Quackery in Dental Practice in Nepal.

Quackery and fraud in dental practice, seen in many countries, is also rampant in Nepal, and they are unethical practices. There is a growing need for strict enforcement of government policy measures to eliminate quackery and fraudulent dental practice in Nepal. The government should mobilize all dental workforce (dental specialists, dentists, and dental auxiliaries) and aware of their responsibilities and limitations. This article presents a brief review showing some cases of malpractice in dentistry in Nepal.

Disciplinary supervision following ethics complaints: goals, tasks, and ethical dimensions.

Clinical supervision is considered an integral component of the training of psychologists, and most of the professional literature is focused on this type of supervision. But psychologists also may supervise fully credentialed colleagues in other circumstances. One such context occurs when licensing boards mandate supervision as part of a disciplinary order. When supervision is provided in disciplinary cases, there are significant implications for the ethical dimensions of the supervisory relationship and concomitant ethical challenges for supervisors. Not only are the goals, objectives, and supervisory tasks of disciplinary supervision distinct from other types of supervision, but the supervisor's ethical responsibilities also encompass unique dimensions. Competence, informed consent, boundaries, confidentiality, and documentation are examined. Recommendations for reports to licensing boards include a statement of the clinical or ethical problems instigating discipline, description of how these problems have been addressed, and an assessment of the supervisee's current practices and ability to perform competently.

The senior obstetrician requesting obstetric privileges.

As the American physician workforce matures in age, senior physicians on the active clinical staff may become vulnerable to diminished professional performance. Many physicians compensate by using experiential rather than analytic methods to effectively solve clinical problems. Surgical expertise also may be at risk in these circumstances. Organized medical staffs must confront these realities before adverse events are reported as patient safety is their primary responsibility. The appropriate credentialing process will enable talented and experienced senior clinicians to continue to provide high quality medical care.

Conflict of credentialing: accolade or unfair trade.

The newly appointed chief of surgery at an open-staff hospital received an application for vascular privileges from a senior general surgeon who took a period of additional fellowship in vascular surgery at a nonacademic regional medical center. The fellowship does not make him board eligible in vascular surgery, but he has maintained his general surgery board certification and the pertinent bylaws do not specifically state which certification is required, only that the surgeon must be board certified and have additional training in vascular surgery. He is a member of a large politically powerful group practice that apparently wants to refer their substantial number of vascular cases internally. The chief of surgery finished vascular surgery training locally 3 years ago. The applicant has a checkered past, with multiple lawsuits and in-house investigations of cases with poor outcomes. The credentialing procedure is that the chief of service makes a recommendation to the chief of staff who makes a recommendation to the board of directors for approval. The chief of staff, who will make the final recommendation to the hospital board of directors, is a member of the applicant's group practice. What recommendation should the chief of vascular surgery make to the chief of staff?

Medical pluralism in India: patient choice or no other options?

The maldistribution of biomedical services creates a dilemma for Indian patients. They encounter a bewildering array of medical services, ranging from qualified traditional medical practitioners to untrained, self-taught purveyors of medicines and cures. Research on Indian healthcare has decried the inefficient distribution of services in rural and urban areas. The studies discussed here reveal the ground reality of the consequences of limited choices for patients, characterised as "forced pluralism," with no state regulation of type of care, quality of care, or credentials of practitioners.

A política de formação dos agentes comunitários de saúde: memória de uma formulação em disputa nos anos 2003-2005 / The education policy of community health agents: memory of a formulation in dispute between the years 2003-2005

Este estudo trata da formulação da política de formação do agente comunitário de saúde (ACS), buscando compreender as disputas que então se travaram, a partir dos processos políticos relativos à gestão da educação e do trabalho do ACS, implementados no período compreendido entre o início de 2003 e meados de 2005. Para tal fim, foram analisados os documentos debatidos nessa formulação, no intervalo de tempo compreendido entre março de 2003 e julho de 2004, o qual se revelou um período intenso de produção conceitual em torno dessa política. Nos documentos analisados, revelaram-se posições acerca do perfil social do ACS e do trabalho que este deve realizar, articuladas a concepções de ensino e formação em saúde, que disputaram o conteúdo e a forma que a política de formação desses trabalhadores deveria assumir. Tais disputas guardam relação também com o modo como esta função se instituiu no SUS e as contradições geradas desde então; ao mesmo tempo, as posições conflitantes apontam para distintos projetos de saúde, educação e trabalho. Esse processo resultou na publicação do Referencial Curricular para Curso Técnico de Agente Comunitário de Saúde, que consolidou a proposta de formação técnica, mas cuja implementação não tem se dado integralmente, configurando a prevalência de uma qualificação inicial, conforme determina a legislação que orienta o exercício da profissão de ACS. Entretanto, a dissertação indica que o processo não se esgotou, sendo a atual política de formação dos ACS objeto de disputas e demandas, tanto pela sua conservação, quanto pela sua transformação.

Ethics and rural healthcare: what really happens? What might help?

Relatively few articles discuss the ethical issues that accompany healthcare in rural areas. This article presents and discusses the key findings obtained from multi-method research studies conducted over a 9-year period of time in a multi-state rural area. It challenges the efficacy of current models for bioethics, shows what kinds of ethical issues develop in rural communities, and offers a framework for envisioning resources and approaches that may be more appropriate.

A questão ambiental na promoção da saúde: uma oportunidade de ação multiprofissional sobre doenças emergentes / Environmental issues on health promotion: a multi-professional action on emerging diseases

A discussão sobre a emergência de agravos à saúde coloca todos os profissionais de saúde em alerta. Através de uma revisão sobre os conceitos de doença emergente, relacionando-a com uma situação concreta, a emergência da hantavirose em Santa Catarina, Brasil, constatou-se a necessidade de um enfoque sobre as condições ambientais em tais situações. O melhor conhecimento sobre os fatores ambientais envolvidos e contextualizados torna possível um melhor posicionamento para a elaboração das políticas de controle e prevenção a serem adotadas. Tal posicionamento possibilita a ação multiprofissional, sob a forma de orientação às comunidades, como necessidade de um modelo assistencial diferenciado.

The discussion on the emergence of health injuries preoccupies all health workers. In a review on the concepts of emerging disease, related to a concrete situation, the emergence of the Hantaviruses in the State of Santa Catarina, Brazil, the author highlights the need for focusing on environmental conditions in such situations. The best knowledge on environmental factors makes it possible to elaborate controlling and preventive policies. This enables the multi-professional action in providing community information, as the need for a differentiated assistance model.

The ethics of administrative credentialing.

A vascular surgeon has practiced in the same community for more than 20 years, holding privileges at the two largest local general hospitals. She is widely respected and admired by patients and fellow physicians in all specialties, and her results are consistently good. Recently, the board of directors at the hospital that has been the source of 80% of her case referrals hired a notorious slash-and-burn management firm to improve the balance sheet. The new chief executive officer (CEO) installed an information technology system that can provide management with physician-specific figures on costs and reimbursements. The management consultants identified the 10% of physicians with the worst cost/reimbursement ratios over the preceding 5 years and persuaded the board of directors to order their clinical privileges withdrawn. Our seasoned surgeon learns that she is among the targeted group. Is there an ethical issue here, and, if so, how should she respond?