Informed consent in urology.

Appropriate professional practice includes the diagnostic and treatment process of urologic pathology, as well as patient information and respect for patient autonomy in decision making. Informed consent is the gradual process of providing information to the patient and their subsequent decision making. The informed consent document (ICD), when required, demonstrates that information has been provided sufficiently in advance to allow for the patient's deliberation. The dual need for simple yet complete documents make the preparation of adequate ICDs extremely difficult. If the information process is not carried out properly, the professional may incur a medical malpractice liability that is treated as a loss of opportunity. To avoid such situations, the work of scientific societies in the preparation, accessibility, and dissemination of ICD models is fundamental.

Medical malpractice liability and its consequences. / Encuesta a los urólogos sobre responsabilidad profesional médica y sus consecuencias.

INTRODUCTION: Urology is a specialty of medium risk of claim. Receiving a claim for medical professional liability is a stressful experience with significant repercussions. The objective of this study was to assess the impact of these claims on Spanish urologists. METHODOLOGY: A survey on medical professional liability in urology was designed. The Spanish Association of Urology and the Urological Research Foundation approved the questionnaire, generated by the PIEM online tool. RESULTS: The total number of responses obtained was 202 (11.6% rate), of which 25.24% reported having been claimed, 88% reported mood changes after being claimed, 100% in criminal proceedings. The level of emotional involvement reported was the highest at the beginning of the process and progressively decreasing until its resolution. An affected doctor-patient relationship was considered in 67.9% of cases and 71.4% acknowledged increased defensive medicine in their professional practice. A percentage of 6.7% considered leaving the profession. DISCUSSION: The response rate obtained and the medical acts motivating the claims were comparable to those obtained in a similar survey conducted in the United States. The fact that claims are perceived as very stressful situations and may give rise to the phenomenon of the second victim or to the clinical judicial syndrome is clear, so efforts should be devoted to develop training in this matter and programs that address the consequences derived from these situations.

Infracción del deber de cuidado y responsabilidad penal del profesional de la salud

Introducción: A pesar de su antigüedad la cuestión de la responsabilidad jurídico-penal del profesional de la salud adquiere cada vez mayor importancia en el orden teórico y práctico, en cuyo escenario se pone de manifiesto una excesiva judicialización de la actividad médica como mecanismo de tutela de los derechos del paciente. Objetivo: Sistematizar las diferentes posturas teóricas que en la actualidad se aprecian en torno a la judicialización de la actividad médica y las causas que la estimulan. Método: Se llevó a cabo un estudio de carácter documental a través de una revisión bibliográfica exhaustiva en buscadores bibliográficos como Scopus, SciELO, Google Académico y PubMed. La indagación de carácter argumentativa y exploratoria se realizó el 16 de marzo de 2023 y de los 30 artículos encontrados que abordaron la problemática de la mala praxis médica, solo 11 fueron elegidos para el estudio según criterios de selección. Desarrollo: Se sistematizaron las posturas teóricas sobre la judicialización de la actividad médica y las causas que la estimulan; además se determina la correcta interpretación de la lex artis como mecanismo de heterointegración normativa del deber de cuidado del ejecutor de actos médicos, en aras de evitar excesos en la aplicación de la ley penal en este ámbito de actuación profesional. Consideraciones finales: Una mayor intervención del Derecho Penal en el ejercicio de la Medicina no es el paradigma político criminal más eficiente en aras de proteger la vida e integridad del paciente frente a hechos de mala praxis médica.

Introduction: Legal and criminal liability of the health professionals, regardless its antiquity, at present has becoming more and more theoretical and practical relevance in which an excessive judicialization of medical activity is revealed as a mechanism for the protection of patient rights. Objective: Systematization of the different theoretical positions that are currently identified around the judicialization process of medical activity and the likely causes that stimulate it. Method: A documentary study was carried out through an exhaustive bibliographic review in bibliographic search engines such as Scopus, SciELO, Google Scholar and PubMed. The argumentative and exploratory research was conducted on March 16, 2023 and of the 30 articles found concerning medical malpractice, only 11 were chosen for the study with strict selection criteria. Development: The theoretical positions on the judicialization of medical activity and the causes that stimulate it were systematized; in addition, the correct interpretation of the lex artis was presented as a mechanism of normative heterointegration of the duty of care by the medical personnel, in order to avoid excesses in the application of the criminal law in this area of professional activity. Final considerations: A much greater intervention of criminal law in the practice of medicine is not the most efficient policy to protect the life and integrity of the patient in the face up to the medical malpractice.

Introdução: Apesar de sua idade, a questão da responsabilidade jurídico-penal do profissional de saúde adquire cada vez maior importância na ordem teórica e prática, cenário em que se revela uma excessiva judicialização da atividade médica como mecanismo de proteção dos direitos. do paciente. Objetivo: Sistematizar as diferentes posições teóricas que se apreciam atualmente em torno da judicialização da atividade médica e as causas que a estimulam. Método: Foi realizado um estudo documental por meio de revisão bibliográfica exaustiva em buscadores bibliográficos como Scopus, SciELO, Google Acadêmico e PubMed. A investigação argumentativa e exploratória foi realizada no dia 16 de março de 2023 e dos 30 artigos encontrados que abordavam o problema da impericía médica, apenas 11 foram escolhidos para o estudo de acordo com os critérios de seleção. Desenvolvimiento: Foram sistematizados os posicionamentos teóricos sobre a judicialização da atividade médica e as causas que a estimulam; Além disso, determina-se a correta interpretação da lex artis como mecanismo de heterointegração normativa do dever de cuidado do executor de atos médicos, a fim de evitar excessos na aplicação do direito penal neste campo de atuação profissional. Considerações finais: Uma maior intervenção do Direito Penal no exercício da Medicina não é o paradigma político criminal mais eficiente a fim de proteger a vida e a integridade do paciente contra atos de imperícia médica.

[Urological diseases most frequently involved in medical professional liability claims]. / Patologías urológicas más frecuentemente implicadas en las reclamaciones por responsabilidad profesional médica.

Clinical safety and medical professional liability are international major concerns, especially in surgical specialties such as urology. This article analyzes the claims filed at the Council of Medical Colleges of Catalonia between 1990 and 2012, exploring urology procedures. The review of the 173 cases identified in the database highlighted the importance of surgical procedures (74%). Higher frequencies related to scrotal-testicular pathology (34%), especially testicular torsion (7.5%) and vasectomy (19.6%), and prostate pathology (26 %), more specifically the surgical treatment of benign prostatic hyperplasia (17.9%). Although urology is not among the specialties with the higher frequency of claims, there are special areas of litigation in which it is advisable to implement improvements in clinical safety.

Articulación de lenguaje, praxis y poder: discurso en la relación médico-paciente / Language, praxis and power articulation: speech at the doctor-patient relationship

En este ensayo se presentan diversas reflexiones relativas a la articulación de lenguaje, praxis y poder: discurso en la relación médico-paciente. Se muestran de manera concreta los siguientes aspectos:(i) Lenguaje y Sentido Social; (ii) Lenguaje y Praxis; (iii) Lenguaje y Poder; (iv) Lenguaje, Praxis y Poder en la Relación Médico-Paciente; finalizamos con la exposición de las reflexiones producto del proceso de análisis-síntesis aplicado para el examen de los conceptos presentados. Su objetivo es exponer aspectos teóricos fundamentales respecto a la relación Médico-Paciente durante los actos que caracterizan el desarrollo de la terapéutica para la sanación. En concreto, lo referido a la calidad del lenguaje del médico, el cual debe estar dirigido hacia el bien, mediante el adecuado uso de las relaciones de autoridad y poder; el autor considera que el discurso debe modelar, entre otros condicionantes, la dignidad del acto con el fin de erigir una vida buena. Estas ideas están impregnadas por la necesidad del mantenimiento y desarrollo de una atención con humanidad, en la cual se manifieste la importancia de percibir al paciente como humano-integral y no como una sistematización de órganos y sistemas, síntomas y reacciones. La comunicación tiene el poder de lograr que el ser humano tenga conciencia de sí mismo y que pueda ser reconocido por el otro, el médico reconociendo al paciente como ser humano y el paciente en igual forma con el médico, además de los roles que les toca cubrir por efecto de la situación de enfermedad-salud, redundarían en el logro de los altos intereses humanos de la acción médica.

In this essay different reflections on joint language and praxis and power are discussed. The following aspects are considered in concrete terms: (i) Language and Social Sense; (ii) Language and Praxis; (iii) Language and Power; (iv) Language, Praxis and Power in the doctor-patient relationship; I ended with the exposure of the product reflections of the analysis-synthesis process applied for the examination of the concepts presented. Its aim is to present basic theoretical aspects concerning the doctor-patient relationship during the events that characterize the development of therapeutics for healing. In particular, as regards the quality of medical language, which must be directed toward the good, through the proper use of authority and power relations; the author considers that the speech should model, among other conditions, the dignity of the act in order to build a good life. These ideas are impregnated by the need to maintain and develop a care humanely, in which the importance of perceiving the patient as a human-integral and not as a systematization of organs and systems, manifest symptoms and reactions. The communication has the power to make the human being aware of itself and can be recognized by the other, the doctor recognized the patient as a human being and the patient in the same manner with the doctor, in addition to the roles that they cover the effect of disease-health situation, would result in achieving high human interests of medical action.

La etica y la booetica en el pregrado ponencia ntroductoria: la enseñanza de lla bioetica en el pregrado. reflexiones sobre un problema inconcluso

Enseñar bioética en el pregrado es un problema no resuelto en nuestras Universidades Médicas; en el presente artículo se reflexiona sobre este interesante tema. El autor defiende que el especialista que va a enseñar bioética ha de tener una doble vocación: de una parte debe estar familiarizado con el estado actual de los conocimientos científicos, de otra debe hundir las raíces de su formación humanista en el ámbito de la filosofía moral, de manera que pueda juzgar, con suficiente conocimiento de juicio, los hechos que en la praxis clínica se le presentan. Se propone además, enseñar bioética como una disciplina propia desde el ciclo básico y lograr que esos conocimientos se integren en el actuar diario de cada estudiante, para que llegue a ser un profesional integral, colmado de virtudes en cada una de sus actuaciones.