Subject(s)
Transgender Persons , Humans , United States , Transgender Persons/legislation & jurisprudence , Gastroenterology/ethics , Gastroenterology/legislation & jurisprudence , Gastroenterologists , Female , Delivery of Health Care/legislation & jurisprudence , Delivery of Health Care/ethics , MaleABSTRACT
Introduction: Medical professional liability (MPL) is a notable concern for many clinicians, especially in procedure-intensive specialties such as gastroenterology (GI). Comprehensive understanding of the basis for MPL claims can improve gastroenterologists' practice, lower MPL risk, and improve the overall patient care experience. This is particularly relevant in the setting of the increasing average compensation per paid GI-related MPL claim, and evolving healthcare delivery patterns and regulations.Areas Covered: MPL claims are generally grounded in the concept of negligence, a broad term that may apply to situations involving medical errors, ameliorable adverse events, inadequate informed consent and/or refusal, and numerous others. Though often not directly discussed in GI training or thereafter, there are various mechanisms and behaviors that can alter (decrease or increase) MPL risk. Additional dimensions of MPL include telemedicine, social media, and vicarious liability. We discuss these topics as well as takeaways to mitigate risk, thus reducing unnecessary clinician anxiety, promoting professional development, and optimizing healthcare outcomes.Expert Opinion: MPL risk is modifiable. Strong provider-patient relationships, through effective communication, patient reassurance, and enhanced informed consent, decrease risk, as does thorough documentation. Conversely, provider 'defensive' mechanisms intended to decrease MPL risk, including assurance and avoidance behaviors, may paradoxically increase it.
Subject(s)
Gastroenterology , Liability, Legal , Communication , Documentation , Gastroenterology/economics , Gastroenterology/legislation & jurisprudence , Gastroenterology/standards , Humans , Informed Consent , Liability, Legal/economics , Malpractice/economics , Malpractice/legislation & jurisprudence , Medical Errors/legislation & jurisprudence , Physician-Patient Relations , Risk FactorsABSTRACT
The rapid development of artificial intelligence (AI) and digital health raise concerns about equitable access to innovative interventions, appropriate use of health data and privacy, inclusiveness, bias and discrimination, and even changes to the clinician-patient relationship. This article outlines a number of ethical and legal issues when examining the use of AI in gastroenterology. Substantive ethico-legal principles including respect for persons, privacy and confidentiality, integrity, conflict of interest, beneficence, nonmaleficence, and justice, are discussed. Much of what we articulated is relevant to the use of AI in other medical fields. Going forward, consorted efforts should be use to address more particular and concrete problems, but for now, a principle-based approach is best used in problem-solving.
Subject(s)
Artificial Intelligence/ethics , Artificial Intelligence/legislation & jurisprudence , Gastroenterology/ethics , Gastroenterology/legislation & jurisprudence , Artificial Intelligence/trends , Confidentiality , Conflict of Interest , Gastroenterology/trends , Humans , Physician-Patient RelationsABSTRACT
ABSTRACT: A paradox describes the clash between 2 seemingly reasonable prepositions whose joint occurrence appears impossible. Like any other human endeavor, medicine is also filled with paradoxes that await resolution. This editorial lists several common paradoxes frequently encountered by clinical gastroenterologists. These examples illustrate the interplay between risk and benefit, cost and effect, disease and cure, and escape and exposure. It is hoped that addressing these paradoxes and trying to resolve their underlying contradictions will ultimately lead to a more efficacious and rational delivery of healthcare.
Subject(s)
Gastroenterology/ethics , Endoscopy, Gastrointestinal/ethics , Gastroenterology/education , Gastroenterology/legislation & jurisprudence , Hippocratic Oath , Humans , Liability, Legal , Risk AssessmentABSTRACT
OBJECTIVES: We aimed to investigate national allocation policies for pediatric liver transplantation (LT). METHOD: A survey was prepared by the European Society for Paediatric Gastroenterology Hepatology and Nutrition Hepatology Committee in collaboration with the North American Studies of Pediatric Liver Transplantation consortium. The survey was sent to pediatric hepatologists and transplant surgeons worldwide. National data were obtained from centrally based registries. RESULTS: Replies were obtained from 15 countries from 5 of the world continents. Overall donation rate varied between 9 and 35 per million inhabitants. The number of pediatric LTs was 4 to 9 per million inhabitants younger than 18 years for 13 of the 15 respondents. In children younger than 2 years mortality on the waiting list (WL) varied between 0 and 20%. In the same age group, there were large differences in the ratio of living donor LT to deceased donor LT and in the ratio of split liver segments to whole liver. These differences were associated with possible discrepancies in WL mortality. CONCLUSIONS: Similarities but also differences between countries were detected. The described data may be of importance when trying to reduce WL mortality in the youngest children.
Subject(s)
Gastroenterology/legislation & jurisprudence , Health Policy , Liver Transplantation/legislation & jurisprudence , Pediatrics/legislation & jurisprudence , Tissue and Organ Procurement/legislation & jurisprudence , Adolescent , Child , Child, Preschool , Female , Humans , Male , Waiting Lists/mortalitySubject(s)
Consent Forms/legislation & jurisprudence , Gastroenterologists/legislation & jurisprudence , Inflammatory Bowel Diseases/therapy , Malpractice/legislation & jurisprudence , Medical Errors/legislation & jurisprudence , Gastroenterologists/economics , Gastroenterologists/standards , Gastroenterology/economics , Gastroenterology/legislation & jurisprudence , Gastroenterology/standards , Humans , Inflammatory Bowel Diseases/diagnosis , Liability, Legal/economics , Malpractice/economics , Medical Errors/economics , Medical Errors/prevention & control , Practice Guidelines as Topic , Risk Factors , Risk Management/economics , Risk Management/legislation & jurisprudence , Risk Management/methodsABSTRACT
Litigation and compensation claims have started occurring with increasing frequency against gastroenterologists in India. A study of few such cases decided by Indian Courts shows that commonest reason for allegations of negligence being upheld by Indian Courts is an improper consent being taken. Professional organisations need to focus on these issues more aggressively than has been done in the past. Judgments which do not appear to be in conformity with standard medical practices need to be challenged in higher courts, failing in which they would become precedents for future similar judgments.
Subject(s)
Compensation and Redress/legislation & jurisprudence , Gastroenterology/legislation & jurisprudence , Jurisprudence , Malpractice/legislation & jurisprudence , Humans , India , Informed Consent/legislation & jurisprudence , JudgmentABSTRACT
The past decade has witnessed an outstanding scientific production focused towards the possible clinical applications of mesenchymal stromal cells (MSCs) in autoimmune and chronic inflammatory diseases. This raised the need of novel standards to adequately address quality, efficacy and safety issues of this advanced therapy. The development of a streamlined regulation is currently hampered by the complexity of analyzing dynamic biological entities rather than chemicals. Although numerous pieces of evidence show efficacy in reducing intestinal inflammation, some inconsistencies between the mechanisms of action of rodent vs human MSCs suggest caution before assigning translational value to preclinical studies. Preliminary evidence from clinical trials showed efficacy of MSCs in the treatment of fistulizing Crohn's disease (CD), and preparations of heterologous MSCs for CD treatment are currently tested in ongoing clinical trials. However, safety issues, especially in long-term treatment, still require solid clinical data. In this regard, standardized guidelines for appropriate dosing and methods of infusion could enhance the likelihood to predict more accurately the number of responders and the duration of remission periods. In addition, elucidating MSC mechanisms of action could lead to novel and more reliable formulations such as those derived from the MSCs themselves (e.g., supernatants).
Subject(s)
Gastroenterology/methods , Gastrointestinal Diseases/surgery , Government Regulation , Health Policy , Mesenchymal Stem Cell Transplantation , Mesenchymal Stem Cells/physiology , Regenerative Medicine/methods , Translational Research, Biomedical/methods , Animals , Biomarkers/metabolism , Gastroenterology/legislation & jurisprudence , Gastrointestinal Diseases/diagnosis , Gastrointestinal Diseases/metabolism , Gastrointestinal Diseases/physiopathology , Humans , Mesenchymal Stem Cell Transplantation/adverse effects , Mesenchymal Stem Cell Transplantation/legislation & jurisprudence , Mesenchymal Stem Cells/metabolism , Patient Safety , Phenotype , Regeneration , Regenerative Medicine/legislation & jurisprudence , Risk Factors , Translational Research, Biomedical/legislation & jurisprudence , Treatment OutcomeABSTRACT
Informed consent and refusal for pediatric procedures involves a process in which the provider, child, and parents/guardians participate. In pediatric gastroenterology, many procedures are considered elective and the process generally begins with an office visit and ends with the signing of the consent document. If the process is emergent then this occurs more expeditiously and a formal consent may not be required. Information about the procedure should be shared in a way that allows a decision-making process to occur for both the parent/guardian and the child, if of assenting age.
Subject(s)
Endoscopy, Gastrointestinal/legislation & jurisprudence , Gastroenterology/legislation & jurisprudence , Informed Consent/legislation & jurisprudence , Pediatrics/legislation & jurisprudence , Child , Decision Making , Disclosure/legislation & jurisprudence , Gastroenterology/methods , Humans , Parents , Pediatrics/methodsSubject(s)
Delivery of Health Care, Integrated/trends , Gastroenterology/trends , Health Care Reform/trends , Medicare/trends , Practice Management, Medical/trends , Reimbursement Mechanisms/trends , Delivery of Health Care, Integrated/economics , Delivery of Health Care, Integrated/legislation & jurisprudence , Forecasting , Gastroenterology/economics , Gastroenterology/legislation & jurisprudence , Health Care Costs/trends , Health Care Reform/economics , Health Care Reform/legislation & jurisprudence , Humans , Medicare/economics , Medicare/legislation & jurisprudence , Practice Management, Medical/economics , Practice Management, Medical/legislation & jurisprudence , Quality Improvement/trends , Quality Indicators, Health Care/trends , Reimbursement Mechanisms/economics , Reimbursement Mechanisms/legislation & jurisprudence , United StatesSubject(s)
Delivery of Health Care/legislation & jurisprudence , Delivery of Health Care/methods , Gastroenterology/legislation & jurisprudence , Gastroenterology/methods , Professional Competence/legislation & jurisprudence , Delivery of Health Care/ethics , Gastroenterology/ethics , Professional Competence/economicsABSTRACT
The optimal care of patients with inflammatory bowel disease depends on adherence to standards of care regarding diagnosis, informing the patient of potential risks of treatment, obtaining recommended baseline studies, and monitoring the patient for efficacy and adverse effects. In clinical research as well as practice, financial conflicts of interest must be disclosed and managed to insure that patients have sufficient information to make a decision regarding participation in a study and to insure their safety. Medical education of care-givers in training carries the obligation and liability to oversee the care of the IBD patient and insure that safe and optimal care. This review addresses medicolegal issues that can arise in the care of the patient with IBD. Clinicians who provide optimal care for patients with inflammatory bowel diseases (IBD) must employ appropriate diagnostic and therapeutic options and also adhere to standards of care and ethical principles. Ethical and medicolegal issues can arise from the failure to adhere to the standards of medical care, clinical research and education. In a report in the New England Journal of Medicine in 2011, gastroenterologists in the U.S. ranked 6th out of 26 subspecialities as the most commonly sued for malpractice, with the mean payment to the plaintiff of just under $200,000 [1]. It is noteworthy that two other specialties that involve invasive procedures ranked lower on the list than Gastroenterology. For example, Cardiology and Anesthesiology ranked 11th and 17th, respectively. In this review, nine of the pitfalls to adherence to the standards of practice for IBD are reviewed.
Subject(s)
Gastroenterology/ethics , Inflammatory Bowel Diseases/therapy , Practice Guidelines as Topic , Standard of Care/ethics , Gastroenterology/legislation & jurisprudence , Gastroenterology/standards , Humans , Malpractice , Patient Compliance , Standard of Care/legislation & jurisprudence , United States , WorkforceABSTRACT
Physician reimbursement is in a turbulent time. In 2013 and 2014 we have seen an increased public scrutiny of how Medicare sets reimbursement rates and questions about the American Medical Association's Relative Value Scale Update Committee (RUC). The AGA board requested that two members knowledgeable about the RUC process and related policies help members understand the RUC and how it impacts our field.
Subject(s)
Gastroenterology/economics , Health Care Costs , Health Policy/economics , Medicare/economics , Relative Value Scales , Advisory Committees , Gastroenterology/legislation & jurisprudence , Health Care Costs/legislation & jurisprudence , Health Policy/legislation & jurisprudence , Humans , Medicare/legislation & jurisprudence , Patient Protection and Affordable Care Act/economics , Patient Protection and Affordable Care Act/legislation & jurisprudence , Policy Making , Societies, Medical , United StatesABSTRACT
Throughout the past 20 years, the rising use of social media has revolutionized health care as well as other businesses. It allows large groups of people to create and share information, ideas, and experiences through online communications, and develop social and professional contacts easily and inexpensively. Our Gastroenterology organizations, among others, have embraced this technology. Although the health-care benefits may be many, social media must be viewed through a legal lens, recognizing the accompanying burdens of compliance, ethical, and litigation issues. Theories of liability and risk continue to evolve as does the technology. Social media usage within the medical community is fraught with potential legal issues, requiring remedial responses to meet patients' needs and comply with current laws, while not exposing physicians to medical malpractice and other tort risks.
Subject(s)
Gastroenterology/legislation & jurisprudence , Social Media/legislation & jurisprudence , Gastroenterology/ethics , Health Insurance Portability and Accountability Act , Health Personnel/ethics , Health Personnel/legislation & jurisprudence , Humans , Internet , Liability, Legal , Malpractice/legislation & jurisprudence , Organizational Policy , Privacy/legislation & jurisprudence , Social Media/ethics , United StatesABSTRACT
OBJECTIVES: In 2001, the University of Michigan Health System (UMHS) implemented a novel medical error disclosure program. This study analyzes the effect of this program on gastroenterology (GI)-related claims and costs. METHODS: This was a review of claims in the UMHS Risk Management Database (1990-2010), naming a gastroenterologist. Claims were classified according to pre-determined categories. Claims data, including incident date, date of resolution, and total liability dollars, were reviewed. Mean total liability incurred per claim in the pre- and post-implementation eras was compared. Patient encounter data from the Division of Gastroenterology was also reviewed in order to benchmark claims data with changes in clinical volume. RESULTS: There were 238,911 GI encounters in the pre-implementation era and 411,944 in the post-implementation era. A total of 66 encounters resulted in claims: 38 in the pre-implementation era and 28 in the post-implementation era. Of the total number of claims, 15.2% alleged delay in diagnosis/misdiagnosis, 42.4% related to a procedure, and 42.4% involved improper management, treatment, or monitoring. The reduction in the proportion of encounters resulting in claims was statistically significant (P=0.001), as was the reduction in time to claim resolution (1,000 vs. 460 days) (P<0.0001). There was also a reduction in the mean total liability per claim ($167,309 pre vs. $81,107 post, 95% confidence interval: 33682.5-300936.2 pre vs. 1687.8-160526.7 post). CONCLUSIONS: Implementation of a novel medical error disclosure program, promoting transparency and quality improvement, not only decreased the number of GI-related claims per patient encounter, but also dramatically shortened the time to claim resolution.