Managing professional boundaries.

The maintenance of boundaries in the doctor-patient relationship is central to good medical practice and the appropriate care of patients. This article examines the nature of boundaries in medical practice and outlines some strategies to minimise the risk of a boundary violation.

An intellectual property sharing initiative in agricultural biotechnology: development of broadly accessible technologies for plant transformation.

The Public Intellectual Property Resource for Agriculture (PIPRA) was founded in 2004 by the Rockefeller Foundation in response to concerns that public investments in agricultural biotechnology benefiting developing countries were facing delays, high transaction costs and lack of access to important technologies due to intellectual property right (IPR) issues. From its inception, PIPRA has worked broadly to support a wide range of research in the public sector, in specialty and minor acreage crops as well as crops important to food security in developing countries. In this paper, we review PIPRA's work, discussing the failures, successes, and lessons learned during its years of operation. To address public sector's limited freedom-to-operate, or legal access to third-party rights, in the area of plant transformation, we describe PIPRA's patent 'pool' approach to develop open-access technologies for plant transformation which consolidate patent and tangible property rights in marker-free vector systems. The plant transformation system has been licensed and deployed for both commercial and humanitarian applications in the United States (US) and Africa, respectively.

Consent to medical treatment: the mature minor.

Can children and young people consent to their own medical treatment? Consent issues involving children and young people are complex. This article examines the legal obligations of general practitioners when obtaining consent to medical treatment from patients who are less than 18 years of age.

Failure to diagnose: brain tumour.

Case studies are based on actual medical negligence claims or medicolegal referrals; however certain facts have been omitted or changed by the author to ensure the anonymity of the parties involved. This article discusses a recent coronial inquest into the death of a 5 year old girl from a brain tumour.

Harassment of GPs.

The maintenance of clear professional boundaries is an essential part of general practice. Boundary violations are usually considered to be the result of the exploitation of a patient by their doctor, but they can also occur as a result of the behaviour of a patient. This article discusses harassment and stalking of doctors by patients, and outlines some strategies on how to manage this situation.

Failure to diagnose: bowel obstruction.

Case histories are based on actual medical negligence claims or medicolegal referrals; however certain facts have been omitted or changed by the author to ensure the anonymity of the parties involved.

Medicare Australia and the professional services review scheme.

Medicare Australia's Practitioner Review Program and the Professional Services Review (PSR) Scheme aim to protect the integrity of Medicare and pharmaceutical benefits programs by protecting patients and the community from the risks associated with 'inappropriate practice' and also protecting the Commonwealth Government from having to meet the cost of services provided as a result of inappropriate practice. This article outlines the operation of the Practitioner Review Program and PSR.

Access to children's medical records.

Case histories are based on actual medical negligence claims or medicolegal referrals; however certain facts have been omitted or changed by the author to ensure the anonymity of the parties involved. When the parents of a young child are separated or divorced, it is not uncommon for general practitioners to receive requests from one of the parents for information about the medical management of the child, including a request for a copy of the child's medical records. The role of the GP is to provide medical care to the child and act in the child's best interests. This article outlines some strategies for GPs to minimise the possibility of becoming 'piggy in the middle' of a dispute between the parents.

Ear syringing: minimising the risks.

The patient, 61 years of age, saw the general practitioner for a repeat prescription for her blood pressure medication. During the consultation, the patient mentioned that she had some discomfort in her left ear. The GP examined the patient's ears and noted that both external auditory canals were blocked by wax. He recommended that the patient have her ears syringed and arranged for the practice nurse to perform the procedure. The GP did not see the patient again.

Doctors as patients.

Case histories are based on actual medical negligence claims or medicolegal referrals; however certain facts have been omitted or changed by the author to ensure the anonymity of the parties involved. All the medical boards and medical colleges recommend that medical practitioners have their own general practitioner. The aim of this article is to provide guidance for GPs about how to deal with the potential complexities of managing medical colleagues as patients.

Unsafe sharps management.

Case histories are based on actual medical negligence claims or medicolegal referrals. However, certain facts have been omitted or changed by the author to ensure the anonymity of the parties involved. This article examines an incident involving a patient who sustained a 'needlestick' injury at a general practitioner's surgery. Advice on how to manage a 'needlestick' injury and strategies to ensure the safe management of sharps are outlined.

Failure to follow up CT reports.

Case histories are based on actual medical negligence claims or medicolegal referrals, however certain facts have been omitted or changed by the author to ensure the anonymity of the parties involved. A failure to follow up test results is a common underlying cause of medical negligence claims and complaints involving general practitioners. This article examines a case in which an incidental finding of an aneurysm on cerebral computerised tomography scan was not followed up with disastrous consequences for the patient.

Failure to diagnose: Addison disease.

On 11 May 2007, the State Coroner of Western Australia, made a number of recommendations regarding the recognition of serious illnesses in a general practice setting, and the supervision of medical practitioners undertaking prevocational training. The recommendations arose out of a Coronial Inquest into the death of a 16 year old patient from Addison disease. This article discusses the case and the recommendations made by the coroner.

Follow up of test results after hours.

This article examines a recent Coronial inquest in which the Coroner made recommendations to general practitioners regarding the process of notification by pathology practices of abnormal and life threatening results and how GPs respond to such notifications. An addendum to the Standards for general practices provides guidance for GPs and their staff on the systems to manage the follow up of test results outside normal general practice opening hours.

Failure to diagnose: long QT syndrome.

This article examines a medical negligence claim involving an allegation of failure to perform an electrocardiogram, leading to a delay in diagnosis of long QT syndrome.

Failure to diagnose: epidural abscess.

Early diagnosis of spinal epidural abscess is often elusive. Late diagnosis may leave the patient with permanent and severe neurological disability. The aim of this article is to raise general practitioners' awareness of this uncommon condition.

Insurance reports.

Case histories are based on actual medical negligence claims or medicolegal referrals, however certain facts have been omitted or changed by the author to ensure the anonymity of the parties involved. General practitioners find their patients requesting that they complete documentation for a myriad of insurance purposes. Often these forms are time consuming to complete, containing seemingly irrelevant questions. This article examines the responsibilities of GPs in providing reports to insurance companies.

Risk management: what is it?

Case histories are based on actual medical negligence claims or medicolegal referrals, however certain facts have been omitted or changed by the author to ensure the anonymity of the parties involved. From time to time, errors will occur in medical care. The identification of clinical risks is a critical first step to improving patient safety. This article discusses the role of risk management in a general practice setting. What does risk management actually mean? What risk management strategies and tools are available for general practitioners?