Judicialización en cardiología y cirugía cardiovascular: estudio observacional transversal en materia de responsabilidad patrimonial en la sanidad pública española / Litigation in cardiology and cardiovascular surgery: A cross-sectional observational study of liability in the spanish public healthcare system

Introducción: la sobrestimación por los facultativos del riesgo a una demanda judicial tiene, entre otras consecuencias, la intensificación de la medicina defensiva. El objetivo del trabajo fue analizar las características de las sentencias sobre la responsabilidad médica en España en la asistencia sanitaria pública en las especialidades de cardiología y cirugía cardiovascular.Material y métodos: estudio observacional transversal cuyo objetivo fue analizar las sentencias dictadas en la jurisdicción contencioso-administrativa por los Tribunales Superiores de Justicia entre el período 2008-2020, en las especialidades de cardiología y cirugía cardiovascular. Las variables fueron administrativas, clínicas, judiciales e indemnizatorias.Resultados: se analizaron 1.015 sentencias, de las cuales 47 (4,63%) se refirieron a las especialidades de cardiología y cirugía cardiovascular. Ambas obtuvieron porcentajes de frecuencia similares, cardiología 22 (2,16%) y cirugía cardiovascular 25 (2,46%). El 74,1% de las sentencias fueron desestimatorias en primera instancia y el 75% en segunda instancia. Los 2 motivos de sentencia estimatoria más frecuentes fueron la pérdida de oportunidad 6 (42,85%) y la mala praxis diagnóstica y/o terapéutica 5 (35,71%). Los daños reclamados fueron: fallecimiento 21 (44,68%) y secuelas 26 (55,32%). La mediana de las indemnizaciones fue 30.000 euros.Conclusiones: la baja frecuencia de las demandas en cardiología y cirugía cardiovascular indica que se trata de especialidades de «bajo riesgo» de litigiosidad. La inmensa mayoría de las sentencias son, además, desestimatorias de la pretensión de los pacientes. Los datos contribuyen a estructurar el papel de las demandas judiciales y a aumentar el conocimiento de los profesionales en la dimensión médico-legal de la asistencia sanitaria. (AU)

Introduction: The overestimation by physicians of the risk of a lawsuit has, among other consequences, the stepped-up of defensive medicine. To analyze the characteristics of medical liability rulings in Spain in public health care in the specialties of cardiology and cardiovascular surgery.Materials and methods: Cross-sectional observational study analyzing the rulings handed down in the contentious-administrative jurisdiction by the High Courts of Justice in the period 2008-2020, in the specialties of cardiology and cardiovascular surgery. The variables were administrative, clinical, judicial, and compensatory.Results: A total of 1015 rulings were analyzed; 47 (4.63%) involved to the specialties of cardiology and cardiovascular surgery. Both obtained similar frequency percentages, cardiology 22 (2.2%) and cardiovascular surgery 25 (2.5 %). A total of 74.1 % of the rulings were dismissed in the first instance and 75% in the second instance. The two grounds for finding against the defendent were loss of chance 6 (42.85%) and diagnostic and/or therapeutic malpractice 5 (35.71%). Damages were usually claimed: death 21 (44.68%) and sequelae 26 (55.32%). The median award was 30,000 euros.Conclusions: The low frequency of claims in cardiology and cardiovascular surgery indicates that these are “low risk” specialties for litigation. The vast majority of the rulings are, moreover, dismissive of the patients' claims. The data help to structure the role of lawsuits and to increase professionals' knowledge of the medical-legal dimension of health care. (AU)

El corazón frágil. El doloroso despertar moral del Dr. Edgar Pascoe / The fragile heart. The painful moral awakening of Dr. Edgar Pascoe

El corazón frágil es una miniserie británica, estrenada en 1996. Dado que este drama médico ofrece, entre otras, una variedad de posibilidades de debate sobre facetas deontológicas y actitudinales para médicos en particular y profesionales del área de la salud en general resulta más que recomendable apreciar las varias lecturas que permite. El objetivo de este trabajo es abordarla y presentar algunas de tales posibilidades

The fragile heart is a British miniseries, released in 1996. Since this medical drama offers, among others, a variety of possibilities for debate on deontological and attitudinal features for physicians in particular and professionals in health area in general is more than recommended appreciating the various readings it allows. The aim of this paper is to address it and present some of those possibilities

You Are the Perfect Age: An Inquiry into Surgical Ethics during the Arc of a Career.

There is an old saying that history only makes sense in retrospect. I am sure that I am as susceptible to this adage as any other person. However, I will tell the story of my long history as an amateur medical ethicist, which is, to this day, how I would describe myself. My interest in the ethics of medicine, particularly as these ethical principles apply to interventions or procedures, started at a young age, fairly frequently going to the hospital with my father, a General and Thoracic Surgeon. I think that I found myself agreeing to accompany him, when invited, presuming that doing so would be a chance to spend some time with my dad, who was, throughout my childhood, either a surgical resident or a busy practicing surgeon. I will admit that I probably also figured that, at least late at night on the way home, we would stop by some establishment where we could get burgers and fries. However, I will start my reminiscences and reflections on these issues with a more recent story, as it prompted me to think back on my perceptions of those experiences of my youth.

The elephant in the room: ethical issues associated with rare and expensive medical conditions.

The treatment of rare and expensive medical conditions is one of the defining qualities of paediatric cardiology and congenital heart surgery. Increasing concerns over healthcare resource allocation are challenging the merits of treating more expensive forms of congenital heart disease, and this trend will almost certainly continue. In this manuscript, the problems of resource allocation for rare and expensive medical conditions are described from philosophical and economic perspectives. The argument is made that current economic models are limited in the ability to assess the value of treating expensive and rare forms of congenital heart disease. Further, multi-disciplinary approaches are necessary to best determine the merits of treating a patient population such as those with significant congenital heart disease that sometimes requires enormous healthcare resources.