Plastic surgery professional misconduct: a cross-sectional study on cases between 2008 and 2017, filed before the São Paulo State Medical Board

ABSTRACT BACKGROUND: In plastic surgery, a lack of ethical and moral behavior by professionals can result in unfortunate circumstances and can justify ethical-disciplinary procedures. OBJECTIVE: To review 421 plastic surgery professional-misconduct cases filed before the São Paulo State Medical Board (CREMESP) between 2008 and 2017. DESIGN AND SETTING: Cross-sectional study conducted in a medical council. METHODS: The cases were categorized according to sex, age, medical specialty (plastic surgery, other field or none), medical ethics code chapter(s) involved, ethics code articles violated and board ruling/outcome. RESULTS: Most of the defendants were men over 40 years of age who were experienced in their professional practice and who graduated from public and private universities all over Brazil; 47.74% had a specialist title in plastic surgery. Violation of professional responsibility (medical malpractice, recklessness or negligence) was the commonest complaint (28.43%), followed by medical advertising (24.19%) and poor doctor-patient relationship (10.39%), in violation of articles 18, 51, 75 and 1. Among the 233 cases adjudicated over this period, 133 resulted in disciplinary sanction, 80 were ruled in the physician's favor and 20 were dismissed. CONCLUSION: Classification of plastic surgery professional-misconduct cases creates possibilities for adopting preventive measures for good practice in this specialty, which would consequently reduce the number of complaints to the regional medical boards.

Classification of plastic surgery malpractice complaints brought before the São Paulo Medical Board that were treated as professional-misconduct cases: a cross-sectional study

ABSTRACT BACKGROUND: Nowadays, there is an ethical and moral necessity to establish rules that govern professional attitudes and conduct. In the medical field, these rules are multifaceted, given the health consequences inherent to medical procedures. Ethics is an even more delicate subject when it comes to plastic surgery, since one of the aims of this particular medical specialty is esthetic improvement of the body. OBJECTIVE: To survey and classify São Paulo State Medical Board investigations of plastic-surgery complaints that were treated as professional-misconduct cases between 2007 and 2016. DESIGN AND SETTING: Cross-sectional study conducted in a medical council. METHODS: A total of 360 cases were reviewed. Among these, 8 (2.23%) were dismissed, 1 (0.27%) became an administrative lawsuit and 351 (97.50%) were treated as professional-misconduct cases. RESULTS: A breakdown of the complaints filed over the nine-year period showed that complaints concerning malpractice were the most common (28.43%), followed by those regarding medical advertising (24.19%) and poor doctor-patient relationships (10.39%). CONCLUSION: Overall, the number of complaints lodged decreased over the last two years reviewed, although complaints regarding malpractice and poor doctor-patient relationships increased by 10% over the same period. In order to further reduce the number of medical board investigations, the medical establishment needs to carefully review the medical training of students and doctors at every stage of their careers.

The National Clinical Database as an Initiative for Quality Improvement in Japan

The JCVSD (Japan Cardiovascular Surgery Database) was organized in 2000 to improve the quality of cardiovascular surgery in Japan. Web-based data harvesting on adult cardiac surgery was started (Japan Adult Cardiovascular Surgery Database, JACVSD) in 2001, and on congenital heart surgery (Japan Congenital Cardiovascular Surgery Database, JCCVSD) in 2008. Both databases grew to become national databases by the end of 2013. This was influenced by the success of the Society for Thoracic Surgeons' National Database, which contains comparable input items. In 2011, the Japanese Board of Cardiovascular Surgery announced that the JACVSD and JCCVSD data are to be used for board certification, which improved the quality of the first paperless and web-based board certification review undertaken in 2013. These changes led to a further step. In 2011, the National Clinical Database (NCD) was organized to investigate the feasibility of clinical databases in other medical fields, especially surgery. In the NCD, the board certification system of the Japan Surgical Society, the basic association of surgery was set as the first level in the hierarchy of specialties, and nine associations and six board certification systems were set at the second level as subspecialties. The NCD grew rapidly, and now covers 95% of total surgical procedures. The participating associations will release or have released risk models, and studies that use 'big data' from these databases have been published. The national databases have contributed to evidence-based medicine, to the accountability of medical professionals, and to quality assessment and quality improvement of surgery in Japan.

Role of forensic medicine in administration of justice a critical review.

Two small round opaque shadows of metallic densities opined as that the injury was not a firearm injury but was self inflicted one by the first Medical Board under the Chairmanship of Chief Medical Officer. Opinion of another Medical Board comprising Forensic Medicine expert considered it as a: Clear cut case of firearm wound. Based on two contradictory opinions, Allahabad Court held that the Charge: sheet submitted under sections 323, 504, and 506 IPC, ought to have been submitted under some graver sections too. This paper deals with a critical review of case where two Medical Boards were constituted in the interest of justice. Views of various other relevant judgments of Hon’ble Supreme Court and various High Courts emphasizes the importance of Forensic Medicine in the administration of justice and need for refresher courses and training for medical officers suggested to avoid future recurrences of such nature are discussed in brief.

Res ipsa loquitor in post mortem examination.

The doctrine of Res ipsa loquitor means that “facts or thing speaks for itself”. It signifies that further details are unnecessary; the facts of the case are self-evident. This doctrine is applied when there is gross medical negligence on the part of treating doctor. It is often being presented when the damage resulted from teamwork where the doctor and some other persons were involved. In such circumstances, the doctor himself being ignorant about the cause of damage and the person actually responsible may find it difficult to prove his innocence, though he may actually be innocent. I am presenting here a case report of year 2008, which is a new type of example of Res Ipsa Loquitor in which an expert opinion was given by a board of medical doctors about medical negligence as per orders of Hon’ High Court on the basis of documents forwarded by Police.

Clinical Nutrition Education in Undergraduate Medical Education: A Questionnaire Investigation / 医学教育

To improve doctors' understanding of dietary and nutritional therapy, clinical nutrition must be taught during undergraduate medical education. Using questionnaires given to every medical university in Japan, we examined how clinical nutrition education has been adopted into their curricula. Only 9 (12.9%) of 70 universities have adopted this topic as a cultural or professional subject. Many other universities are performing nonintegrated nutrition education by teaching nutrition-related items in basic and clinical subjects. Although many nutrition-related topics are included in the Essentials for the National Medical Board Examination published by the Ministry of Health and Welfare, only 1% to 5% of the 320 to 330 questions appearing on the national medical board examination are nutritionrelated. The present report suggests that the nutritional knowledge of doctors and medical students is not sufficient. We believe that national guidelines for problem-based nutritional education as part of an integrated curriculum must be established. The present situation of nutrition education in the United States, the United Kingdom, and Europe are also discussed.