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1.
Ann Agric Environ Med ; 27(4): 680-688, 2020 Dec 22.
Artigo em Inglês | MEDLINE | ID: mdl-33356078

RESUMO

INTRODUCTION AND OBJECTIVE: The aim of the study is to discuss the legal framework for telemedicine services in Poland, and to present telemedicine solutions used in selected European countries. MATERIAL AND METHODS: The analysis of legal cts was chosen as a research method in order to determine legal possibilities for medical professionals to use telemedicine services. A literature review was undertaken to demonstrate the possibilities of telemedicine as used in the United Kingdom, Germany, Norway, The Netherlands and Sweden. RESULTS: The Act on the professions of a doctor and a dentist states that the doctor and the dentist can perform their profession via ICT systems or communication systems. The doctor is obliged to practice in accordance with current medical knowledge and available methods. 'Available methods' include considering information and communication measures that may allow prevention, recognition or treatment. The Act on the profession of a nurse and a midwife states that the nurse and midwife perform the professions using current medical knowledge and the mediation of ICT systems or communication systems. Thus, the legislator has clearly authorized persons performing these professions to provide services in the field of telemedicine. However, despite the existence of a legal basis for using telemedicine, its development in Poland is not as high as in the United Kingdom, Germany, Norway, The Netherlands or Sweden. CONCLUSIONS: The legislator gradually introduces legal solutions necessary for the development of telemedicine services, although the pace of these changes, as well as building the technical infrastructure that is the basis for the proper provision of telemedicine services, are too slow.


Assuntos
Odontólogos/legislação & jurisprudência , Tocologia/legislação & jurisprudência , Enfermeiras e Enfermeiros/legislação & jurisprudência , Médicos/legislação & jurisprudência , Telemedicina/legislação & jurisprudência , Comunicação , Polônia , Telemedicina/normas
2.
N Z Med J ; 133(1522): 149-160, 2020 09 25.
Artigo em Inglês | MEDLINE | ID: mdl-32994626

RESUMO

AIM: To provide an overview of the New Zealand End of Life Choice Act in comparison with other countries, arguments for and against euthanasia, and consideration of relevant legal and practical issues. METHOD: Structured descriptive summary of criteria for medical euthanasia in various jurisdictions currently allowing the practice, compared with New Zealand legislation. Narrative review of arguments for and against euthanasia with reference to existing medical literature and legal cases. RESULTS: A strong case for medical assistance in dying, based on autonomy and quality of life arguments, is countered by a long history of medical and legal tradition protecting life. CONCLUSION: This highly contentious issue is coming before the New Zealand public as a referendum in October 2020. The results will have profound implications for medical practice as well as reflecting societal shifts in attitudes toward death and dying.


Assuntos
Eutanásia/legislação & jurisprudência , Médicos/legislação & jurisprudência , Humanos , Nova Zelândia , Qualidade de Vida/legislação & jurisprudência
5.
Tex Med ; 116(8): 38-40, 2020 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-32866276

RESUMO

Under Texas law, physicians treating COVID-19 patients in a volunteer capacity have potential defenses against lawsuits that might arise from that care. But for non-volunteer physicians on the COVID battlefield - often working in harrowing, overloaded settings, high on patient count and low on equipment - the same liability shields don't exist. And with a resurgence in COVID-19 cases and hospitalizations taking hold in June, the Texas Medical Association continued its pandemic-long push to extend liability protections to all frontline physicians, volunteer or not.


Assuntos
Infecções por Coronavirus , Responsabilidade Legal , Pandemias , Administração dos Cuidados ao Paciente , Médicos , Pneumonia Viral , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Humanos , Seguro de Responsabilidade Civil/legislação & jurisprudência , Determinação de Necessidades de Cuidados de Saúde , Administração dos Cuidados ao Paciente/ética , Administração dos Cuidados ao Paciente/legislação & jurisprudência , Administração dos Cuidados ao Paciente/métodos , Médicos/ética , Médicos/legislação & jurisprudência , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Texas/epidemiologia , Voluntários/legislação & jurisprudência
6.
Neurology ; 95(7): e930-e935, 2020 08 18.
Artigo em Inglês | MEDLINE | ID: mdl-32680949

RESUMO

OBJECTIVE: To determine whether the 2013 nerve conduction study (NCS) reimbursement reduction changed Medicare use, payments, and patient access to Medicare physicians by performing a retrospective analysis of Medicare data (2012-2016 fee-for-service data from the CMS Physician and Other Supplier Public Use File). METHODS: Individual billable services were identified by Healthcare Common Procedure Coding System Current Procedural Terminology and G codes. Medicare use and payments were stratified by specialty and type of service (electrodiagnostic tests, including NCS and EMG, and other neurologic procedures). We also assessed access to Medicare physicians using the annual number of unique beneficiaries receiving initial Evaluation and Management (E/M) services. RESULTS: We identified 676,113 Medicare providers included in all analysis years from 2012 to 2016 (10,599 neurologists, 5,881 physiatrists, and 659,633 other specialties). Comparing 2016 to 2012 showed that 21.1% fewer neurologists, 28.6% fewer physiatrists, and 69.3% fewer other specialists performed NCS and 3.8% fewer neurologists, 21.7% fewer physiatrists, and 5.6% fewer other specialists performed EMG. For NCS providers in 2012, the mean number of unique Medicare beneficiaries increased for neurologists (1.2%) and physiatrists (4.8%) but decreased for other specialists (-6.5%) by 2016. After the NCS cut, the number of providers performing autonomic and evoked potential testing increased substantially. CONCLUSIONS: The Medicare NCS reimbursement policy resulted in a larger decrease in NCS providers than in EMG providers. Despite fewer neurologists and physiatrists performing NCS, Medicare access to these physicians for E/M services was not affected. Increased autonomic and evoked potential testing may be an unintended consequence of NCS reimbursement change.


Assuntos
Medicare/legislação & jurisprudência , Políticas , Padrões de Prática Médica/legislação & jurisprudência , Mecanismo de Reembolso , Humanos , Medicare/economia , Médicos/legislação & jurisprudência , Estudos Retrospectivos , Estados Unidos
7.
Rev. bioét. derecho ; (49): 107-123, jul. 2020.
Artigo em Inglês | IBECS | ID: ibc-192097

RESUMO

The results of an empirical study show that,taken as a group, physicians in Mexico do not know what is legal and what is not legal with respect to certain areas of clinical practice.   A number of legal cases are cited showing the ways in which the legal system is ineffective with respect to providing guidance on bioethicalissues.   We conclude that physicians in Mexico do not know what is legal and what is illegal with respect to bioethics because they cannot know (the law is unclear) and because they do not need to know (there is no effective legal precedent or enforcement).   We suggest that the way forward must be through institutional policies establishing standards that depend only upon the traditional contract for medical care


Los resultados de un estudio empírico (Hall, 2017) muestran que, tomados como grupo, los médicos en México no saben qué es legal y qué no lo es con respecto a ciertas áreas de la práctica clínica. Se citan varios casos legales que muestran las formas en que el sistema legal es inefectivo con respecto a proporcionar orientación sobre cuestiones bioéticas. Concluimos que los médicos en México no saben qué es legal porque no pueden saberlo (la ley no es clara) y porque no necesitan saberlo (no existe un sistema legal efectivo). Sugerimos que el camino a seguir debe ser a través de políticas institucionales que establezcan estándares que dependan únicamente del contrato tradicional para la atención médica


Els resultats d'un estudi empíric (Hall, 2017) mostren que, considerats com a grup, els metges a Mèxic no saben què és legal I què no ho és pel que fa a certes àrees de la pràctica clínica. Se citen diversos casos legals que mostren les formes en què el sistema legal és inefectiu pel que fa a proporcionar orientació sobre qüestions bioètiques. Concloem que els metges a Mèxic no saben què és legal perquè no poden saber-ho (demostrem diverses maneres en què la llei no és clara) I perquè no necessiten saber-ho (el sistema legal no proporciona una aplicació efectiva). Suggerim que el camí a seguir ha de ser a través de polítiques institucionals que estableixin estàndards que depenguin únicament del contracte tradicional per a l'atenció médica


Assuntos
Humanos , Médicos/legislação & jurisprudência , Serviços de Saúde/ética , Cuidados Paliativos/ética , Temas Bioéticos/legislação & jurisprudência , Cuidados Paliativos/legislação & jurisprudência , México
8.
Acad Med ; 95(10): 1492-1494, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32520751

RESUMO

The COVID-19 pandemic has presented unprecedented challenges and opportunities for medical schools in the United States. In this Invited Commentary, the authors describe a unique collaboration between the University of Massachusetts Medical School (UMMS), the only public medical school in the state; the University of Massachusetts Memorial Medical Center (UMMMC); and the Commonwealth of Massachusetts. Through this partnership, UMMS was able to graduate fourth-year medical students 2 months early and deploy them to UMMMC to care for patients and alleviate workforce shortages during the COVID-19 surge, which peaked in Massachusetts in April 2020. The authors describe how they determined if students had fulfilled graduation requirements to graduate early, what commencement and the accompanying awards ceremony looked like this year as virtual events, the special emergency 90-day limited license these new graduates were given to practice at UMMMC during this time, and the impact these new physicians had in the hospital allowing residents and attendings to be redeployed to care for COVID-19 patients.


Assuntos
Mão de Obra em Saúde/legislação & jurisprudência , Licenciamento/legislação & jurisprudência , Pandemias/legislação & jurisprudência , Médicos/provisão & distribução , Estudantes de Medicina/legislação & jurisprudência , Betacoronavirus , Infecções por Coronavirus , Humanos , Massachusetts/epidemiologia , Médicos/legislação & jurisprudência , Pneumonia Viral , Faculdades de Medicina , Estados Unidos
9.
Tunis Med ; 98(5): 334-342, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32548835

RESUMO

The COVID-19 infection causes to medical community many difficulties worldwide. In addition to its therapeutic problems, it can generate situations with high medico-legal risk to doctor who can see his criminal medical liability engaged. In fact, in Tunisia, this new infection imposes many specific legal obligations. Some of these obligations have recently been introduced, therefore still little or not known by doctors, despite the need for them to comply with. In this paper, we propose to analyse the circumstances of medical practice in Covid-19 pandemic period , which risk to engage the doctor's criminal medical liability, and to set out the sanctions incurred, in order to protect health professionals against the specific legal risk of this emerging disease.


Assuntos
Infecções por Coronavirus/epidemiologia , Responsabilidade Legal , Médicos/legislação & jurisprudência , Pneumonia Viral/epidemiologia , Humanos , Pandemias , Tunísia/epidemiologia
10.
Pain Physician ; 23(3): E297-E304, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32517406

RESUMO

BACKGROUND: Prescribing opioids has become a challenge. The US Drug Enforcement Agency (DEA) and Centers for Disease Control and Prevention (CDC) have become more involved, culminating in the March 2016 release of the CDC's "Guidelines for Prescribing Opioids for Chronic Pain." OBJECTIVES: Given the new guidelines, we wanted to see if there have been any changes in the numbers, demographics, physician risk factors, charges, and sanctions involving the DEA against physicians who prescribe opioids, when compared to a previous DEA database review from 1998 to 2006. STUDY DESIGN: This study involved an analysis of the DEA database from 2004 to 2017. SETTING: The review was conducted at the Henry Ford Health System Division of Pain Medicine. METHOD: After institutional review board approval at Henry Ford Health System, an analysis of the DEA database of criminal prosecutions of physician registrants from 2004-2017 was performed. The database was reviewed for demographic information such as age, gender, type of degree (doctor of medicine [MD] or doctor of osteopathic medicine [DO]), years of practice, state, charges, and outcome of prosecution (probation, sentencing, and length of sentencing). An internet-based search was performed on each registrant to obtain demographic data on specialty, years of practice, type of medical school (US vs foreign), board certification, and type of employment (private vs employed). RESULTS: Between 2004 and 2017, Pain Medicine (PM) had the highest percentage of in-specialty action at 0.11% (n = 5). There was an average of 18 prosecutions per year vs 14 in the previous review. Demographic risk factors for prosecution demonstrated the significance of the type of degree (MD vs. DO), gender, type of employment (private vs. employed), and board certification status for rates of prosecution. Having a DO degree and being male were associated with significantly higher risk as well as being in private practice and not having board certification (P < .001). In terms of type of criminal charges as a percent of cases, possession with intent to distribute (n = 90) was most prevalent, representing 52.3% of charges, with new charges being prescribing without medical purpose outside the usual course of practice (n = 71) representing 41.3% of charges. Comparison of US graduates (MD/DO) vs. foreign graduates showed higher rates of DEA action for foreign graduates but this was of borderline significance (P = .072). LIMITATIONS: State-by-state comparisons could not be made. Specialty type was sometimes self-reported, and information on all opioid prosecutions could not be obtained. The previous study by Goldenbaum et al included data beyond DEA prosecution, so direct comparisons may be limited. CONCLUSION: The overall risk of DEA action as a percentage of total physicians is small but not insignificant. The overall rates of DEA prosecution have increased. New risk factors include type of degree (DO vs. MD) and being in private practice with a subtle trend toward foreign graduates at higher risk. With the trend toward less prescribing by previously high-risk specialties such as Family Medicine, there has been an increase in the relative risk of DEA action for specialties treating patients with pain such as PM, Physical Medicine and Rehabilitation, neurology, and neurosurgery bearing the brunt of prosecutions. New, more subtle charges have been added involving interpretation of the medical purpose of opioids and standard of care for their use. KEY WORDS: Certification, CDC, criminal, DEA, opioid, prescribing, prosecution, sanctions.


Assuntos
Analgésicos Opioides/uso terapêutico , Médicos/legislação & jurisprudência , Padrões de Prática Médica/legislação & jurisprudência , Má Conduta Profissional/legislação & jurisprudência , Adulto , Prescrições de Medicamentos , Disciplina no Trabalho/estatística & dados numéricos , Feminino , Órgãos Governamentais/legislação & jurisprudência , Regulamentação Governamental , Fidelidade a Diretrizes , Humanos , Masculino , Pessoa de Meia-Idade , Estados Unidos
13.
J Med Internet Res ; 22(5): e16708, 2020 05 14.
Artigo em Inglês | MEDLINE | ID: mdl-32406851

RESUMO

BACKGROUND: Physician rating websites are commonly used by the public, yet the relationship between web-based physician ratings and health care quality is not well understood. OBJECTIVE: The objective of our study was to use physician disciplinary convictions as an extreme marker for poor physician quality and to investigate whether disciplined physicians have lower ratings than nondisciplined matched controls. METHODS: This was a retrospective national observational study of all disciplined physicians in Canada (751 physicians, 2000 to 2013). We searched ratings (2005-2015) from the country's leading online physician rating website for this group, and for 751 matched controls according to gender, specialty, practice years, and location. We compared overall ratings (out of a score of 5) as well as mean ratings by the type of misconduct. We also compared ratings for each type of misconduct and punishment. RESULTS: There were 62.7% (471/751) of convicted and disciplined physicians (cases) with web-based ratings and 64.6% (485/751) of nondisciplined physicians (controls) with ratings. Of 312 matched case-control pairs, disciplined physicians were rated lower than controls overall (3.62 vs 4.00; P<.001). Disciplined physicians had lower ratings for all types of misconduct and punishment-except for physicians disciplined for sexual offenses (n=90 pairs; 3.83 vs 3.86; P=.81). Sexual misconduct was the only category in which mean ratings for physicians were higher than those for other disciplined physicians (3.63 vs 3.35; P=.003). CONCLUSIONS: Physicians convicted for disciplinary misconduct generally had lower web-based ratings. Physicians convicted of sexual misconduct did not have lower ratings and were rated higher than other disciplined physicians. These findings may have future implications for the identification of physicians providing poor-quality care.


Assuntos
Médicos/legislação & jurisprudência , Má Conduta Profissional/estatística & dados numéricos , Estudos de Casos e Controles , Feminino , Humanos , Internet , Masculino , Satisfação do Paciente , Estudos Retrospectivos
14.
J Forensic Leg Med ; 72: 101965, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32452455

RESUMO

Within the regime of professional liability of doctors in training, the limits and the medico-legal aspects of their professional duties are not well-defined. The Italian Court of Cassation established in its sentence no. 26311/2019 that resident doctors do not work at hospitals just to receive their professional training. They are, indeed, licensed physicians and therefore bear full responsibility for the acts performed within the compass of their professional activity. The purpose of this article is to briefly define the possible consequences of this judgment.


Assuntos
Internato e Residência/legislação & jurisprudência , Responsabilidade Legal , Imperícia/legislação & jurisprudência , Humanos , Itália , Relações Médico-Paciente , Médicos/legislação & jurisprudência
15.
Emerg Med Clin North Am ; 38(2): 539-548, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32336339

RESUMO

Being named in a medical malpractice case is one of the most stressful events in a physician's career. This article reviews the legal system and the medical malpractice process. It details the steps a physician experiences during a medical malpractice case, from being served to the deposition and then to trial and appeals if the physician loses. This article also reviews necessary steps to take in order to proactively participate in one's own defense.


Assuntos
Medicina de Emergência/legislação & jurisprudência , Imperícia , Médicos/legislação & jurisprudência , Prova Pericial/legislação & jurisprudência , Humanos , Responsabilidade Legal , Imperícia/legislação & jurisprudência , Médicos/psicologia , Estados Unidos
20.
BMC Palliat Care ; 19(1): 4, 2020 Jan 04.
Artigo em Inglês | MEDLINE | ID: mdl-31901225

RESUMO

BACKGROUND: Austria has recently been embroiled in the complex debate on the legalization of measures to end life prematurely. Empirical data on end-of-life decisions made by Austrian physicians barely exists. This study is the first in Austria aimed at finding out how physicians generally approach and make end-of-life therapy decisions. METHODS: The European end-of-life decisions (EURELD) questionnaire, translated and adapted by Schildmann et al., was used to conduct this cross-sectional postal survey. Questions on palliative care training, legal issues, and use of and satisfaction with palliative care were added. All Austrian specialists in hematology and oncology, a representative sample of doctors specialized in internal medicine, and a sample of general practitioners, were invited to participate in this anonymous postal survey. RESULTS: Five hundred forty-eight questionnaires (response rate: 10.4%) were evaluated. 88.3% of participants had treated a patient who had died in the previous 12 months. 23% of respondents had an additional qualification in palliative medicine. The cause of death in 53.1% of patients was cancer, and 44.8% died at home. In 86.3% of cases, pain relief and / or symptom relief had been intensified. Further treatment had been withheld by 60.0%, and an existing treatment discontinued by 49.1% of respondents. In 5 cases, the respondents had prescribed, provided or administered a drug which had resulted in death. 51.3% of physicians said they would never carry out physician-assisted suicide (PAS), while 30.3% could imagine doing so under certain conditions. 38.5% of respondents supported the current prohibition of PAS, 23.9% opposed it, and 33.2% were undecided. 52.4% of physicians felt the legal situation with respect to measures to end life prematurely was ambiguous. An additional qualification in palliative medicine had no influence on measures taken, or attitudes towards PAS. CONCLUSIONS: The majority of doctors perform symptom control in terminally ill patients. PAS is frequently requested but rarely carried out. Attending physicians felt the legal situation was ambiguous. Physicians should therefore receive training in current legislation relating to end-of-life choices and medical decisions. The data collected in this survey will help political decision-makers provide the necessary legal framework for end-of-life medical care.


Assuntos
Tomada de Decisões , Médicos/psicologia , Suicídio Assistido/psicologia , Assistência Terminal/tendências , Adulto , Idoso , Atitude do Pessoal de Saúde , Áustria , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Médicos/legislação & jurisprudência , Psicometria/instrumentação , Psicometria/métodos , Suicídio Assistido/estatística & dados numéricos , Inquéritos e Questionários , Assistência Terminal/legislação & jurisprudência , Assistência Terminal/métodos
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