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.

Influencia de las reclamaciones en la gestión asistencial de un servicio de cirugía ortopédica y traumatología / Influence of claims on the management of an orthopaedic surgery and traumatology service

Introducción: Las reclamaciones constituyen una de las principales fuentes de información para evaluar la calidad percibida en los centros asistenciales, siendo la cirugía ortopédica y traumatología (COT) una de las especialidades con mayor probabilidad de recibirlas por su elevada demanda quirúrgica que genera importantes listas de espera. Objetivos: Mostrar la evolución de las reclamaciones presentadas en un servicio de COT, clasificar los motivos expuestos e identificar las oportunidades de mejora derivadas de las mismas. Metodología: Estudio epidemiológico descriptivo, observacional y de orientación temporal retrospectiva. Revisión de los registros correspondientes a las reclamaciones presentadas durante el periodo 2014-2018 en el servicio de COT de un hospital universitario. Para la clasificación de las reclamaciones se han utilizado los motivos establecidos por la aseguradora pública CatSalut. El análisis estadístico se ha realizado mediante el programa Excel® y el software R-Project (versión 4.0.2), considerándose un nivel de significación estadística de p<0,05. Resultados: El servicio de COT ha recibido un total de 424 reclamaciones durante el periodo 2014-2018, mostrando una tasa global de 3,18 reclamaciones por cada 1.000 episodios asistenciales considerados. Los principales motivos de reclamación han sido los organizativos (73%) y los asistenciales (20%). A partir del año 2016 se evidencia un descenso en el número de las reclamaciones presentadas. Conclusión: La implantación de procedimientos informativos estables para modular las expectativas de los pacientes incorporados a las listas de espera, y una comunicación más empática que facilite una buena relación paciente-profesional son acciones de mejora identificadas para reducir su frecuencia de presentación.(AU)

Introduction: Claims constitute one of the main sources of information to evaluate the perceived quality in healthcare centres, being Orthopaedic and Traumatology Surgery (OTS) one of the specialties with greater probability of receiving them due to its high surgical demand generating long waiting lists. Objectives: To display the evolution of the filed claims addressed to the OTS department, to classify the reasons stated in the complaint, and to identify the opportunities for improvement derived from the forementioned. Methodology: Descriptive, observational and retrospective epidemiological study. The target population has been configured by those citizens who have submitted a claim addressed to the OTS Service of a University Hospital of Barcelona from 2014 to 2018. In reference with the classification of claims, it has been used the reasons established by the public service CatSalut: assistance, treat, information, organisation, documentation and hospitality/habitability/comfort. Results: OTS service received a total of 424 claims during the study period, showing an overall rate of 3.18 claims per 100 assistance episodes considered. The main reasons for claiming were organizational (73%) and assistance (20%). No claims regarding dissatisfaction of hospitality/habitability/comfort were registered. A noticeable decrease in the number of claims submitted is observed since 2016. Conclusion: Actions in the management of waiting lists and standardised information procedures that improve the doctor–patient relationship have been identified as measures of improvement to reduce the claim presentation rate.(AU)

[Translated article] Influence of claims on the management of an orthopaedic surgery and traumatology service / Influencia de las reclamaciones en la gestión asistencial de un servicio de cirugía ortopédica y traumatología

Introducción: Las reclamaciones constituyen una de las principales fuentes de información para evaluar la calidad percibida en los centros asistenciales, siendo la cirugía ortopédica y traumatología (COT) una de las especialidades con mayor probabilidad de recibirlas por su elevada demanda quirúrgica que genera importantes listas de espera. Objetivos: Mostrar la evolución de las reclamaciones presentadas en un servicio de COT, clasificar los motivos expuestos e identificar las oportunidades de mejora derivadas de las mismas. Metodología: Estudio epidemiológico descriptivo, observacional y de orientación temporal retrospectiva. Revisión de los registros correspondientes a las reclamaciones presentadas durante el periodo 2014-2018 en el servicio de COT de un hospital universitario. Para la clasificación de las reclamaciones se han utilizado los motivos establecidos por la aseguradora pública CatSalut. El análisis estadístico se ha realizado mediante el programa Excel® y el software R-Project (versión 4.0.2), considerándose un nivel de significación estadística de p<0,05. Resultados: El servicio de COT ha recibido un total de 424 reclamaciones durante el periodo 2014-2018, mostrando una tasa global de 3,18 reclamaciones por cada 1.000 episodios asistenciales considerados. Los principales motivos de reclamación han sido los organizativos (73%) y los asistenciales (20%). A partir del año 2016 se evidencia un descenso en el número de las reclamaciones presentadas. Conclusión: La implantación de procedimientos informativos estables para modular las expectativas de los pacientes incorporados a las listas de espera, y una comunicación más empática que facilite una buena relación paciente-profesional son acciones de mejora identificadas para reducir su frecuencia de presentación.(AU)

Introduction: Claims constitute one of the main sources of information to evaluate the perceived quality in healthcare centres, being Orthopaedic and Traumatology Surgery (OTS) one of the specialties with greater probability of receiving them due to its high surgical demand generating long waiting lists. Objectives: To display the evolution of the filed claims addressed to the OTS department, to classify the reasons stated in the complaint, and to identify the opportunities for improvement derived from the forementioned. Methodology: Descriptive, observational and retrospective epidemiological study. The target population has been configured by those citizens who have submitted a claim addressed to the OTS Service of a University Hospital of Barcelona from 2014 to 2018. In reference with the classification of claims, it has been used the reasons established by the public service CatSalut: assistance, treat, information, organisation, documentation and hospitality/habitability/comfort. Results: OTS service received a total of 424 claims during the study period, showing an overall rate of 3.18 claims per 100 assistance episodes considered. The main reasons for claiming were organizational (73%) and assistance (20%). No claims regarding dissatisfaction of hospitality/habitability/comfort were registered. A noticeable decrease in the number of claims submitted is observed since 2016. Conclusion: Actions in the management of waiting lists and standardised information procedures that improve the doctor–patient relationship have been identified as measures of improvement to reduce the claim presentation rate.(AU)

[Translated article] Influence of claims on the management of an orthopaedic surgery and traumatology service.

INTRODUCTION: Claims constitute one of the main sources of information to evaluate the perceived quality in healthcare centres, being Orthopaedic and Traumatology Surgery (OTS) one of the specialties with greater probability of receiving them due to its high surgical demand generating long waiting lists. OBJECTIVES: To display the evolution of the filed claims addressed to the OTS department, to classify the reasons stated in the complaint, and to identify the opportunities for improvement derived from the forementioned. METHODOLOGY: Descriptive, observational and retrospective epidemiological study. The target population has been configured by those citizens who have submitted a claim addressed to the OTS Service of a University Hospital of Barcelona from 2014 to 2018. In reference with the classification of claims, it has been used the reasons established by the public service CatSalut: assistance, treat, information, organisation, documentation and hospitality/habitability/comfort. RESULTS: OTS service received a total of 424 claims during the study period, showing an overall rate of 3.18 claims per 100 assistance episodes considered. The main reasons for claiming were organisational (73%) and assistance (20%). No claims regarding dissatisfaction of hospitality/habitability/comfort were registered. A noticeable decrease in the number of claims submitted is observed since 2016. CONCLUSION: Actions in the management of waiting lists and standardised information procedures that improve the doctor-patient relationship have been identified as measures of improvement to reduce the claim presentation rate.

Influence of claims on the management of an orthopaedic surgery and traumatology service. / Influencia de las reclamaciones en la gestión asistencial de un servicio de cirugía ortopédica y traumatología.

INTRODUCTION: Claims constitute one of the main sources of information to evaluate the perceived quality in healthcare centres, being Orthopaedic and Traumatology Surgery (OTS) one of the specialties with greater probability of receiving them due to its high surgical demand generating long waiting lists. OBJECTIVES: To display the evolution of the filed claims addressed to the OTS department, to classify the reasons stated in the complaint, and to identify the opportunities for improvement derived from the forementioned. METHODOLOGY: Descriptive, observational and retrospective epidemiological study. The target population has been configured by those citizens who have submitted a claim addressed to the OTS Service of a University Hospital of Barcelona from 2014 to 2018. In reference with the classification of claims, it has been used the reasons established by the public service CatSalut: assistance, treat, information, organisation, documentation and hospitality/habitability/comfort. RESULTS: OTS service received a total of 424 claims during the study period, showing an overall rate of 3.18 claims per 100 assistance episodes considered. The main reasons for claiming were organizational (73%) and assistance (20%). No claims regarding dissatisfaction of hospitality/habitability/comfort were registered. A noticeable decrease in the number of claims submitted is observed since 2016. CONCLUSION: Actions in the management of waiting lists and standardised information procedures that improve the doctor-patient relationship have been identified as measures of improvement to reduce the claim presentation rate.

Litigabilidad y defendibilidad en neurología y neurocirugía. Un modelo «terapéutico» para el manejo de reclamaciones por mala praxis asistencial / Litigability and defensibility in neurology and neurosurgery. A “therapeutic” model for handling claims for malpractice care

Pese a su indiscutible importancia, no abundan los datos oficiales sobre reclamaciones por mala praxis asistencial a nivel nacional en España, debido principalmente a las transferencias de Sanidad a las comunidades autónomas. Esta falta de información unificada, junto a otras variables relacionadas con la moderna medicina asistencial (tipo de sistema sanitario, aspectos éticos, consentimiento, derechos de los pacientes, nuevas tecnologías, etc.), complica la respuesta del profesional sanitario ante las reclamaciones y podría no garantizar una adecuada protección de este ante posibles denuncias. Este artículo analiza la situación actual en España y enfatiza aspectos como la defendibilidad y la litigabilidad en las reclamaciones por mala praxis, tomando como modelo la especialidad de neurocirugía, una de las más proclives a este tipo de situaciones. Se ofrecen líneas guía de prevención y actuación mediante un modelo encaminado a reforzar la defendibilidad y reducir la litigabilidad. Dicho enfoque, al que llamamos «modelo terapéutico», considera el problema análogamente a una enfermedad, proporcionando bases para su prevención y manejo. Creemos que este enfoque puede ser útil tanto al Neurocirujano como a cualquier sanitario en un momento, como el actual, en que existe cierta confusión sobre estos temas y también alguna reticencia de las Compañías aseguradoras a proporcionar cobertura en algunos casos (AU)

Despite its indisputable importance, there are not many official data on claims for malpractice at the national level in Spain, mainly due to transfers from Health to the Autonomous Communities. This lack of unified information, together with other variables related to modern Healthcare Medicine (type of healthcare system, ethical aspects, consent, patients’ rights, new technologies, etc.), complicates the healthcare professional's response to claims, and could not guarantee adequate protection of this against possible liability. This article analyzes the current situation in Spain and emphasizes aspects such as defensibility and liability in malpractice claims, taking as a model the Neurosurgery Specialty, one of the most prone to this type of situation. Prevention and action guidelines are offered, through a model aimed at reinforcing defensibility and reducing liability. This approach, which we call a «therapeutic model», considers the problem analogously to a disease, providing the basis for its prevention and management.We believe that this approach can be useful both to the neurosurgeon and to any healthcare provider at a time, such as today, when there is some confusion on these issues and some reluctance of insurance companies to provide coverage in some cases (AU)

Responsabilidad profesional médica en la asistencia urgente de especialistas en medicina familiar y comunitaria / Professional liability in primary care emergencies of specialists of family and community medicine

Introducción: La atención urgente en atención primaria es un ámbito clave del sistema sanitario, señalándose como un estresor importante el estar expuestos a recibir reclamaciones por responsabilidad profesional. El objetivo fue analizar las reclamaciones por responsabilidad profesional en la asistencia urgente de especialistas en medicina familiar y comunitaria y sus principales características en nuestro entorno.MétodosAnálisis descriptivo/retrospectivo de las reclamaciones contra especialistas de medicina familiar y comunitaria entre 1986 y 2015.ResultadosSe analizaron 224 reclamaciones, todas ellas resueltas, motivadas por error o retraso diagnóstico (122-54,5%), problemas de accesibilidad en la atención médica (48-21,4%), errores en el tratamiento (29-12,9%) y errores en la emisión de documentos (25-11,1%). En 147 (65,6%) se trataba de asistencia urgente y en 77 (34,3%) programada. La vía de interposición fue judicial en el 71,4%. En 6 casos (2,6%) la resolución implicó una indemnización, tratándose de 3 casos de asistencia urgente y 3 de programada.ConclusiónSe confirma el riesgo muy bajo de reclamación y de indemnización, no habiéndose hallado diferencias entre asistencia urgente y programada. Debe insistirse en aspectos de seguridad clínica, enfatizando en el error diagnóstico. (AU)

Introduction: Urgent assistance in primary care is a key area of the health system, being as an important stressor to be claimed for professional liability. The objective was to analyze the professional liability in primary care emergencies of specialists of family and community medicine and their main characteristics in our environment.MethodsRetrospective descriptive analysis of claims against General Practitioners between 1986 to 2015 was performed.Results224 claims, all resolved, were analyzed, due to error or diagnostic delay (122-54.5%), accessibility problems in medical care (48-21.4%), treatment errors (29-12.9%) and errors in the issuance of documents (25-11.1%). In 147 (65.6%) it was urgent assistance and in 77 (34.3%) scheduled. The way of interposition was judicial in 71.4%. In 6 cases (2.6%) the resolution involved compensation in 3 cases of urgent assistance and 3 of scheduled.ConclusionThe very low risk of claim and compensation payment is confirmed, with no differences found between urgent and scheduled assistance. Clinical safety aspects should be emphasized, especially in the diagnostic error. (AU)

Litigability and defensibility in neurology and neurosurgery. A "therapeutic" model for handling claims for malpractice care.

Despite its indisputable importance, there are not many official data on claims for malpractice at the national level in Spain, mainly due to transfers from Health to the Autonomous Communities. This lack of unified information, together with other variables related to modern Healthcare Medicine (type of healthcare system, ethical aspects, consent, patients' rights, new technologies, etc.), complicates the healthcare professional's response to claims, and could not guarantee adequate protection of this against possible liability. This article analyzes the current situation in Spain and emphasizes aspects such as defensibility and liability in malpractice claims, taking as a model the Neurosurgery Specialty, one of the most prone to this type of situation. Prevention and action guidelines are offered, through a model aimed at reinforcing defensibility and reducing liability. This approach, which we call a "therapeutic model", considers the problem analogously to a disease, providing the basis for its prevention and management. We believe that this approach can be useful both to the Neurosurgeon and to any healthcare provider at a time, such as today, when there is some confusion on these issues and some reluctance of insurance companies to provide coverage in some cases.

Análisis de las Reclamaciones al Servicio de Urgencias de un hospital detercer nivel en el primer año de Pandemia / Análise de Sinistros ao Serviço de Emergência de um hospital terciário no primeiro ano daPandemia / Analysis of Claims to the Emergency Department of a tertiary care hospital in the first year of the Pandemic

The hospital emergency department (ED) has become the gateway to the health system during thefirst COVID-19 wave. The objective of this study is to describe the behaviour of claims in the first yearof the pandemic, comparing them with the previous year. Method: Retrospective descriptive study of thecomplaints addressed to the ED of the Nuestra Señora de Candelaria University Hospital Complex(CHUNSC) during the years 2019 and 2020. The variables studied were: the number of claims receivedat the CHUNSC and at the ED and of the latter: year, month, dimensions, reasons, professional category,sex, relationship of the claimant and the number of emergencies attended. Results: 347 claims from theED and 6259 from the CHUNSC were analyzed, with the average for 2019 being higher than that of 2020. The most requested dimension in the ED is health care assistance and the reason for dissatisfactionfor the provision of care. The professional category with more claims is health care staff and the userhimself, is the one who claims the most. Conclusions: the number of claims has decreased in the firstyear of the pandemic but the dimension has not changed, nor the reason in relation to the previous year. (AU)

El servicio de urgencias hospitalario (SUH) es la puerta de entrada al sistema sanitario de lospacientes COVID-19. El objetivo de este estudio es describir el comportamiento de las reclamaciones enel primer año de pandemia, comparándolas con el año anterior. Método: Estudio descriptivo retrospectivode las reclamaciones dirigidas al SUH del Complejo Hospitalario Universitario Nuestra Señora deCandelaria (CHUNSC) durante los años 2019 y 2020. Las variables estudiadas fueron: número dereclamaciones recibidas en el CHUNSC y en el SUH y de estas últimas: año, mes, dimensiones, motivos,categoría profesional, sexo, parentesco del reclamante y número de urgencias atendidas. Resultados: seanalizaron 347 reclamaciones del SUH y 6259 del CHUNSC, siendo la media del 2019 mayor que la de2020. La dimensión más reclamada en el SUH, es la asistencial y el motivo la insatisfacción por laprestación de la asistencia, la categoría profesional más demandada es la sanitaria y el propio usuario, esel que más reclama. Conclusiones: el número de reclamaciones, ha disminuido en el primer año depandemia pero no ha variado la dimensión, ni el motivo en relación al año anterior. (AU)

O pronto-socorro hospitalar (DE) é a porta de entrada do sistema de saúde para pacientes comCOVID-19. O objetivo deste estudo é descrever o comportamento dos sinistros no primeiro ano dapandemia, comparando-os com o ano anterior. Método: Estudo descritivo retrospectivo das queixasdirigidas ao SU do Complexo Hospitalar Universitário Nuestra Señora de Candelaria (CHUNSC) duranteos anos de 2019 e 2020. As variáveis estudadas foram: número de queixas recebidas no CHUNSC e noSU e do último: ano, mês, dimensões, motivos, categoria profissional, sexo, parentesco do reclamante enúmero de emergências atendidas. Resultados: foram analisadas 347 reclamações do PS e 6259 doCHUNSC, sendo a média de 2019 superior à de 2020. A dimensão mais solicitada no PS é o atendimentoe o motivo é a insatisfação com o atendimento, a categoria profissional mais demandado é o serviço desaúde e o próprio usuário é quem mais reclama. Conclusões: o número de sinistros diminuiu no primeiroano da pandemia mas a dimensão não mudou, nem o motivo em relação ao ano anterior. (AU)

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.

El manejo de la torsión testicular en Urgencias: lecciones aprendidas de las reclamaciones por responsabilidad profesional médica / Management of testicular torsion in the ER: Lessons learned from medical professional liability claims

Objetivo: Evaluar la atención en Urgencias por torsión testicular en reclamaciones por responsabilidad profesional médica.MétodoSe extrajeron las reclamaciones relacionadas con torsión testicular del 2000 al 2018, analizando la asistencia dispensada y la asociación con responsabilidad profesional médica.ResultadosSe identificaron 80 reclamaciones, registrándose como síntoma principal el dolor testicular en el 83,75% de las primeras asistencias, con 15,5h de evolución media. El tiempo hasta el diagnóstico fue de 7,98 días de media. La primera consulta fue hospitalaria en el 75,1% de los casos, pero solo en el 7,5% se realizó ecografía. Cuando se diagnosticó la torsión testicular, se hizo uso de pruebas complementarias en el 97,3% de los casos. La responsabilidad profesional médica se asoció significativamente con la vía de reclamación no penal y con cuadros de menos de 6h de evolución, y dentro de este subgrupo, con la no realización de ecografía.ConclusionesSe reclaman consultas tardías, el error y el retraso en el diagnóstico. Cuando la reclamación es por vía no penal, es frecuente que se considere la existencia de responsabilidad, y más en los casos en que la consulta fue antes de las 6h y sin haber realizado prueba complementaria alguna. (AU)

Objective: To evaluate emergency care for testicular torsion in medical professional liability claims.MethodClaims related to testicular torsion from 2000 to 2018 were located. The assistance provided and the association with medical professional liability were analyzed.ResultsEighty complaints were identified, testicular pain was reported in 83.75% of first consultations, with a mean evolution time of 15.5h. 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 testicular torsion diagnosis was performed, 97.3% had undergone ancillary tests. The medical professional liability was significantly associated with non-criminal proceedings and with less than 6h of symptoms’ evolution, and, within this subgroup, without undergoing an ultrasound scan.ConclusionsLate consultations, wrong diagnosis and late diagnosis are claimed. When medical professional liability 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 6h of evolution with no ancillary tests having been performed. (AU)

[Outcome of complaints by patients due to the refusal of Primary Care Physicians to agree to a treatment request]. / Reclamaciones por la negativa del médico de primaria a aceptar una petición del paciente.

OBJECTIVE: To analyse the frequency of complaints due to the refusal of Primary Care Physicians to indicate a diagnostic test, treatment, or referral requested by a patient. METHODS: Observational, retrospective study was conducted by analysing the complaints filed in a Primary Care Area during the years 2016, 2017, and 2018. RESULTS: A total of 378 complaints were included. Of these, 30 (8%) were justified in the refusal by the doctors to a request of the patient (28 addressed to general practitioners and 2 to paediatricians). The most frequent related to the request was for a treatment (18 [60%]) followed by the request for diagnostic tests (9 [30%]). While the total number of claims increased by 151%, the relative weight of the claims for not responding to a patient's request was reduced (2016, 8/70, 11.4%; 2017, 11/132, 8.3%; and 2018, 11/176, 6.3%). No professional liability claims were filed. CONCLUSIONS: Complaints for rejecting patient requests increased slightly, but tends to decrease their relative weight when considering the volume of complaints.

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.

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.

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.

[Clinical safety and professional liability claims in Orthopaedic Surgery and Traumatology]. / Seguridad clínica y reclamaciones por responsabilidad profesional en Cirugía Ortopédica y Traumatología.

The specialist in orthopaedic and traumatological surgery, like any other doctor, is subject to the current legal provisions while exercising their profession. Mandatory training in the medical-legal aspects of health care is essential. Claims against doctors are a reality, and orthopaedic and traumatological surgery holds first place in terms of frequency of claims according to the data from the General Council of Official Colleges of Doctors of Catalonia. 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. The aim of this review is to contribute to this training, for the benefit of professionals and patients.

[Analysis of patient complaints in Primary Care: An opportunity to improve clinical safety]. / Análisis de las reclamaciones de pacientes en Atención Primaria: una oportunidad para mejorar la seguridad clínica.

OBJECTIVE: To determine the prevalence and type of the clinical safety problems contained in the complaints made by patients and users in Primary Care. MATERIAL AND METHODS: An observational, descriptive, cross-sectional study was conducted by analysing both the complaint forms and the responses given to them in the period of one year. RESULTS: At least 4.6% of all claims analysed in this study contained clinical safety problems. The family physician is the professional who received the majority of the complaints (53.6%), and the main reason was the problems related to diagnosis (43%), mainly the delay in diagnosis. Other variables analysed were the severity of adverse events experienced by patients (in 68% of cases the patient suffered some harm), the subsequent impact on patient care, which was affected in 39% of cases (7% of cases even requiring hospital admission), and the level of preventability of adverse events (96% avoidable) described in the claims. Finally the type of response issued to each complaint was analysed, being purely bureaucratic in 64% of all cases. CONCLUSIONS: Complaints are a valuable source of information about the deficiencies identified by patients and healthcare users. There is considerable scope for improvement in the analysis and management of claims in general, and those containing clinical safety issues in particular. To date, in our area, there is a lack of appropriate procedures for processing these claims. Likewise, we believe that other pathways or channels should be opened to enable communication by patients and healthcare users.

Las reclamaciones de los usuarios externos en un centro pediatrico de referencia nacional en Lima, Peru / External user’s complaints in a national reference pediatric center

Objetivo:Identificar las características de las reclamaciones de los usuarios externos de un centro pediátrico de referencia nacional.Diseño:Estudio descriptivo, retrospectivo. Institución:Instituto Nacional de Salud del Niño, Lima, Perú. Material:Libro de reclamaciones.Métodos:Del libro de reclamaciones del Instituto Nacional de Salud del Niño, entre julio 2011 y setiembre 2012, se elaboró una base dedatos. El paciente podía tener más de un motivo de reclamación.Principales medidas de resultados: Datos demográficos, frecuencia,motivos, tiempo de resolución, personal aludido y resultados de las reclamaciones.Resultados: Se recolectó 283 copias de formatosque contenían 358 motivos de reclamaciones, siendo los más frecuentes:trato inapropiado 32,1%, tiempo de espera prolongado18,4%, información deficiente 14,5%, dificultad para el acceso en la atención...

Objective: To identify complaints characteristics of external users in a national pediatric reference center. Design: Descriptive, retrospective study. Setting: Instituto Nacional de Salud del Ni¤o (INSN), Lima, Peru. Material: Book of Complaints. Methods: A database was elaborated from the INSN Book of Complaints for the period July 2011 to September 2012. The patient could have had more than one complaint reason. Main outcome measures: Demographic data, frequency, motives, time of resolution, alluded personnel, and solution of complaints. Results: Two hundred and eighty-three formats were collected containing 358 complaints. Most frequent complaint reasons were: inappropriate attitude 32.1 per cent, long waiting time 18.4 per cent, deficient information 14.5 per cent, deficient access to services 9.5 per cent, loss of documentation (laboratory results or x-rays, formats, clinical records, among others) 7.8 per cent, problems in communication 7.5 per cent, privileged access to attention 5.9 per cent, objective aspects (facilities, appearance, cleaning, equipment) 4.2 per cent. The areas that received more complaints were: outpatient attention by physicians 41.7 per cent (rate of 0.5 per thousand patients), security 9.2 per cent, private hospital service 9.2 per cent, and cashiers 6.0 per cent. Sixty per cent of claims were solved, and of these 84.2 per cent were solved before 4 weeks since the complaint. Occupational groups generating complaints were: physician (26,4 per cent), nurse technician (13,9 per cent), administrative personnel (12,2 per cent), security personnel (12,2 per cent), archive personnel (9,7 per cent), nurse (9,0 per cent), cashier (5,9 per cent), admission (2,1 per cent). Conclusions: Complaints’ characteristics suggest the need to take appropriate corrective and educational measures, so as to avoid or decrease them. Routine periodic evaluation of complaints is necessary to increase user’s satisfaction.

[Surgical procedures involved in claims for alleged defects in praxis]. / Procedimientos quirúrgicos objeto de reclamación por presunto defecto de praxis.

Medical professional liability and adverse events in health care are major concerns worldwide and the analysis of claims for alleged defects in praxis is a potential source of knowledge. High rates of adverse events and complaints have been reported in surgical procedures. This article analyzes the claims registered by the Council of Medical Colleges in Catalonia between 1986 and 2012, and explores surgical procedures claimed (ICD- 9-CM coding), as well as the final outcome of the claim. Among the 5,419 records identified on surgical procedures, the interventions of the musculoskeletal system and skin and integument showed the highest frequencies. Interventions related to "non-curative" medicine should be emphasized because of their higher rates of economical agreement or condemnation outcomes, which were significantly higher for mastopexia. The results underscore the importance of the surgical area in medical professional liability and the high risk of payouts among those procedures belonging to the so-called "non-curative" medicine.