Study of medical students' malpractice fear and defensive medicine: a "hidden curriculum?".

INTRODUCTION: Defensive medicine is a medical practice in which health care providers' primary intent is to avoid criticism and lawsuits, rather than providing for patients' medical needs. The purpose of this study was to characterize medical students' exposure to defensive medicine during medical school rotations. METHODS: We performed a cross-sectional survey study of medical students at the beginning of their third year. We gave students Likert scale questionnaires, and their responses were tabulated as a percent with 95% confidence interval (CI). RESULTS: Of the 124 eligible third-year students, 102 (82%) responded. Most stated they rarely worried about being sued (85.3% [95% CI=77.1% to 90.9%]). A majority felt that faculty were concerned about malpractice (55.9% [95% CI=46.2% to 65.1%]), and a smaller percentage stated that faculty taught defensive medicine (32.4% [95% CI=24.1% to 41.9%]). Many students believed their satisfaction would be decreased by MC and lawsuits (51.0% [95% CI=41.4% to 60.5%]). Some believed their choice of medical specialty would be influenced by MC (21.6% [95% CI=14.7% to 30.5%]), and a modest number felt their enjoyment of learning medicine was lessened by MC (23.5% [95% CI=16.4% to 32.6%]). Finally, a minority of students worried about practicing and learning procedures because of MC (16.7% [95% CI=10.7% to 25.1%]). CONCLUSION: Although third-year medical students have little concern about being sued, they are exposed to malpractice concerns and taught considerable defensive medicine from faculty. Most students believe that fear of lawsuits will decrease their future enjoyment of medicine. However, less than a quarter of students felt their specialty choice would be influenced by malpractice worries and that malpractice concerns lessened their enjoyment of learning medicine. [West J Emerg Med. 2014;15(3):293-298.].

El riesgo de judicialización de la medicina / No disponible

No disponible

Are neurology residents in the United States being taught defensive medicine?

OBJECTIVE: To study whether and how fear of litigation and defensive medicine are communicated during residency training and to assess whether this affects residents' attitudes. METHODS: Neurology residents in the US (n=25) and, as a control group, Neurology residents training in Germany (n=42) were asked to rate multiple items regarding litigation, defensive strategies and how often these issues are raised by teaching physicians. Statistic analysis was performed using nonparametric tests. RESULTS: Residents in both countries indicated that litigation is an "important problem", although US residents stated this significantly more often (p<0.001). Initiation of tests motivated mainly by fear of litigation (p=0.004) and explicit teaching of defensive strategies by teaching physicians (p<0.02) were reported more often by US residents. CONCLUSION: Neurology residents in both the US and Germany perceive a litigational threat, but significantly less so in Germany. This difference may result at least in part from teaching of defensive strategies reported more often in US programs.

Suicidio infantil. Factores de riesgo suicida en menores de edad / Children suicide. Risk factors suicide in infants

Realizando estudios epidemiológicos se pueden determinar las circunstancias comunes en las conductas suicidas infantiles. Como factores de riesgo más importantes destacan los abusos en la infancia, tanto físicos como psíquicos y sexuales y la depresión. Es también importante la psicopatología familiar y las alteraciones en la estructura familiar y en el rol que cada miembro desempeña dentro de la misma. En enfermos mentales puede darse muerte por abuso de las sustancias utilizadas como medicamentos. Conociendo los factores de riesgo y las señales de alarma se puede ejercer una prevención eficaz del problema (AU)

Evaluation of a residency program's experience with a one-week emergency medicine resident rotation at a medical liability insurance company.

INTRODUCTION: The authors' residency program implemented a one-week rotation at the office of a medical liability insurance company. Residents examined 30 closed malpractice claims cases and sat in on settlement discussions. OBJECTIVE: To review the residents' evaluations of their experiences and to determine whether this was a worthwhile addition to the emergency medicine (EM) residency curriculum. METHODS: This was a five-year retrospective study that reviewed residents' annual evaluations from 1994 to 1999 regarding the medical liability rotation. A five-point scale was used to score specific categories in the rotation and an open-ended section was used to collect general comments. RESULTS: A total of 179 resident evaluations were reviewed. The quality of teaching ranked in the 80th percentile, the clinical caseload ranked in the 85th percentile, and level of responsibility ranked in the 79th percentile for all EM rotations. Specific comments included "All MDs should do this in their training"; "Quite an eye opener"; and "Good exposure to legal aspects of EM." CONCLUSIONS: Overall, EM residents found the one-week rotation to be invaluable and a good learning experience. This rotation ranked above average when compared with all of our other EM residency rotations.

El cirujano ante la justicia / The surgeon in the presence of the justice

Antecedentes: El creciente aumento de las demandas por mala práctica es una preocupación de los cirujanos e interfiere en el libre ejercicio de su especialidad. Objetivo: Analizar los principales factores que influyen en este problema, los inherentes al médico y los ajenos al mismo. Proponer hechos o gestos para disminuir o frenar las demandas judiciales. Marco de referencia: Comité de Asuntos Profesionales de la Asociación Argentina de Cirugía. Diseño y población: Análisis retrospectivo de las demandas contestadas desde 1982 hasta 1997. Totalizan 209 casos con progresivo aumento. Sólo el 5,7 por ciento en el fuero penal. La patología más frecuente fueron apendicitis y oblitos, a partir de 1996 la cirugía laparoscópica con 36,7 por ciento. Conclusiones: Rescatar la relación médico-paciente, correcta redacción de la historia clínica y del parte quirúrgico, no omitir el consentimiento informado, limitar el; beneficio de litigar sin gastos y poner topes a las sumas reclamadas, impulsar y motivar a las Instituciones Científicas para unirse en defensa de una profesión sin trabas o cercamientos

El cirujano ante la justicia / The surgeon in the presence of the justice

Antecedentes: El creciente aumento de las demandas por mala práctica es una preocupación de los cirujanos e interfiere en el libre ejercicio de su especialidad. Objetivo: Analizar los principales factores que influyen en este problema, los inherentes al médico y los ajenos al mismo. Proponer hechos o gestos para disminuir o frenar las demandas judiciales. Marco de referencia: Comité de Asuntos Profesionales de la Asociación Argentina de Cirugía. Diseño y población: Análisis retrospectivo de las demandas contestadas desde 1982 hasta 1997. Totalizan 209 casos con progresivo aumento. Sólo el 5,7 por ciento en el fuero penal. La patología más frecuente fueron apendicitis y oblitos, a partir de 1996 la cirugía laparoscópica con 36,7 por ciento. Conclusiones: Rescatar la relación médico-paciente, correcta redacción de la historia clínica y del parte quirúrgico, no omitir el consentimiento informado, limitar el; beneficio de litigar sin gastos y poner topes a las sumas reclamadas, impulsar y motivar a las Instituciones Científicas para unirse en defensa de una profesión sin trabas o cercamientos (AU)

A data-generated basis for medical ethics education: categorizing issues experienced by students during clinical training.

PURPOSE: To use issues identified by students in order to establish an experience- and evidence-based approach to medical ethics education. METHOD: A total of 628 sophomore and senior students at the State University of New York at Buffalo School of Medicine and Biomedical Sciences were asked to identify incidents during their clinical training that had raised ethical concerns. The sophomores were surveyed during two time periods: 1979-80, and 1991-92 and 1992-93; the seniors were surveyed in 1991-92 and 1992-93. Responses were analyzed and categorized through content analysis. RESULTS: In all, 249 students (45% of the sophomores and 20% of the seniors) responded. The categories of issues identified were professional norms, limits of intervention, defensive shielding of professional colleagues, respect toward patients, communication, and student boundaries (situations where the student feels uncomfortable). The most frequently reported incidents reflected the students' perceptions of lapses in level of care (under- or over-treatment), communication, respect toward patients, and maintenance of professional norms. The seniors and the 1979-80 sophomores reported respect toward patients as an issue less often than did the 1991-92 and 1992-93 sophomores. The seniors most often identified concerns raised over limits of intervention and resource allocation. CONCLUSION: The differences between the responses of the sophomores and seniors tend to support other research suggesting a retardation of moral sensitivity in the course of medical education. It may be that clinical teaching and faculty behavior model values at odds with what is taught in the classroom. Ethics education should focus on issues relevant to students' experience.

Teaching law, ethics, and risk management at the School of Dental Medicine State University of New York at Stony Brook.

An upgraded course (program) in Law, Ethics, and Risk Management has been taught at the School of Dental Medicine, State University of New York at Stony Brook, since 1977 and was revised effective 1988. It brings together didactic instruction and an extensive clinical component beginning immediately before students enter the school's dental clinic and ending when clinical instruction is completed before graduation. The program is designed to (1) prepare students for the management of patients in the clinic; (2) ensure that student management of patients in the clinic does not place the supervising faculty and university administration at legal risk; (3) provide the student with knowledge about the law and legal system; (4) provide students with information about the regulation of dental practice; (5) identify areas of legal vulnerability in the practice of the profession, and risk management office principles designed to control or eliminate the risks; and (6) instruct the student about professional codes regulating ethical behavior and ethical standards of conduct.