ABSTRACT
À medida que os avanços médico-tecnológicos continuam a se tornar mais facilmente disponíveis, o diagnóstico de pseudo-doenças atingiu o cerne dos sistemas de saúde e tornou-se uma das atividades mais prejudiciais da medicina moderna, tanto individual quanto coletivamente, pois ameaça a sustentabilidade dos sistemas de saúde. Aqui descrevemos um caso hipotético, mas baseado em casos reais, de uma jovem de 36 anos diagnosticada com um carcinoma papilífero de tireoide após ter sido submetida a um check-up excessivo e desnecessário solicitado por um ginecologista em uma consulta de rotina. (AU)
As medical technological advances continue to become more readily available, diagnosis of pseudo-disease has hit the heart of medicine and has become one of the most harmful activities in modern medicine, both individually and collectively speaking as it threatens the sustainability of health systems. Here we describe a hypothetical case (but based on many similar real ones) of a young adult woman in her middle 30's that has been diagnosed with a papillary thyroid cancer after she had been submitted to an excessive and unnecessary check-up elicited by a gynaecologist in a routine medical consultation. (AU)
Subject(s)
Humans , Female , Adult , Unnecessary Procedures/adverse effects , Medical Overuse , Clinical DiagnosisABSTRACT
Expertise in a medical specialty requires countless hours of learning and practice and a combination of neural plasticity and contextual case experience resulting in advanced gestalt clinical reasoning. This holistic thinking assimilates complex segmented information and is advantageous for timely clinical decision-making in the emergency department and paediatric or neonatal intensive care units. However, the same agile reasoning that is essential acutely may be at odds with the slow deliberative thought required for ethical reasoning and weighing the probability of patient morbidity. Recent studies suggest that inadequate ethical decision-making results in increased morbidity for patients and that clinical ethics consultation may reduce the inappropriate use of life-sustaining treatment. Behavioural psychology research suggests there are two systems of thinking - fast and slow - that control our thoughts and therefore our actions. The problem for experienced clinicians is that fast thinking, which is instinctual and reflexive, is particularly vulnerable to experiential biases or assumptions. While it has significant utility for clinical reasoning when timely life and death decisions are crucial, I contend it may simultaneously undermine the deliberative slow thought required for ethical reasoning to determine appropriate therapeutic interventions that reduce future patient morbidity. Whilst health-care providers generally make excellent therapeutic choices leading to good outcomes, a type of substitutive thinking that conflates clinical reasoning and ethical deliberation in acute decision-making may impinge on therapeutic relationships, have adverse effects on patient outcomes and inflict lifelong burdens on some children and their families.
Subject(s)
Clinical Decision-Making/ethics , Clinical Decision-Making/methods , Critical Care/ethics , Medical Futility/ethics , Thinking , Unnecessary Procedures/ethics , Acute Disease , Child , Critical Care/psychology , Emergency Service, Hospital/ethics , Humans , Intensive Care Units, Pediatric/ethics , Medical Futility/psychology , Pediatrics/ethics , Quality of Life , Unnecessary Procedures/adverse effects , Unnecessary Procedures/psychologyABSTRACT
Vascularized composite allotransplantation has enabled the performance of five reported penile transplantations across the world with additional transplantations planned. Penile transplantation raises ethical questions concerning aesthetics, morbidity, function, and cost-burden given the more readily available and less morbid alternative of phalloplasty.
Subject(s)
Clinical Decision-Making/ethics , Penile Transplantation , Penis/blood supply , Unnecessary Procedures/ethics , Vascularized Composite Allotransplantation/ethics , Coitus , Cost-Benefit Analysis , Health Care Costs , Humans , Male , Patient Safety , Penile Erection , Quality of Life , Recovery of Function , Risk Assessment , Risk Factors , Treatment Outcome , Unnecessary Procedures/adverse effects , Unnecessary Procedures/economics , Vascularized Composite Allotransplantation/adverse effects , Vascularized Composite Allotransplantation/economicsABSTRACT
Background: To identify practices that do not add value, cause harm, or subject patients with chronic obstructive pulmonary disease (COPD) to a level of risk that outweighs possible benefits (overuse). Methods: A qualitative approach was applied. First, a multidisciplinary group of healthcare professionals used the Metaplan technique to draft and rank a list of overused procedures as well as self-care practices in patients with stable and exacerbated COPD. Second, in successive consensus-building rounds, description files were created for each "do not do" (DND) recommendation, consisting of a definition, description, quality of supporting evidence for the recommendation, and the indicator used to measure the degree of overuse. The consensus group comprised 6 pulmonologists, 2 general practitioners, 1 nurse, and 1 physiotherapist. Results: In total, 16 DND recommendations were made for patients with COPD: 6 for stable COPD, 6 for exacerbated COPD, and 4 concerning self-care. Conclusion: Overuse poses a risk for patients and jeopardizes care quality. These 16 DND recommendations for COPD will lower care risks and improve disease management, facilitate communication between physicians and patients, and bolster patient ability to provide self-care.
Subject(s)
Medical Overuse , Pulmonary Disease, Chronic Obstructive/therapy , Self Care/adverse effects , Clinical Decision-Making , Consensus , Cost-Benefit Analysis , Disease Progression , Health Care Costs , Humans , Medical Overuse/economics , Patient Safety , Pulmonary Disease, Chronic Obstructive/diagnosis , Pulmonary Disease, Chronic Obstructive/economics , Risk Assessment , Risk Factors , Self Care/economics , Unnecessary Procedures/adverse effectsSubject(s)
Acute Kidney Injury/diagnosis , Arthritis, Psoriatic/drug therapy , Bronchoscopy/adverse effects , Creatinine/blood , Mycobacterium Infections, Nontuberculous/drug therapy , Nontuberculous Mycobacteria/isolation & purification , Pneumonia/drug therapy , Unnecessary Procedures , Acute Kidney Injury/blood , Acute Kidney Injury/therapy , Anti-Bacterial Agents/therapeutic use , Arthritis, Psoriatic/complications , Bacteriological Techniques/standards , Biological Therapy/adverse effects , Biomarkers/blood , Community-Acquired Infections/drug therapy , Culture Techniques/standards , Female , Humans , Middle Aged , Mycobacterium Infections, Nontuberculous/diagnosis , Pneumonia/diagnosis , Practice Guidelines as Topic , Societies, Medical , United States , Unnecessary Procedures/adverse effectsABSTRACT
Birth, whether at home or in the hospital, should involve shared decision making that empowers women to choose or decline the interventions that are best for the woman and her baby. Obstetricians and home birth midwives must share important information with their patients.
Subject(s)
Decision Making , Delivery, Obstetric , Home Childbirth , Midwifery , Physicians , Animals , Female , Health Knowledge, Attitudes, Practice , Male , Narration , Pregnancy , United States , Unnecessary Procedures/adverse effects , Unnecessary Procedures/ethics , Unnecessary Procedures/trendsABSTRACT
OBJECTIVE: To test the hypothesis that declining fertility would affect the number of cesarean sections (c-sections) on maternal demand, but not medically indicated c-sections. DATA SOURCES: The 1996-2004 National Health Insurance Research Database in Taiwan for all singleton deliveries. STUDY DESIGN: Retrospective population-based, longitudinal study. Estimation was performed using multinomial probit models. PRINCIPAL FINDINGS: Results revealed that declining fertility had a significant positive effect on the probability of having a c-section on maternal request but not medically indicated c-section. CONCLUSIONS: Our findings offer a precautionary note to countries experiencing a fertility decline. Policies to contain the rise of c-sections should understand the role of women's preferences, especially regarding cesarean deliveries on maternal request.
Subject(s)
Birth Rate/trends , Cesarean Section/statistics & numerical data , Elective Surgical Procedures/statistics & numerical data , Fertility , Adult , Cesarean Section/adverse effects , Cesarean Section/psychology , Choice Behavior , Community Health Planning , Elective Surgical Procedures/adverse effects , Elective Surgical Procedures/psychology , Female , Health Care Surveys , Health Services Needs and Demand/trends , Humans , Longitudinal Studies , National Health Programs/statistics & numerical data , Patient Acceptance of Health Care/psychology , Patient Acceptance of Health Care/statistics & numerical data , Patient Selection , Pregnancy , Pregnant Women/psychology , Regression Analysis , Retrospective Studies , Social Values , Taiwan , Unnecessary Procedures/adverse effects , Unnecessary Procedures/psychology , Unnecessary Procedures/statistics & numerical dataSubject(s)
Circumcision, Male , Midwifery , Nurse's Role , Unnecessary Procedures , Circumcision, Male/adverse effects , Circumcision, Male/ethics , Health Knowledge, Attitudes, Practice , Humans , Male , Midwifery/methods , Risk Factors , Time Factors , Unnecessary Procedures/adverse effects , Unnecessary Procedures/ethicsABSTRACT
Se destaca que iatrogenia es un tema médico y no quirúrgico. Se establecen las diferencias entre enfermedad iatrogénica excusable, sin responsabilidad jurídica e inexcusable. En este último caso el actuar del médico genera responsabilidad jurídica. (AU)