Stress and medical malpractice: Organizational risk assessment and intervention.

Four studies were conducted to examine both the relation between stress and medical malpractice and the impact of stress management programs in reducing malpractice risk. Sixty-seven hospitals and more than 12,000 individuals participated. In Study 1, hospital departments with a current record of malpractice reported higher levels of on-the-job stress than did matched, low-risk departments. In Study 2, workplace stress levels of 61 hospitals correlated significantly with frequency of malpractice claims. In Study 3, a longitudinal investigation was conducted to evaluate the impact of an organization-wide stress management program on the frequency of reported medication errors. Results suggest a significant drop in average monthly medication errors as a result of the program. Study 4 was a 2-year longitudinal investigation that compared the frequency of medical malpractice claims. Hospitals (n?=?22) that implemented an organization-wide stress management program had significantly fewer claims as compared with a matched sample of hospitals (n?=?22) that did not participate. Implications of these findings are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Specialist practice: advancing the profession?

In 1994, the United Kingdom Central Council for Nursing, Midwifery and Health Visiting (UKCC) completed its framework for post-registration education and practice. The UKCC's strategy was based upon the two principles of compulsory re-registration for all practising nurses and graduate-level (or equivalent) entry to specialist practice. It may be seen as the culmination of a gradual process of professionalization, as well as a response to changes in the organization and delivery of health care in the late 20th century. This paper uses both primary and secondary sources to trace the development of the new strategy, and its wider implications for the profession.     

Determinants of output in group and solo medical practice

Certain structural and environmental factors other than technical combination of resources and firm size are hypothesized to affect medical practice output. Four groups of variables related to physician attributes and activities, practice organization and patient characteristics, community characteristics, and factors specific to medical groups are examined by regression for correlation with two measures of practice output: gross revenue and total patient visits. Some tentative conclusions are discussed in relation to policies that might increase practice output.     

Tort of outrage in medical malpractice

Rats born of mothers fed a low protein diet (8% casein versus a normal 25% casein diet) starting 5 weeks prior to mating showed a 50-100% increase in protein synthesis in the brain and kidney on the day of birth. This effect was due to a 50-100% increase in the uptake of IP injected 14C-leucine in the malnourished rats. The proportion of total tissue radioactivity in the trichloroacetic acid-protein precipitates was the same in the 8% and 25% casein groups. For the most part, there were no significant diet related changes in uptake or incorporation of 14C-leucine in the brain, liver or kidney in the 8% and 25% casein groups on Days 5, 10-11 and 21. While the physiological basis of the diet related changes seen on the day of birth is unknown, the present data represent a previously undescribed effect of prenatal protein malnutrition.     

Revision of the medical malpractice law--legal aspects

Since the beginning of this century, modifications of the criminal law regarding medicine have been outlined frequently. The focus of these modifications was to eliminate the circumstance that each medical procedure is a criminal offense even if it was performed correctly and was successful. Treatment without consent was supposed to be punished. The draft recently submitted to the ministry of justice seems to be a failure. The prerequisites of an effective consent remain unclear. An incorrect information of the patient would be classified as intent and, thus, be punishable. By application of uncertain criteria, medical experiments and treatment procedures might be followed by excessive punishment.     

The feminization of the medical profession in Israel

Two factors have caused major changes in the gender composition of the Israeli medical profession in recent years: (i) a wave of immigration from the former USSR, which increased the doctor population by approximately 70% and which included a majority of women physicians, and (ii) the entry of more Israeli women into medical school. This report presents the current gender status of the Israeli medical profession, regarding students and physicians, and the choice of medical specialty and academic seniority, and compares gender differences in Israel with those in other countries. Traditional patterns of specialization persist in Israel, with women still concentrated in primary care (family medicine, paediatrics and psychiatry). In addition, women still face obstacles in entering the more prestigious (mainly surgical) specialties. Whilst the number of women in academic medicine has increased over the last decade, women are still concentrated in the lowest echelons of academic medicine. However, the steady trend towards the feminization of medicine will inevitably lead to an increase of women in all areas of the medical profession. Because cross-cultural studies have repeatedly revealed that women doctors have a more humanistic and personalized approach to patient care, a higher ratio of women in the profession should have a qualitative effect in this direction, despite the bureaucratic and fiscal constraints incumbent upon practising doctors. As more women become role models for medical students, their approach will influence the education of the doctors of the future.     

Medical practice guidelines in malpractice litigation: an early retrospective

The role of practice guidelines in malpractice litigation has been discussed in some theoretical detail. Little information is available, however, on how courts use guidelines or on the effort of state legislatures to explicitly link guideline compliance with malpractice defenses. We review all relevant case law and legislative enactments to shed light on the influence of medical malpractice on guidelines. We also use data from a nationwide survey of malpractice attorneys to supplement our legal analysis. Although guidelines are being used for both inculpatory and exculpatory purposes in common-law litigation (a two-way street), legislatures are interested in applying them only for exculpatory purposes (a one-way street).     

Medicaid reform: an opportunity for the osteopathic medical profession

The autoantigen in adjuvant arthritis in Lewis rats is still unknown despite the knowledge that the 65 kDa mycobacterial heat-shock protein (hsp) is involved in the disease process. T cells and antibodies obtained from rats with adjuvant arthritis respond to chondrocyte membrane antigen(s). In Western blots a 65 kDa chondrocyte membrane protein (CH65) is stained by sera from arthritic rats. In addition, spleen cells from rats with adjuvant arthritis proliferate in vitro to chondrocyte membranes and CH65 as antigens. Furthermore, pretreatment of rats with CH65 or mycobacterial hsp65 but not human hsp60, induces a significant retardation of the onset of adjuvant arthritis in Lewis rats. The data suggest that CH65 is a potential autoantigen involved in the pathogenesis of adjuvant arthritis in Lewis rats.     

Ethical and malpractice issues in hospital practice.

Ethical and malpractice issues arising in hospital practice are reviewed. Topics include (a) preparation and authorization to carry out clinical responsibilities, (b) personnel procedures, (c) financial and political forces influencing hospital policies, (d) billing procedures, (e) clinical procedures for responding to patients' needs, (f) confidentiality, (g) discrimination, (h) internship and training issues, (i) sexual abuse of patients, and (j) staff conflicts influencing patient care. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Career preferences of medical students: influence of a new four-week attachment in general practice

BACKGROUND: It is not clear why medical students choose one specialty over another. Experiences at medical school are extremely strong determinants of attitudes to the medical specialties, and attitude is the most important factor in determining choice. AIM: This study sought to describe the factors influencing career choices of final year medical students, the effect of a new four-week attachment in general practice on career choices, and changes in career choices towards or away from general practice between the final year and the end of the preregistration house officer year. METHOD: Career preferences, and influences on them, were assessed by questionnaires administered to 206 medical students undergoing their final clinical attachment at the University of Glasgow immediately before and immediately after a four-week attachment in general practice. These were followed up by a postal questionnaire at the end of the preregistration house officer year. RESULTS: One hundred and thirty-one students returned all three questionnaires. Before the attachment, students born outside the UK, and those who had a previous or intercalated degree were significantly less likely to put general practice as a career preference; female students were more likely to put it as their first career choice. After the attachment, the number stating that it was 'likely' or 'very likely' that they would choose general practice as a career increased from 60 to 72--mainly through male students changing their preference--but after the preregistration house officer year it had fallen back to 56. Seventeen of the preregistration house officers were planning to complete posts which would qualify for GP training. Reasons for changing preference towards general practice were mainly to do with a dislike of and disillusionment with hospital medicine and with the perceived lifestyle advantages of general practice. Reasons for changing preference away from general practice were mainly to do with positive feelings about hospital medicine and a dislike of the management aspects of general practice. CONCLUSION: The general practice attachment influenced students, especially males, towards a career in general practice, but this effect was transient. This cohort of doctors should be followed up in order to discover their ultimate career choices.     

Resident attrition from family practice residencies: United States versus international medical graduates

BACKGROUND: Attrition of residents from family practice residency programs may cause significant problems for faculty, residents, and patients. The objective of this study was to determine international medical graduates' attrition rate from family practice residencies, compared with US medical school graduates. METHODS: Surveys were sent to all family practice residency program directors asking them to calculate their attrition rate for a 10-year period. RESULTS: The overall response rate was 56.6%, but interpretable responses were received from 45% of all civilian, continental US family practice residencies. Responding programs did not differ from all family practice programs with respect to program overall. Of those residents leaving, 63% did so to enter other specialties. The attrition rate was 18.5% for international graduates, compared with 7.8% for US graduates (P < .0001). International graduates enrolled outside of the National Resident Matching Program (NRMP) were most likely to leave programs before completion. CONCLUSIONS: Attrition rates from family practice residency programs are higher for international medical graduates than for US graduates. International graduates enrolled outside of the NRMP were most likely to leave a program.