Aspectos éticos de las periciales en la valoración de la praxis médica / Ethical aspects of the experts in the evaluation of medical praxis

Los médicos que realizan actividades médico-periciales deben o debemos detenernos a reflexionar sobre nuestra propia tarea, sobre los valores que desarrollamos, sobre el servicio que aportamos a la sociedad, sobre los fines que perseguimos, las consecuencias que podemos llegar a soportar, etc., y cómo orientar nuestra práctica hacia la calidad y la excelencia. En el entorno de la medicina pericial se hace necesaria esta reflexión, para tratar de evitar que determinados criterios o cuestiones sustituyan en buena medida al compromiso responsable con nuestra actitud médica, y que podamos llegar a dejar de lado los elementos que legitiman nuestra acción, en pro de un beneficio o de una labor de intercambio de servicios que es al menos digna de ser analizada en nuestro ámbito

Physicians who carry out medical-expert activities must pause to reflect on our work, on the values we develop, on the service we provide to society, on the goals we pursue, the consequences we can endure, etc., and how to guide our practice towards quality and excellence. In the area of expert medicine, this reflection is necessary, to prevent certain criteria or questions largely replacing responsible commitment with our medical attitude, and get rid of the elements that legitimize our action, in favour of a benefit or exchange of services that is at least worthy of being analysed in our field

Assessment of competence: developing trends and ethical considerations.

PURPOSE OF REVIEW: This review explores new concepts in competency assessment in anesthesiology, the associated ethical challenges, and directions for new research. RECENT FINDINGS: Many new tools for the assessment of competence are currently in development to address changes in medical education curricula. The assessment of competence currently focuses on technical skills, nontechnical skills, and the interaction of both through the use of simulation, with increasing emphasis on validity and reliability testing. SUMMARY: The search for objective measures of competence is well underway. Current methods require substantial investment of resources, and further research into more efficient and financially feasible tools of assessment is needed. As these assessments become more common in use, the ethical challenges raised by defining competency in high-stakes clinical practice situations will need to be addressed.

A practical perspective on remedial ethics: Minnesota Board of Dentistry.

The President and Executive Director of the Minnesota Board of Dentistry describe how the Bebeau course in ethics, for dentists referred because of ethical lapses, is used as part of the disciplinary process in the state. It is understood that breaches of ethical standards are a complex phenomenon, often engaged in by practitioners who know that they are doing wrong but nevertheless choose to do so. Typical patterns of transgression that result in referral to Dr. Bebeau's course include inappropriate billing practices, improper relations with staff or patients, questionable advertising, substandard care, "rough behavior," and gaps in infection control.

Consenso multidisciplinar español sobre la profilaxis de la infección respiratoria pediátrica por virus respiratorio sincitial. Consenso / Spanish multidisciplinary consensus on the prevention of respiratory syncytial virus infection in children

Antecedentes: Existe cierta variabilidad de práctica clínica en España sobre las intervenciones preventivas para evitar la infección respiratoria infantil por el virus respiratorio sincitial (VRS), entre las que se incluyen medidas higiénicas e inmunoprofilaxis intramuscular con palivizumab. Esta tarea implica varias especialidades pediátricas, que pueden tener distinta percepción de la magnitud del problema y distinto criterio profesional sobre las actuaciones apropiadas. Objetivos: Desarrollar un consenso multidisciplinar español sobre la prevención de la infección por VRS, con participación de las sociedades científicas pediátricas implicadas: Sociedad Española de Neonatología (SEN), Sociedad Española de Cardiología Pediátrica y Cardiopatías Congénitas (SECPCC), Sociedad Española de Neumología Pediátrica (SENP) y Sociedad Española de Hematología y Oncología Pediátrica (SEHOP). Métodos: Consenso Delphi modificado en dos rondas. El estudio se efectuó en cuatro fases: 1) constitución de un comité científico multidisciplinar, a propuesta de las sociedades científicas participantes, para la revisión bibliográfica y formulación de las recomendaciones a debate; 2) constitución de un panel experto con 77 representantes de las especialidades; 3) encuesta postal en dos rondas con procesamiento intermedio de opiniones e informe a los panelistas, y 4) discusión de resultados en sesión presencial del comité científico. Resultados: Se consensúan 48 de las 57 recomendaciones preventivas analizadas. En las nueve cuestiones restantes no se consigue acuerdo, bien por disparidad de opinión profesional, bien por falta de criterio establecido en la mayoría de los expertos. Sólo en tres recomendaciones, la opinión de los expertos se asocia a la especialidad de procedencia. Conclusiones: Se presenta una lista de recomendaciones profilácticas anti-VRS, cualificadas según el grado de acuerdo profesional en que se sustentan, que pueden considerarse vigentes hasta la aparición de nueva información científica que indique su revisión (AU)

Background: A certain degree of feasibility exists in Spanish clinical practice with respect to interventions performed to prevent paediatric respiratory infection by RSV, including hygienic measures and intramuscular immunoprophylaxis with palivizumab. This task involves different paediatric specialties that may have a different perception of the magnitude of the problem and different professional criteria regarding the most appropriate actions. Objectives: To develop Spanish multidisciplinary consensus on preventing infection by RSV with the participation of the paediatric scientific societies involved (SNS, SSPC, SSPP and SSHPO). Methods: Delphi Consensus modified in two rounds was used. The study was conducted in four phases: 1) constitution of a multidisciplinary Scientific Committee at the recommendation of the scientific entities participating in the study, for bibliographic review and submission of the recommendations to discussion; 2) constitution of an Expert Panel with 77 speciality representatives; 3) postal survey organised in two rounds and intermediate processing of opinions and issuing of a report for the panellists, and 4) discussion of the results in a meeting of the Scientific Committee. Results: Consensus was reached on 48 of the 57 preventive recommendations analysed. With respect to the 9 remaining issues, no consensus was reached, due to differences in professional opinion and the absence of established criteria among the majority of the experts. Only in 3 recommendations was the opinion of the experts associated with the speciality of origin. Conclusions: A list of anti-RSV prophylactic recommendations was submitted, rated in accordance with the degree of professional consensus on which they were based. These can be considered valid until such time as new scientific information emerges that warrants a review there of (AU)

The treating physician as expert witness: ethical and pragmatic considerations.

OBJECTIVE: The objective of this analysis is to apprise pain physicians of the ethical concerns and practical considerations that arise when a treating physician is called upon to testify as an expert witness in a legal proceeding involving his or her own patient. The provision of expert testimony in medico-legal proceedings has come under heightened scrutiny in recent years. When a physician testifies as an expert witness, such testimony is considered to be the practice of medicine, and hence subject to the same ethical and professional obligations as patient care. Increasingly, medical professional organizations have promulgated guidelines for such activities, and even implemented oversight mechanisms to review complaints concerning expert testimony by their members. Additional issues are raised when the expert witness is also the treating physician for the patient who is a party to the legal proceeding in which the expert testimony is offered. CONCLUSIONS: While it is not categorically unethical or inadvisable for a physician to testify as an expert witness in a medico-legal proceeding involving his or her own patient, such activity raises special issues and concerns. Prospective expert witnesses in such situations should be cognizant of these issues and insure that they have been adequately addressed before and during the testimony.