Medical negligence and diagnosis: further inroads into Bolam?

2021 ◽  
Vol 71 (4) ◽  
pp. 683-693
Author(s):  
Kumaralingam Amirthalingam
Keyword(s):  
Cancer Screening ◽  
Standard Of Care ◽  
Medical Professionals ◽  
Medical Negligence ◽  
Duty To Inform

The Bolam test allows medical professionals to set the standard of care in medical negligence litigation. There is growing recognition that the medical professional’s duty to the patient is complex and multifaceted and that Bolam may not be appropriate with respect to some aspects of the duty. Significantly, it has been rejected with respect to the duty to inform. Recent cases involving diagnosis and cancer screening raise questions about its application to these aspects of the medical professional’s duty. It is timely to consider further inroads into Bolam by curtailing its application to diagnosis and rejecting its application to screenings tests.

The Role of the Autopsy in Medical Malpractice Cases, I

2002 ◽  
Vol 126 (9) ◽  
pp. 1023-1031 ◽  
Author(s):  
Kevin E. Bove ◽  
Clare Iery
Keyword(s):  
Clinical Diagnosis ◽  
Medical Malpractice ◽  
Standard Of Care ◽  
State Court ◽  
Medical Negligence ◽  
Trial Court ◽  
Autopsy Findings ◽  
Original Trial ◽  
Autopsy Diagnosis

Abstract Context.—Fear that damaging information from autopsy may be introduced as evidence in lawsuits alleging medical malpractice is often cited as one factor contributing to the decline in autopsy rates. Objective.—To determine how autopsy information influences the outcome of medical malpractice litigation. Design.—We studied state court records in 99 cases of medical malpractice adjudicated from 1970 to the present to assess the role of information from autopsies in the outcomes. Results.—The 3 largest groups defined by cause of death at autopsy were acute pulmonary embolism, acute cardiovascular disease, and drug overdose/interaction. Findings for defendant physicians outnumbered medical negligence in the original trial proceedings by a 3:1 margin. The appellate courts affirmed 51 acquittals and 19 findings of negligence, and reversed the original trial court decision in 29 cases for technical reasons. We found no significant relationship between accuracy of clinical diagnosis (using the autopsy standard) and outcome of a suit charging medical negligence. Even when a major discrepancy existed between the autopsy diagnosis and the clinical diagnosis, and the unrecognized condition was deemed treatable, defendant physicians were usually exonerated. Moreover, major diagnostic discrepancies were relatively uncommon in suits in which a physician was found to be negligent. Conversely, in about 20% of cases, autopsy findings were helpful to defendant physicians. Conclusions.—Our study confirms that a finding of medical negligence is based on standard-of-care issues rather than accuracy of clinical diagnosis. Autopsy findings may appear to be neutral or favorable to either the plaintiff or the defendant, but are typically not the crux of a successful legal argument for either side in a malpractice action. We conclude that fear of autopsy findings has no rational basis and is an important obstacle to uninhibited outcomes analysis.

scholarly journals Self-sampling for human papillomavirus (HPV) testing: a systematic review and meta-analysis

2019 ◽  
Vol 4 (3) ◽  
pp. e001351 ◽  
Author(s):  
Ping Teresa Yeh ◽  
Caitlin E Kennedy ◽  
Hugo de Vuyst ◽  
Manjulaa Narasimhan
Keyword(s):  
Systematic Review ◽  
Cervical Cancer ◽  
Cancer Screening ◽  
Cervical Cancer Screening ◽  
Clinical Assessment ◽  
Meta Analysis ◽  
Standard Of Care ◽  
Hpv Testing ◽  
Screening Uptake ◽  
Screening Frequency

IntroductionHuman papillomavirus (HPV) self-sampling test kits may increase screening for and early detection of cervical cancer and reduce its burden globally. To inform WHO self-care guidelines, we conducted a systematic review and meta-analysis of HPV self-sampling among adult women on cervical (pre-)cancer screening uptake, screening frequency, social harms/adverse events and linkage to clinical assessment/treatment.MethodsThe included studies compared women using cervical cancer screening services with HPV self-sampling with women using standard of care, measured at least one outcome, and were published in a peer-reviewed journal. We searched PubMed, the Cumulative Index to Nursing and Allied Health Literature (CNIAHL), Latin American and Caribbean Health Sciences Literature (LILACS) and Embase through October 2018. Risk of bias was assessed using the Cochrane tool for randomised controlled trials (RCTs) and the Evidence Project tool for non-randomised studies. Meta-analysis was conducted using random-effects models to generate pooled estimates of relative risk (RR).Results33 studies in 34 articles with 369 017 total participants met the inclusion criteria: 29 RCTs and 4 observational studies. All studies examined HPV self-sampling; comparison groups were standard of care (eg, Pap smear, visual inspection with acetic acid, clinician-collected HPV testing). 93% of participants were from high-income countries. All 33 studies measured cervical cancer screening uptake. Meta-analysis found greater screening uptake among HPV self-sampling participants compared with control (RR: 2.13, 95% CI 1.89 to 2.40). Effect size varied by HPV test kit dissemination method, whether mailed directly to home (RR: 2.27, 95% CI 1.89 to 2.71), offered door-to-door (RR: 2.37, 95% CI 1.12 to 5.03) or requested on demand (RR: 1.28, 95% CI 0.90 to 1.82). Meta-analysis showed no statistically significant difference in linkage to clinical assessment/treatment between arms (RR: 1.12, 95% CI 0.80 to 1.57). No studies measured screening frequency or social harms/adverse events.ConclusionA growing evidence base, mainly from high-income countries and with significant heterogeneity, suggests HPV self-sampling can increase cervical cancer screening uptake compared with standard of care, with a marginal effect on linkage to clinical assessment/treatment.Systematic review registration numberPROSPERO CRD42018114871.

20. Utility of human papillomavirus (HPV) 16 E6 and L1 DNA levels for anal cancer screening in HIV-infected individuals

Sexual Health ◽  
2013 ◽  
Vol 10 (6) ◽  
pp. 580 ◽  
Author(s):  
Doreen Lee ◽  
Mark H. Einstein ◽  
Rebecca A. Levine ◽  
Mark J. Suhrland ◽  
Samer Khader ◽  
...  
Keyword(s):  
Cancer Screening ◽  
Anal Cancer ◽  
Pap Smear ◽  
Standard Of Care ◽  
Molecular Testing ◽  
Hpv Testing ◽  
Hpv16 E6 ◽  
Screening Programs ◽  
Anal Cancer Screening ◽  
Better Than

Background In this prospective study we evaluate the sampling performance of HPV16 DNA E6 and L1 levels in detecting anal intraepithelial neoplasm using either a moistened Dacron swab (DS) or cytobrush (CB). Methods: We recruited HIV-infected (n = 57) and organ-transplanted subjects (n = 3) with an abnormal anal Pap smear who presented for high-resolution anoscopy (HRA). Prior to HRA, the first 30 subjects underwent sampling with a moistened DS, and the next 30 with a CB. HRA was then performed in the usual fashion. Samples were tested for HPV16 DNA E6 and L1 DNA using a validated qPCR technique. Anal biopsies were taken as per standard-of-care and categorised as negative, AIN 1/warts, or AIN 2 or 3. Results: 59 of 60 samples had adequate DNA and were evaluated for the comparison of HPV16 E6 and L1 DNA levels. A CB performed better than the DS in detecting low positive and positive levels of HPV16 E6 DNA (P = 0.01). We then further evaluated the correlation of HRA-directed biopsies and HPV16 DNA E6 levels. There was a positive correlation of HRA-directed biopsy results stratified by increasing histological levels with HPV16 E6 DNA (P = 0.018, Kruskal–Wallis test). Conclusions: A CB performed better than DS for molecular HPV testing. If molecular testing is included in anal cancer screening, consideration should be made for co-sampling with both a DS for cytology and CB for HPV testing. Further studies evaluating the sample yields should be performed to assist in implementation of anal cancer screening programs in defined populations of at-risk individuals.

The legal and ethical aspects of telemedicine. 4: Product liability and jurisdictional problems

1998 ◽  
Vol 4 (3) ◽  
pp. 132-139 ◽  
Author(s):  
Ben Stanberry
Keyword(s):  
Health Care ◽  
Medical Care ◽  
Human Factor ◽  
Product Liability ◽  
Standard Of Care ◽  
Review Article ◽  
Medical Professionals ◽  
Communications Technology ◽  
Ethical Aspects ◽  
Cross Border

The use of telemedicine brings with it the risk that the human factor-the teleconsultant-will fail to reach the standard of care that the law requires of medical professionals. It also brings the risk that the telemedical equipment or system will fail at a crucial moment. Such risks, of course, are inherent in many aspects of medical care but in telemedicine, at the interface between communications technology and health care, one must consider not only who is liable for failure, but under which country's laws will that liability be determined. This final review article describes the challenges facing manufacturers and their customers in providing safe, properly endorsed telemedicine systems. The problem of which country's laws should apply to a cross-border teleconsultation is also reviewed.

scholarly journals Beyond the Standard of Care: A New Model to Judge Medical Negligence

2012 ◽  
Vol 470 (5) ◽  
pp. 1357-1364 ◽  
Author(s):  
Lawrence H. Brenner ◽  
Alison Tytell Brenner ◽  
Eric J. Awerbuch ◽  
Daniel Horwitz
Keyword(s):  
Standard Of Care ◽  
Medical Negligence ◽  
New Model

scholarly journals Relationship between dementia severity in older women and family caregivers’ preferences for shared decision making about breast cancer screening

2021 ◽  
Vol 4 (1) ◽  
Author(s):  
Molly Frank ◽  
Nicole Fowler
Keyword(s):  
Breast Cancer ◽  
Decision Making ◽  
Cancer Screening ◽  
Breast Cancer Screening ◽  
Shared Decision Making ◽  
Family Caregiver ◽  
Standard Of Care ◽  
Shared Decision ◽  
Dementia Severity ◽  
The Relationship

Background/Objective: Mammography is one of the most effective ways to diagnose breast cancer early; however, its perceived benefits are complicated by terminal conditions such as dementia. By undergoing mammography, women with dementia risk treatment complications and false-positive results, which can exacerbate psychological distress. The lack of a standard of care confounds the individual roles of the patient, family caregiver, and physician in the decision-making process. This study evaluates the relationship between dementia severity and family caregiver preferences for shared decision making. Methods: Data were gathered from the Decisions about Cancer screening in Alzheimer’s Disease trial, which uses the Dementia Severity Rating Scale (DSRS) and a revised version of the Control Preferences Scale (CPS) to assess family caregiver preferences for decision-making as a dyad (patient and caregiver) and triad (patient, caregiver, and physician). Two multinomial logistic regression models assessed the relationship between DSRS and CPS categories (active, passive, and collaborative), while controlling for the caregivers’ age, gender, education, relationship to patient, self-perceived income, and race. Both models used the “active” group as the baseline; however, Model 1 examined preferences as a dyad and Model 2 as a triad. Results: Model 1 found a statistically significant association between dementia severity and a collaborative approach (p<0.001), and between dementia severity and a passive approach (p=0.014). For every one-unit increase in DSRS score, the odds of being in the collaborative group decreased by 0.083 and the odds of being in the passive group decreased by 0.085. There was no statistically significant association between dementia severity and decision-making preferences in Model 2. Clinical Significance: The association between dementia severity and family caregiver decision-making preferences supports the need for a standard of care regarding breast cancer screening in women with dementia.

scholarly journals Impact of an enhanced screening program on the detection of non-AIDS neoplasias in patients with human immunodeficiency virus infection

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
M. Masiá ◽  
S. Padilla ◽  
G. Estañ ◽  
J. Portu ◽  
A. Silva ◽  
...  
Keyword(s):  
Cancer Screening ◽  
Early Diagnosis ◽  
Adverse Events ◽  
Screening Program ◽  
Intervention Group ◽  
Standard Of Care ◽  
Cost Utility ◽  
Research Network ◽  
Early Diagnosis Of Cancer ◽  
Diagnosis Of Cancer

Abstract Background The incidence of non-AIDS defining cancer (NADC) is higher in people living with HIV (PLWH) than in the general population, and it is already one of the leading causes of death in the HIV-infected population. It is estimated that the situation will be aggravated by the progressive aging of PLWH. Early diagnosis through intensive cancer screening may improve the ability for therapeutic interventions and could be critical in reducing mortality, but it might also increase expenditure and harms associated with adverse events. The aim of this study is to evaluate an enhanced screening program for early diagnosis of cancer in PLWH compared to standard practice. The specific objectives are (1) to compare the frequency of cancer diagnosed at an early stage, (2) to analyze safety of the enhanced program: adverse events and unnecessary interventions, (3) to analyze the cost-utility of the program, and (4) to estimate the overall and site-specific incidence of NADC in PLWH. Methods We will conduct a multicenter, non-blinded, randomized, controlled trial, comparing two parallel arms: conventional vs enhanced screening. Data will be recorded in an electronic data collection notebook. Conventional intervention group will follow the standard of care screening in the participating centers, according to the European AIDS Clinical Society recommendations, and the enhanced intervention group will follow an expanded screening aimed to early detection of lung, liver, anal, cervical, breast, prostate, colorectal, and skin cancer. The trial will be conducted within the framework of the Spanish AIDS Research Network Cohort (CoRIS). Discussion The trial will evaluate the efficacy, safety, and efficiency of an enhanced screening program for the early diagnosis of cancer in HIV patients compared to standard of care practice. The information provided will be relevant since there are currently no studies on expanded cancer screening strategies in patients with HIV, and available data estimating cost effectiveness or cost-utility of such as programs are scarce. An enhanced program for NADC screening in patients with HIV could lead to early diagnosis and improve the prognosis of these patients, with an acceptable rate of unnecessary interventions, but it is critical to demonstrate that the benefits clearly outweigh the harms, before the strategy could be implemented. Trial registration ClinicalTrials.gov NCT04735445. Registered on 25 June 2019

Sciatic nerve injury in children after gluteal intramuscular injection: Case reports on medical malpractice

2019 ◽  
Vol 59 (3) ◽  
pp. 139-142
Author(s):  
Peipei Zhuo ◽  
Dong Gao ◽  
Qing Xia ◽  
Dan Ran ◽  
Wentao Xia
Keyword(s):  
Sciatic Nerve ◽  
Causal Relationship ◽  
Nerve Injury ◽  
Medical Malpractice ◽  
Intramuscular Injection ◽  
Case Reports ◽  
Standard Of Care ◽  
Sciatic Nerve Injury ◽  
Foot Drop ◽  
Medical Negligence

Two cases of medical malpractice for sciatic nerve injury caused by gluteal intramuscular injection in China are reported. Two children presented with foot drop indicative of sciatic nerve injury following gluteal intramuscular injections. The appraisal of whether there was medical negligence, the causal relationship between the patients’ nerve injuries and medical standard of care, and the causative potency were entrusted to us by the court. Based on each patient’s original medical history, imaging examination results, limb dysfunction and interviews with their relatives, there was a causal relationship between the children’s injuries and the medical treatment. The causative potency of medical negligence was complete effect in one case and main effect in the other case.

Doctors Police Your Own Expert Witness Testimony

2020 ◽  
pp. 181-188
Author(s):  
Robert C. Solomon
Keyword(s):  
Expert Witness ◽  
Standard Of Care ◽  
Ethical Conduct ◽  
Medical Negligence ◽  
Emergency Physicians ◽  
Witness Testimony ◽  
Expert Witness Testimony

Experienced emergency physicians with involvement in teaching and writing about clinical topics may be approached about a case of alleged medical negligence. The physician must decide whether to get involved as a potential expert witness, subjecting oneself to the requirement for diligent and thorough review of the case in all its particulars. If one agrees to do this, one must interact with attorneys, prepare opinions, and likely give testimony in deposition, and possibly at trial if the case is not settled. Accepting the responsibility for judging whether a colleague has fallen short of the standard of care, and harmed a patient through negligence, cannot be taken lightly. Guidelines for ethical conduct by an expert witness in a medical negligence tort have been developed and promulgated by the American College of Emergency Physicians and should guide physicians’ actions.

Sign in / Sign up

Export Citation Format

Share Document