con la protección del derecho a la vida, en actividades médicas que tengan por efecto colateral la muerte de personas inocentes (AU).

The chilean medical liability leaves a room of discretion in cases when a hazardous condition exists during the pregnancy or palliative care for those dying from a terminal disease. In such cases, the Chilean legal system presents undefined legal concepts. This concepts need to be in accordance with the promotion of the constitutional right to life, in medical cases where innocent people could die by side effect (AU).