[Critical results reporting: the importance of local partnership agreements]. / Overdracht van sterk afwijkende laboratoriumuitslagen.

Critical results should be reported to the physician as soon as possible so that the physician can take the necessary follow-up actions. Failure or non-timely reporting of such results may lead to serious health damage or death to the patient. This article focusses on the reporting of results from the laboratory to the physician and discusses the bottlenecks and the separate (legal) responsibilities of the physician and the laboratory. Improving the process of the reporting and follow-up of critical results is a joint responsibility of the laboratory and the physician requesting the laboratory tests. This could be achieved by local partnership agreements.

Consideraciones bioéticas para la investigación sobre los programas de residencias médicas / Consideracions bioètiques per a la investigació sobre els programes de residències mediques / Bioethical considerations for research on medical residents

El presente artículo argumenta que es necesaria la investigación sobre los programas de residencias médicas para mejorar el entorno laboral y académico que viven los médicos y médicas en su formación como especialistas. Por lo que se proponen algunas consideraciones para garantizar una investigación ética. Para ello, el artículo sigue la estructura de dos premisas y una conclusión, donde cada premisa se fundamenta analíticamente. La primera premisa es que los factores estructurales de los programas de residencias médicas conducen a una condición de vulnerabilidad, se sustenta la primera premisa al explorar los factores estructurales que contribuyen a su vulnerabilidad desde el análisis del contexto mexicano y el marco teórico de la interseccionalidad. Así, se presentan algunas de las características que se entrecruzan y determinan la forma en la que los y las residentes experimentan en sus espacios sociales y ambientes de desarrollo. La segunda premisa es que la investigación de un grupo vulnerable conduce al desarrollo de estrategias para el cambio. El artículo reconoce la necesidad de investigar y desarrollar intervenciones para los grupos sociales vulnerables con el fin de mejorar su situación y proporcionar un entorno más seguro.(AU)

L'article actual argumenta que és necessària la investigació sobre els programes de residències mèdiques per millorar l'entorn laboral i acadèmic que viuen els metges en la seva formació com a especialistes. Per això, es proposen algunes consideracions per garantir una investigació ètica. L'article segueix l'estructura de dues premisses i una conclusió, on cada premissa es fonamenta analíticament. La primera premissa és que els factors estructurals dels programes de residències mèdiques porten a una condició de vulnerabilitat. Aquesta primera premissa es fonamenta explorant els factors estructurals que contribueixen a la seva vulnerabilitat des de l'anàlisi del context mexicà i el marc teòric de la interseccionalitat. Així, es presenten algunes de les característiques que es creuen i determinen la forma en què els residents experimenten en els seus espais socials i entorns de desenvolupament. La segona premissa és que la investigació d'un grup vulnerable condueix al desenvolupament d'estratègies per al canvi. L'article reconeix la necessitat d'investigar i desenvolupar intervencions per als grups socials vulnerables amb l'objectiu de millorar la seva situació i proporcionar un entorn més segur.(AU)

This paper argues that research on medical residency programs is necessary to improve the work and academic environment that physicians experience in their training as specialists. Therefore, some considerations are proposed to ensure ethical research. on medical residents. For this purpose, the paper follows the structure of two premises and a conclusion, where each premise is analytically supported. The first premise is that the structural factors of medical residency programs lead to a condition of vulnerability. The first premise is supported by exploring the structural factors that contribute to their vulnerability from the analysis ofthe Mexican context and the theoretical framework of intersectionality. Thus, some of the characteristics that intersect and determine the way in which residents experience their social spaces and development environments are presented. The second premiseis that researching a vulnerable group leads to the development of strategies for change. The article recognizes the need to research and develop interventions for vulnerable social groups to improve their situation and provide a safer environment.(AU)

Critics Say New State "Conscience Laws" Give Physicians Carte Blanche to Refuse Patients.

This Medical News feature discusses state laws that protect physicians who refuse to provide certain services because of religious or moral beliefs.

The Supreme Court Decision on Affirmative Action-Fewer Black Physicians and More Health Disparities for Minoritized Groups.

This Viewpoint discusses the US Supreme Court's June 2023 ruling on affirmative action and its repercussions for Black physicians and health equity for racial and ethnic minority groups.

Generative AI in Health Care and Liability Risks for Physicians and Safety Concerns for Patients.

This Viewpoint discusses the potential use of generative artificial intelligence (AI) in medical care and the liability risks for physicians using the technology, as well as offers suggestions for safeguards to protect patients.

Acerca del artículo La responsabilidad jurídica del médico, conceptos que se debaten entre dos ciencias / About the Article The legal Responsibility of the Physician, Concepts that are Debated between Two Sciences

Después de leer el artículo La responsabilidad jurídica del médico, conceptos que se debaten entre dos ciencias, del licenciado y profesor Camilo L. Momblanc,1) desearíamos realizar algunas consideraciones y, sobre todo, resaltar algunos aspectos que consideramos clave en la publicación. En primer lugar, quisiéramos destacar la gran importancia del artículo por lo sensible del tema que trata pues, a pesar de su trascendencia, no ha sido abordado con la amplitud necesaria en nuestras revistas médicas. El error en medicina sirvió tradicionalmente para aprender lo que no se podía hacer, hasta que apareció la reacción de castigar al responsable del error, suponiendo que fuera producto de la incapacidad o irresponsabilidad individual, y que generara un sujeto culpable. El error pasó así a constituir una problemática no solo ética sino también con implicación legal. Ciertamente, la posibilidad de equivocarse está presente en toda actividad humana, quien nunca comete errores es porque nunca hace nada, y de hecho comete la mayor de las equivocaciones, que es precisamente no hacer nada. El peor error no es equivocarse, sino no aprender a no cometer el mismo error uno mismo y no enseñar para que no lo cometa ningún otro profesional de salud. La práctica de la medicina está sujeta a una variabilidad que no siempre puede ser controlable. Esta situación expone al personal de salud a la comisión de errores, que pueden conducir o no a la producción de daño para el paciente. Todas las intervenciones médicas diagnósticas y terapéuticas tienen riesgos de complicaciones, a veces mínimos, pero no totalmente ausentes y pueden afectar a cualquiera, aunque sean muy bien indicadas y ejecutadas.2 El problema...(AU)

Legal Penalties for Physicians Providing Gender-Affirming Care.

This Viewpoint explains the "legal limbo" physicians may find themselves in, straddling state laws banning gender-affirming care and federal nondiscrimination law, both of which remain unclear due to ongoing legal challenges in the courts.

As Laws Restricting Health Care Surge, Some US Physicians Choose Between Fight or Flight.

In this Medical News article, 13 physicians and health care experts spoke with JAMA about the increasing efforts to criminalize evidence-based medical care in the US.

Physicians Say an Idaho House Bill That Would Criminalize Administering mRNA Vaccines Is an Attack on the Medical Profession-Even If It Doesn't Become Law.

This Medical News article discusses a bill introduced in Idaho that would ban administering mRNA vaccines.

Legal Risks and Ethical Dilemmas for Clinicians in the Aftermath of Dobbs.

This Viewpoint discusses the ways in which the Supreme Court's ruling in Dobbs v Jackson Women's Health Organization, which triggered abortion bans or restrictions in half of states, presents serious legal risks to clinicians and major ethical dilemmas.

Making doctors stay: Rethinking doctor retention policy in a contracted-out primary healthcare setting in urban Bangladesh.

BACKGROUND: "Contracting Out" is a popular strategy to expand coverage and utilization of health services. Bangladesh began contracting out primary healthcare services to NGOs in urban areas through the Urban Primary Health Care Project (UPHCP) in 1998. Over the three phases of this project, retention of trained and skilled human resources, especially doctors, proved to be an intractable challenge. This paper highlights the issues influencing doctor's retention both in managerial as well as service provision level in the contracted-out setting. METHODOLOGY: In this qualitative study, 42 Key Informant Interviews were undertaken with individuals involved with UPHCP in various levels including relevant ministries, project personnel representing the City Corporations and municipalities, NGO managers and doctors. Verbatim transcripts were coded in ATLAS.ti and analyzed using the thematic analysis. Document review was done for data triangulation. RESULTS: The most cited problem was a low salary structure in contrast to public sector pay scale followed by a dearth of other financial incentives such as performance-based incentives, provident funds and gratuities. Lack of career ladder, for those in both managerial and service delivery roles, was also identified as a factor hindering staff retention. Other disincentives included inadequate opportunities for training to improve clinical skills, ineffective staffing arrangements, security issues during night shifts, abuse from community members in the context of critical patient management, and lack of job security after project completion. CONCLUSIONS: An adequate, efficient and dedicated health workforce is a pre-requisite for quality service provision and patient utilization of these services. Improved career development opportunities, the provision of salaries and incentives, and a safer working environment are necessary actions to retain and motivate those serving in managerial and service delivery positions in contracting out arrangements.

College complaints against resident physicians in Canada: a retrospective analysis of Canadian Medical Protective Association data from 2013 to 2017.

BACKGROUND: An understanding of regulatory complaints against resident physicians is important for practice improvement. We describe regulatory college complaints against resident physicians using data from the Canadian Medical Protective Association (CMPA). METHODS: We conducted a retrospective analysis of college complaint cases involving resident doctors closed by the CMPA, a mutual medicolegal defence organization for more than 100 000 physicians, representing an estimated 95% of Canadian physicians. Eligible cases were those closed between 2008 and 2017 (for time trends) or between 2013 and 2017 (for descriptive analyses). To explore the characteristics of college cases, we extracted the reason for complaint, the case outcome, whether the complaint involved a procedure, and whether the complaint stemmed from a single episode or multiple episodes of care. We also conducted a 10-year trend analysis of cases closed from 2008 to 2017, comparing cases involving resident doctors with cases involving only nonresident physicians. RESULTS: Our analysis included 142 cases that involved 145 patients. Over the 10-year period, college complaints involving residents increased significantly (p = 0.003) from 5.4 per 1000 residents in 2008 to 7.9 per 1000 in 2017. While college complaints increased for both resident and nonresident physicians over the study period, the increase in complaints involving residents was significantly lower than the increase across all nonresident CMPA members (p < 0.001). For cases from the descriptive analysis (2013-2017), the top complaint was deficient patient assessment (69/142, 48.6%). Some patients (22/145, 15.2%) experienced severe outcomes. Most cases (135/142, 97.9%) did not result in severe physician sanctions. Our classification of complaints found 106 of 163 (65.0%) involved clinical problems, 95 of 163 (58.3%) relationship problems (e.g., communication) and 67 of 163 (41.1%) professionalism problems. In college decisions, 36 of 163 (22.1%) had a classification of clinical problem, 66 of 163 (40.5%) a patient-physician relationship problem and 63 of 163 (38.7%) a professionalism problem. In 63 of 163 (38.7%) college decisions, the college had no criticism. INTERPRETATION: Problems with communication and professionalism feature prominently in resident college complaints, and we note the potential for mismatch between patient and health care provider perceptions of care. These results may direct medical education to areas of potential practice improvement.

Reglamento Municipal de Beneficencia y Sanidad, Elche 1928 / Regulamento Municipal de Caridade e Saúde, Elche 1928 / Municipal Regulation of Charity and Health, Elche 1928

The health policy of Primo de Rivera elaborated a regulatory legal body to protect the needyclasses that attended to their needs; the increase in health activity led to the creation of a large number ofcare institutions as well as professional health professionals involved in its development. Objectives: theresearch aims to analyze the practical application of the municipal Health and Welfare Regulations of thecity of 1928 and, on the other hand, its impact on the social life of the underprivileged class. Method: ahistorical research based on the literature review was carried out. Documentary sources: documentarycatalogs of libraries and documentary archives, electronic databases, catalogs of magazines specializingin history and other online sources. Descriptors used: midwife, practitioner, doctor, pharmacist, census ofthe poor. Results: documents from studies based on primary sources were included in the analysis and theresults are presented in 4 sections: The Municipal Regulation of 1928, Pharmacists and medicines forpoor patients, Doctors and practitioners and Midwives, midwives and childbirth teachers. Conclusion: theRegulation is applied long before its publication and health care is constantly exercised by all theprofessionals that comprise it; the number of practitioners is equal to that of doctors in this period; theCity Council is responsible for paying pharmaceuticals for poor patients to pharmacists and is distributedby quarters; With regard to doctors, and since 1924, sufficient places have been created for the demand ofthe poor, which will increase, as well as possible substitutes; the creation of the dental clinic for the poorin the Santo Hospital in 1930 is included; in 1928 and 1929 there are 4 matrons for the four districts ofthe city, following the legislation; In 1930 the municipal midwives received an annual salary increasefrom 720 to 900 pesetas from the town council. (AU)

La política sanitaria de Primo de Rivera elaboró un cuerpo legal reglamentario para proteger a lasclases menesterosas que atendía sus necesidades; el aumento de la actividad sanitaria supuso la creaciónde un gran número de instituciones asistenciales así como de sanitarios profesionales implicados en sudesarrollo. Objetivos: la investigación tiene por objetivos analizar la aplicación práctica del Reglamentomunicipal de Sanidad y Beneficencia de la ciudad de 1928 y, por otra parte, su repercusión en la vidasocial de la clase menesterosa. Método: se llevó a cabo una investigación histórica basada en la revisiónbibliográfica. Fuentes documentales: catálogos documentales de bibliotecas y archivos documentales,bases de datos electrónicas, catálogos de revistas especializadas en historia y otras fuentes de red.Descriptores utilizados: matrona, practicante, médico, farmacéutico, padrón de pobres. Resultados: en elanálisis se incluyeron documentos procedentes de estudios basados en fuentes primarias y los resultadosse presentan en 4 apartados: El Reglamento municipal de 1928, Farmacéuticos y medicamentos paraenfermos pobres, Médicos y practicantes y Matronas, comadronas y profesoras de partos. Conclusión: elReglamento se aplica mucho antes de su publicación y la asistencia sanitaria es ejercida de maneraconstante por todos los profesionales que la integran; el número de practicantes se equipara al de médicosen este período; el Ayuntamiento se hace cargo del pago de medicamentos para enfermos pobres a losfarmacéuticos y se reparte por trimestres; respecto a los médicos, y desde 1924, se van creando plazassuficientes para la demanda del padrón de pobres, que irá en aumento, así como posibles suplentes; seincluye la creación del gabinete odontológico para pobres en el Santo Hospital en 1930; en 1928 y 1929hay 4 matronas para los cuatro distritos de la ciudad, siguiendo la legislación; en 1930 las matronasmunicipales reciben un aumento. (AU)

A política de saúde de Primo de Rivera elaborou um órgão legal regulador para proteger asclasses carentes que atendiam às suas necessidades; O aumento da atividade de saúde levou à criação deum grande número de instituições assistenciais, bem como de profissionais de saúde envolvidos no seudesenvolvimento. Objetivos: a pesquisa visa analisar a aplicação prática do Regulamento Municipal deSaúde e Previdência da cidade de 1928 e, por outro lado, seu impacto na vida social da classe menosfavorecida. Método: foi realizada uma pesquisa histórica com base na revisão de literatura. Fontesdocumentais: catálogos documentais de bibliotecas e arquivos documentais, bases de dados eletrônicas,catálogos de revistas especializadas em história e outras fontes online. Descritores utilizados: parteira,praticante, médico, farmacêutico, censo dos pobres. Resultados: foram incluídos na análise documentosde estudos baseados em fontes primárias e os resultados são apresentados em 4 seções: O RegulamentoMunicipal de 1928, Farmacêuticos e medicamentos para doentes pobres, Médicos e praticantes eParteiras, parteiras e professoras de parto.Conclusão: o Regulamento é aplicado muito antes de suapublicação e a assistência à saúde é exercida constantemente por todos os profissionais que o compõem; onúmero de praticantes é igual ao de médicos nesse período; a Câmara Municipal é responsável pelopagamento dos medicamentos dos doentes pobres aos farmacêuticos e é distribuído por trimestres; Noque diz respeito aos médicos, e desde 1924, foram criadas vagas suficientes para a procura dos pobres,que irá aumentar, bem como eventuais substitutos; inclui-se a criação da clínica odontológica para pobresno Hospital Santo em 1930; em 1928 e 1929 há 4 matronas para os quatro bairros da cidade, seguindo alegislação; Em 1930, as parteiras municipais receberam um aumento salarial anual de 720 para 900pesetas da câmara municipal. (AU)

Must Consent Be Informed? Patient rights, state authority, and the moral basis of the physician's duties of disclosure.

Legal standards of disclosure in a variety of jurisdictions require physicians to inform patients about the likely consequences of treatment, as a condition for obtaining the patient's consent. Such a duty to inform is special insofar as extensive disclosure of risks and potential benefits is not usually a condition for obtaining consent in non-medical transactions.What could morally justify the physician's special legal duty to inform? I argue that existing justifications have tried but failed to ground such special duties directly in basic and general rights, such as autonomy rights. As an alternative to such direct justifications, I develop an indirect justification of physicians' special duties from an argument in Kant's political philosophy. Kant argues that pre-legal rights to freedom are the source of a duty to form a state. The state has the authority to conclusively determine what counts as "consent" in various kinds of transactions. The Kantian account can subsequently indirectly justify at least one legal standard imposing a duty to inform, the reasonable person standard, but rules out one interpretation of a competitor, the subjective standard.