Search results for "Defensive Medicine"
showing 10 items of 10 documents
THE ROLE OF PATIENT-PHYSICIAN RELATIONSHIP IN CARE PROCESSES AND IN THE TECHNOLOGICAL TRANSITION OF HEALTHCARE
2023
Overdiagnosis and overimaging: an ethical issue for radiological protection
2019
Aims and objectives: This study aimed to analyse the key factors that influence the overimaging using X-ray such as self-referral, defensive medicine and duplicate imaging studies and to emphasize the ethical problem that derives from it. Materials and methods: In this study, we focused on the more frequent sources of overdiagnosis such as the total-body CT, proposed in the form of screening in both public and private sector, the choice of the most sensitive test for each pathology such as pulmonary embolism, ultrasound investigations mostly of the thyroid and of the prostate and MR examinations, especially of the musculoskeletal system. Results: The direct follow of overdiagnosis and overi…
Caesarean Section on Maternal Request-Ethical and Juridic Issues: A Narrative Review.
2022
In recent decades, the rate of caesarean deliveries has increased worldwide. The reasons for this trend are still largely misunderstood and controversial among researchers. The decision often depends on the obstetrician, his beliefs and experience, the characteristics of the patients, the hospital environment and its internal protocols, the increasing use of induction of labor, the medico-legal implications, and, finally, the mother’s ability to request delivery by caesarean section without medical indication. This review aims to describe the reasons behind the increasing demand for caesarean sections by patients (CDMR) and strategies aimed at reducing caesarean section rates and educating …
Recommendations for neonatologists and pediatricians working in first level birthing centers on the first communication of genetic disease and malfor…
2021
Abstract Background Genetic diseases are chronic conditions with relevant impact on the lives of patients and their families. In USA and Europe it is estimated a prevalence of 60 million affected subjects, 75% of whom are in developmental age. A significant number of newborns are admitted in the Neonatal Intensive Care Units (NICU) for reasons different from prematurity, although the prevalence of those with genetic diseases is unknown. It is, then, common for the neonatologist to start a diagnostic process on suspicion of a genetic disease or malformation syndrome, or to make and communicate these diagnoses. Many surveys showed that the degree of parental satisfaction with the methods of c…
Revisiting the patient–physician relationship under the lens of value co-creation and defensive medicine
2021
PurposeThis study formulates a new archetypical model that describes and re-interprets the patient–physician relationship from the perspective of two widespread phenomena in the healthcare delivery process: value co-creation (VCC) and defensive medicine (DM).Design/methodology/approachGrounded in the existing literature on VCC and DM, the authors designed and conducted 20 in-depth interviews with doctors (and patients) about their past relationships with patients (and doctors). After putting the recorded interviews through qualitative analysis with a three-level coding activity, the authors built an empirically informed model to classify patient–physician relationships.FindingsThe authors i…
The relationship between Value Co-creation and Defensive Medicine
The purpose of this study is to analyse the patient-physician relationship from the perspective of its consequences in terms of risk of defensive medicine behaviour and of likelihood of value co-creation occurrence. We develop, first, a theoretically informed model which explains the patient-physician relationship in terms of the two phenomena above mentioned; we then collect qualitative empirical data, elaborate on the theory, and develop an empirically informed model. The main result of this research is the definition of four archetypes of the patient-physician relationship, whose discussion leads to theoretical contributions and managerial implications.
Clinical manifestations of head and neck cancer in pediatric patients, an analysis of 253 cases in a single Brazilian center
2021
Pediatric head and neck cancer (PHNC) is rare and its nonspecific clinical manifestations may often lead to delayed diagnosis. We aimed to describe the signs, symptoms, and clinicopathological characteristics of PHNC. Medical records were retrospectively reviewed for all PHNC cases diagnosed from 1986 to 2016 affecting patients aged 19-years and younger from a tertiary referral center in Brazil. Demographic variables, anatomical site of primary tumors, histopathological diagnoses, signs and symptoms, and patterns of misdiagnosis were collected and interpreted by statistical and descriptive analysis. A total of 253 PHNC cases were included. The mean age was 9.3 years and male patients were m…
<p>Guidelines and Current Assessment of Health Care Responsibility in Italy</p>
2020
Clinical guidelines are a potential tool for improving the effectiveness and quality of healthcare, decreasing variability in clinical practice, and preventing adverse events. In the purview of Law no. 24/2017, adherence to national guidelines can lead to a reduction in medical malpractice claims and the practice of so-called "defensive medicine". The law has assigned a central role to the guidelines, establishing the National Institute of Health through the new Italian National Center for Clinical Excellence, Quality, and Security (CNEC) as the methodological guarantor in the process of national guideline development. Here we discuss the issue of professional liability as recently outlined…
Germany: Where Are We Going?
2012
Germany’s health policy, in the past, has tried to limit health expenditures by defining an overall health budget, by installing a DRG-system and by forcing patients to participate directly at health costs by demanding copayments. These measurements were somehow effective in keeping premiums stable but have led to resource allocation at the bedside and therefore on an implicit level. Yet, implicit-level decisions create ethical dilemmas for physicians as they not only have to deliver best medical care but shall also have cost in mind, are unjust because rationing criteria differ from one case to another, and create a general fear of legal uncertainty, in turn leading to defensive medicine w…
Defensive behavior in healthcare: the role of organizational factors
Defensive medicine occurs when a healthcare practitioner performs treatment or procedure to avoid exposure to malpractice litigation. Being the consequences of such a behavior nefarious both in terms of patient care, healthcare operations and cost, much has been done in terms of research and practice with the aim to reduce the likelihood of its occurrence. Because defensive medicine is strictly related to the doctor perception of the risk of litigation and its legal repercussions, in the last years, jurisprudence and insurance contract studies in healthcare focused on this topic, as well as national laws have been introduced with the goal of contrasting it. This paper argues and demonstrate…