کميسيون های پزشکی سازمان پزشکی قانونی. law suit against physician...
TRANSCRIPT
پزشکی های کميسيونقانونی پزشکی سازمان
Law suit against physician
o Have an increasing trendoPatients who now want more explanation in
compare of old paternalistic model of careoPatients want and need to be apologizedoPatients need money oPatients want revenge
Scientific commission
o Standard of careo Appropriatenesso Break a rule
Scientific commission
valid relevant
o Expert o Documento Causationo Classification of medical incidento Apportionmento IMEo writing
Reliability
o Reliability of Scientific commission have to be >70%
Expert
o Privilege experto Cliniciano Scientific Idea, Daubert testimony
o Has been testedo Subjected to peer reviewo Recognize real and potential erroro Whether its generally accepted in
scientific community
Bias
o Out come biaso Hind sight biaso Context biaso Socioculteral biaso Motivation biaso Prejudgement biaso Probability biaso eggshell skull rule, aggravation biaso Confirmation biaso Deep pocket bias
Scientific evaluation
o Theory of Science o Newtonian view, technical rationalityo Aristotelian view
Scientific evaluation
o Theory of probabilityo Frequentist viewo Bayesian view
taxonomy
o Nestingo Mutually exclusiveo Exhaustive
Classification of
Medical incident
o Accidento Erroro Negligenceo Recklessnesso violation
Classification of medical incident
o Application of appropriate rule of lawo Appropriate compensation or
punishment o criminal or medical organization liabilityo Burden of proof, probability, certainty
o Record Full history of pervious medical incident
ACCIDENT
o No liability
Error
o Return all payment??o Compensate error or any residual
disabilityo By physician if he or she is independent
contractoro By employee if error has been down by
employer
negligence
o Compensation o disability, economic injuriesoNoneconomic injuries, stress or pain
Recklessness
o Compensation is as the same as negligence but include
oCompensation of injuries in addition to disability
oMedical organization punishment
Violation
o Compensation is such as recklessness in addition to criminal liability
Bolam test1957-1997
Evaluation of risk
L . P < B
o L, magnitude of injuryo P, probability of injuryo B, benefit to be expected
مثالشده مرگ به منجر بيمارکه به پتاسيم اشتباه تزريق
است.می • تزريق چه آن از داروی هر تزريق قبل بايد کسی هر
. کند حاصل اطمينان کندپس:
است کرده تزريق و است نخوانده را ويال روی يا بخواند رفته يادش
human error skill base error memory lapse, omission نبوده خواندن فرصت چون است نخوانده
negligence است نخوانده
recklessness, violation نداده تشخيص را پتاسيم اسمی تشابه علت به ولی است خوانده يا
confirmation bias است
oCritical rule or Red line
oActive factor and Latent factor
o دارو سازنده کارخانه بيمارستان، فنی مسئول بيمار، مسئول پزشک
oBristol cardiac surgeons
o context specific
o اطالعات از بخشی شکلی بررسی
Theory of causation
o Linear sequence of evento Deterministic view, root causeo Single cause theoryo Reason Swiss cheese model
o Multilinear events sequence
Human error
o Of objective point error should not be occur and so when it occurs is at least negligence, strict liability
o Of subjective point Human is a fallible machine and error may occur
e.g. Three mile island
Buto System have to error proof,
e.g. Pulse Oximeter
Taxonomy of error
o Skill base error, SBE, slip and lapseo Rule base error, RBE or mistakeo Knowledge base error, KBE or mistakeo Judgement base error
Algorithm of
intentional behaviour
Intention
Plan
Desire
error
o Skill base erroro Action slip, commissiono Memory lapse, omission
error
o Rule base erroro Misapplication of good ruleo Application of bad rule
error
o Knowledge base erroro Develop bad rule
Elements of Negligence
o Dutyo Breach of dutyo Proximate cause o Damage
causation
o Factual cause, but for causeo Proximate cause
Proximate cause
o Concurring causeo Superseding cause
Proximate causefutile treatment
o Illegible prescription, MVA, Surgical Incident
o MVA, brain deatho MVA, permanent vegetative state
Proximate cause
o Contributory negligence (patient negligence before and or during physician negligence), concurring cause o Comparative negligence
o Avoidance of consequences, patient negligence after physician care, superseding cause
Proximate cause
o Wrongful pregnancyo Wrongful birtho Wrongful life
Non pecuniary damageo Pain, suffering, loss of love, loss of society
Affirmative Defenses
o Statue limitationo Contributory negligence
o Unreasonable for his or her welfareo Assumption of risk
o Versus Hindsight biaso Informed consent
Informed consent
o Signed inform consent versus oral consent
o Appropriate
1. Procedure2. Alternative3. Risk, even rare but serious
Informed consent
o Therapeutic privilegeo Doctors known your best, old
paternalistic o Emergency conditiono Minority and child abuseo Reasonable prudent patient that
called “Modified objective standard”
Informed consent
o Probability biaso Hindsight bias
Physician countersuit
o Malicious prosecutiono Original instigation of a lawsuit against the doctoro Original proceedings terminated in favor of doctor, exonerateo Lack or probable causeo Maliceo Special injuries
o Abuse of process
Patients who drive
o NIDDM, MVA, BS, o Third party responsibility, proximate
causeo Complication of disease, side effect
of drug but not type or dose of drugo Confidentiality and drivability
Complementary and alternative medicine
o In the future its possible negligence for a physician who do not refer to a CAM specialist.
o Informed consent.o Appropriate and standard CAM o Defense
o Respectable minority standard of care, assumption of risk, plead clinical innovation
Product liability
o Negligenceo Breach of duty of reasonable care
o Breach of contracto There is a promise that the product is fit
for an ordinary use but it is noto Strict liability product
o Defective, quality lower than exception of reasonable consumer
o Unreasonably dangerous, risks > advantage
Product liability
o Blood productso is a product o Unavoidable unsafe product
oBlood transfusion was absolutely essential to save life and blood product was useful and desirable actually
o Hospital, is a consumer not a sailing agent or agency
o Learned intermediate doctrine
Product liability
o Vicarious liability (indirect liability, respondent superior)o Institutional liability
oHospital is responsible for quality and quantity (short staff) of its staff (employee) else independent contractor
oThat include staff accidental, erroneous and negligent action
o Premise liabilityo Direct liability, for nondelegable duty
Product liability
o Deep pocketo Capitan of ship versus respondent
superioro Managed care organization
Medical trainees
o Medical responsibility of medical trainees is similar to vicarious liability, in other word their attending or hospital are liable
o Trainees’ standard is similar to their attending standard
o Trainees have to introduce themselves to patient
o Educational negligence can not be proved
medical records and confidentiality
• Medical records must be relevant and authenticate
• Error of illegibility• Correction of record• Medical record have to save up to 7
years• Basic information have to save up to25
years• Content of medical record belong to
patient• Without record, without document
cyber medicine
o Breach of privacy and confidentialityo Medical negligence
• Substandard conduct• Wrong advice• Untimely diagnosis and referral• Failure to response to electronic message
o Informed consent• Cyber consento On line pharmacy
Malpractice lawsuit
o Before,1 of 7 physicians during their professional life
o Now, 1 of 7 physicians each yearo Typical claimer is different of honor
storieso In USA
o 25% surgical complicationo 24% diagnosis relatedo 20% treatment relatedo 8% medication related
Medical malpractice
o What make it cause?o Explanationo Apologizeo moneyo Revenge
UK GMC Advice
o Make care of your patient your first concerno Treat every patient politely and consideratelyo Give patients information in a way they can
understando Keep your professional knowledge and skills
up to dateo Recognize the limit of your professional
competenceo Make sure that your personal beliefs do not
prejudice your patients careo Act quickly to protect from risk if you have good
reason to believe that you or your colleague may not be fit to practice
Avoid malpractice lawsuit
o Competenceo Compassiono Continuous educationo Unrushed examinationso Obtained informed consento Order appropriate testo Instituting the best evidence- base
therapyo Making timely referral to a specialist
Malpractice law suit
o Negative communication behaviouroNo eye contactoHarsh and clipped tone of voiceoCriticismoMinimal presentation of informationoNo friendly physical contactoNo acknowledgement of verbalizationoRelatively short period of contact 2’ 2” ( 2’ 25”)oNo empathy
Defensive medicine
o Negative communication behaviouro First concern is produce more and
more document not for care but for defense include
o laboratory testo consultationo Consent
های کميسيون انواع 89ماه اسفند مقايسه
NEGLIGENCE; Series1; 100;
48%
FORENSIC PSYCOLOGY; Series1; 35;
17%
CAUSE OF DEATH; Se-
ries1; 11; 5%
FORENSIC CLINICAL EXAMINA-TION; Se-ries1; 63;
30%
Chart Title
NEGLIGENCEFORENSIC PSY-COLOGYCAUSE OF DEATHFORENSIC CLINICAL EXAMINATION
Superior 80 Standard 70 Substandard 60
Out Of Standard 0
! 70 ? 0
5
10
15
20
25
30
35
40
Superior 80; Series1; 16
Standard 70; Se-ries1; 37
Substandard 60; Se-ries1; 22
Out Of Standard 0; Series1; 12
! 70 ; Series1; 6 ? ; Series1; 7
CLASSIFICATION OF A GROUP
Series1
Superior 50 Standard 40 Substandard 30 Out Of Standard 0
! 40 ?0
10
20
30
40
50
60
70
80
90
Superior 50; Series1; 6
Standard 40; Series1; 85
Substandard 30; Se-ries1; 0
Out Of Standard 0; Se-ries1; 6 ! 40; Series1; 0 ?; Series1; 3
CLASSIFICATION OF B GROUP
Series1
Superior 40 Standard 30 Substandard 20 Out Of Standard 0
! 30 ?0
5
10
15
20
25
30
35
40
Superior 40; Series1; 18
Standard 30; Series1; 9
Substandard 20; Se-ries1; 27
Out Of Standard 0; Se-ries1; 9
! 30; Series1; 0
?; Series1; 37
CLASSIFICATION OF C GROUP
Series1
POSTIVE 30 NATURE 20 NEGATIVE 10 OUT OF STANDARD 0
! 20 ? D 2.50
5
10
15
20
25
30
35
40
45
POSTIVE 30; Series1; 9
NATURE 20; Series1; 40
NEGATIVE 10; Series1; 2
OUT OF STANDARD 0; Series1; 25
! 20; Series1; 2
? ; Series1; 8
D 2.5; Series1; 14
Series1; 0
CLASSIFICATION OF D GROUP
Series1
Impa
irmen
t eva
luat
ion
Poo
r Writ
ing
cau
satio
n Ev
alua
tion
App
ortio
nmen
t
Out
com
e Bia
s
Hin
dsite
Bia
s
cla
ssifi
catio
n0
5
10
15
20
25
30
35
40
45
Impairment evaluation; Series1; 18 Poor Writing; Series1;
11 causation Evaluation; Series1; 4
Apportionment; Se-ries1; 41
Outcome Bias; Series1; 4
Hindsite Bias; Series1; 7
classification; Series1; 15
SUBCLASSIFICATION OF "A" SUBSTANDARD GROUP
Series1
شاخص محاسبه روش با مقايسهاستاندارد
ضريب اهميت
امتياز شده کسب
نوع شاخص
نيروی انسانی تخصصی
12=667/7611 S=1 W=10 10 کاهنده
نيروی غير انسانی
تخصصی
21=350/7611 S=1 W=5 5 کاهنده
انرژی هزينه 60=7611/459850 >S=O W=5 0 کاهندهلوله آب هزينه
کشی2.5=7611/19320 >S=O W=5 0 کاهنده
ITکاربرد - <S=0 W=5 0 افرايندهانگيزه 1 >S=0 W=5 0 کاهنده
نيروی امينتانسانی
<S=0 W=5 0 افزاينده
ميانگين اضافه ساعت
کاری
101=75/7611 S=1 W=5 5 کاهنده
و تحقيقموثر توسعه
- S=1 W=5 5 افزاينده
و ابنيهتجهيزات
متر 1000حدود به توجه با و مربع
موجود تجهيزات
S=1 W=5 5 کاهنده
جمع 30
Project Overview
o introduce the topic and objective of your science project.
Statement of the Problem
o Explain the hypothesis you tested. In other words, what question did you want your experiment to answer?
Materials
o List the materials used in your project.
Procedure
List the steps in your experiment.o Step 1 o Step 2 o Step 3o Step 4
Data and Observations
o Indicate what you measured. o Explain how your measurements
changed over time or under different conditions.
Tip: Data are easier to understand when in a table, chart, or graph. Include labels to explain what is being shown.
Conclusion
o Summarize your results based on your data.
o Is your hypothesis supported by the data? Explain why or why not.
More Information
o Related readings o Useful Web sites