ABSTRACT
BACKGROUND: The regulation of medical spas (med-spas) in the United States varies considerably from state to state with important ramifications for patient safety. OBJECTIVE: To describe the current state of med-spas in the United States and degree of medical oversight in these facilities. MATERIALS AND METHODS: Descriptive study based on web search and standardized phone interviews of med-spas in the most heavily populated cities in each state of the United States. Information obtained included the following: whether medical directors were listed; if so, whether they were advertised as being on site; medical directors' training and board certification; and services offered. RESULTS: Of 247 medical spas reviewed, 72% advertised a medical director on their website, and 6.5% claimed that the director was on site. Of listed medical directors, 41% were trained in dermatology and/or plastic surgery. In phone interviews, 79% of med-spas endorsed the medical director to be board certified, and 52% stated that the medical director was on site less than 50% of the time. CONCLUSION: There is significant variation in medical directorship and oversight among medical spas in the United States. Appropriate regulation of medical directors' training and the degree of oversight provided are warranted to optimize patient safety.
Subject(s)
Cosmetic Techniques/standards , Dermatology/standards , Health Facilities/legislation & jurisprudence , Health Facilities/standards , Physician Executives/legislation & jurisprudence , Physician Executives/standards , Certification/legislation & jurisprudence , Certification/standards , Cosmetic Techniques/statistics & numerical data , Dermatology/statistics & numerical data , Government Regulation , Health Facilities/statistics & numerical data , Humans , Patient Safety/legislation & jurisprudence , Patient Safety/standards , United States/epidemiologyABSTRACT
The roles and responsibilities of Canada's Chief Medical Officers of Health (CMOHs) are contested. On the one hand, they are senior public servants who confidentially advise government on public health matters and manage the implementation of government priorities. On the other hand, CMOHs are perceived as independent communicators and advocates for public health. This article analyzes public health legislation across Canada that governs the CMOH role. Our legal analysis reveals that the presence and degree of advisory, communication, and management roles for the CMOH vary considerably across the country. In many jurisdictions, the power and authority of the CMOH is not clearly defined in legislation. This creates great potential for confusion and conflict, particularly with respect to CMOHs' authority to act as public health advocates. We call on governments to clarify their preferences when it comes to the CMOH role and either amend the relevant statute or otherwise find ways to clarify the mandate of their CMOHs.
Subject(s)
Physician Executives/legislation & jurisprudence , Physician's Role , Canada , HumansSubject(s)
Physician Executives , Physicians , Delivery of Health Care/ethics , Delivery of Health Care/legislation & jurisprudence , Delivery of Health Care/standards , Ethics, Institutional , Ethics, Medical , Humans , Physician Executives/ethics , Physician Executives/legislation & jurisprudence , Physicians/ethics , Physicians/legislation & jurisprudence , South DakotaSubject(s)
Job Description , National Health Programs/organization & administration , Personnel Delegation/organization & administration , Physician Executives/organization & administration , Radiology Department, Hospital/organization & administration , Diagnosis-Related Groups/legislation & jurisprudence , Diagnosis-Related Groups/organization & administration , Germany , Humans , Medical Device Legislation/organization & administration , National Health Programs/legislation & jurisprudence , Personnel Management/legislation & jurisprudence , Physician Executives/legislation & jurisprudence , Radiation Protection/legislation & jurisprudence , Radiology Department, Hospital/legislation & jurisprudenceABSTRACT
A pesar de que la cefalea es, con diferencia, el principal motivo neurológico de consulta, y de la complejidad diagnóstica y terapéutica de algunos pacientes, el número de consultas monográficas de cefalea (CC) y de unidades de cefalea (UC) es muy reducido en nuestro país. En este artículo pasaremos revista a los principales argumentos que nos permitan, como neurólogos, defender la necesidad de la implementación de una CC/UC, dependiendo de la población que se debe atender, en todos nuestros servicios de neurología. Para ello deberemos, en primer lugar, vencer las reticencias internas, que hacen que la cefalea sea aún poco apreciada y atractiva dentro de nuestra especialidad. El hecho de que la cefalea justifique más de un cuarto de las consultas a un servicio de neurología estándar de nuestro país y de que existan más de 200 cefaleas diferentes, algunas de ellas realmente invalidantes, y las nuevas opciones de tratamiento para pacientes crónicos, como la OnabotulinumtoxinA para la migraña crónica o las técnicas de neuromodulación, obligan a introducir dentro de nuestras carteras de servicios la asistencia especializada en cefaleas. Aunque no disponemos de datos incontrovertibles, existen ya datos suficientes en la literatura que indican que esta atención es eficiente en pacientes con cefaleas crónicas no sólo en términos de salud, sino también desde el punto de vista económico (AU)
In spite that headache is, by far, the most frequent reason for neurological consultation and that the diagnosis and treatment of some patients with headache is difficult, the number of headache clinics is scarce in our country. In this paper the main arguments which should allow us, as neurologists, to defend the necessity of implementing headache clinics are reviewed. To get this aim we should first overcome our internal reluctances, which still make headache as scarcely appreciated within our specialty. The facts that more than a quarter of consultations to our Neurology Services are due to headache, that there are more than 200 different headaches, some of them actually invalidating, and the new therapeutic options for chronic patients, such as OnabotulinumtoxinA or neuromodulation techniques, oblige us to introduce specialised headache attendance in our current neurological offer. Even though there are no definite data, available results indicate that headache clinics are efficient in patients with chronic headaches, not only in terms of health benefit but also from an economical point of view (AU)
Subject(s)
Female , Humans , Male , Migraine Disorders/metabolism , Migraine Disorders/pathology , Physician Executives/economics , Physician Executives/education , Neurology/education , Pharmaceutical Preparations/administration & dosage , Botulinum Toxins/administration & dosage , Botulinum Toxins/metabolism , Calcitonin/deficiency , Calcitonin/metabolism , Migraine Disorders/complications , Migraine Disorders/diagnosis , Physician Executives/legislation & jurisprudence , Physician Executives/standards , Neurology , Pharmaceutical Preparations/metabolism , Botulinum Toxins/supply & distribution , Botulinum Toxins/standards , Review Literature as Topic , Calcitonin/standardsSubject(s)
Emergency Medical Services/economics , Emergency Medical Services/legislation & jurisprudence , Fees, Medical , Insurance, Health, Reimbursement/economics , Insurance, Health, Reimbursement/legislation & jurisprudence , National Health Programs/economics , National Health Programs/legislation & jurisprudence , Physician Executives/economics , Physician Executives/legislation & jurisprudence , Referral and Consultation/economics , Referral and Consultation/legislation & jurisprudence , Unconsciousness/economics , Unconsciousness/therapy , Germany , Humans , Informed Consent/legislation & jurisprudenceABSTRACT
The nephrologist serving as medical director of a dialysis clinic must understand that the role of director is not simply an extension of being a good nephrologist. The two roles-nephrology practice and the leadership of a dialysis clinic-may be filled by a single person. However, each role contains unique tasks, requiring specific skill sets, and each role comes with inherent, associated legal risks. The medical director assumes a new level of responsibility and accountability defined by contractual obligations to the dialysis provider and by state and federal regulations. Hence, a medical director is accountable not only for providing standard-of-care treatment to his or her private practice patients dialyzed at the clinic but also for maintaining the safety of the dialysis clinic patient population and staff. Accordingly, a nephrologist serving in the role of medical director faces distinct legal risks beyond typical professional liability concerns. The medical director must also be mindful of regulatory compliance, unique avenues to licensure board complaints, and implications of careless communication habits. A thoughtful and prepared medical director can mitigate these risk exposures by understanding the sources of these challenges: contractual obligations, pertinent regulatory responsibilities, and the modern electronic communications environment.
Subject(s)
Ambulatory Care Facilities/legislation & jurisprudence , Liability, Legal , Nephrology/legislation & jurisprudence , Physician Executives/legislation & jurisprudence , Physician's Role , Ambulatory Care Facilities/organization & administration , Communication , Contracts/legislation & jurisprudence , Guideline Adherence/legislation & jurisprudence , Humans , Licensure , Renal DialysisSubject(s)
Compensation and Redress/legislation & jurisprudence , Expert Testimony/legislation & jurisprudence , Malpractice/legislation & jurisprudence , Whistleblowing/legislation & jurisprudence , Cardiovascular Surgical Procedures/legislation & jurisprudence , Employment/legislation & jurisprudence , Female , Germany , Humans , Liability, Legal , National Health Programs/legislation & jurisprudence , Physician Executives/legislation & jurisprudence , Quality Assurance, Health Care/legislation & jurisprudenceSubject(s)
Delegation, Professional/legislation & jurisprudence , Elective Surgical Procedures/legislation & jurisprudence , Fee Schedules/legislation & jurisprudence , Financing, Personal/legislation & jurisprudence , Fraud/legislation & jurisprudence , National Health Programs/legislation & jurisprudence , Physician Executives/legislation & jurisprudence , Clinical Competence/legislation & jurisprudence , Contract Services/legislation & jurisprudence , Employment/legislation & jurisprudence , Germany , Humans , Pacemaker, Artificial/economics , Patient Advocacy/legislation & jurisprudence , Patient Education as Topic/legislation & jurisprudence , Reimbursement Mechanisms/legislation & jurisprudenceABSTRACT
The specialty of Nephrology, by virtue of its relationship with the dialysis procedure, is highly vulnerable to litigation. As is the case with all nephrologists, a dialysis unit medical director is not immune to medical malpractice suits, and can be held liable for any act of perceived or potential harm to any dialysis patient, regardless of the director's level of involvement. The medical director, per the Centers for Medicare and Medicaid Services (CMS) Conditions of Participation, accepts the responsibilities, accountability, and consequent legal liabilities of the quality of the medical care provided to every dialysis patient in the unit. This review is a synopsis of lawsuits filed against medical directors of dialysis units in the past forty years. Six categories of legal actions were noted; medical malpractice, fraudulent claims, self-referral and Stark Law, discrimination, negligence, and violation of patient autonomy and dignity.
Subject(s)
Hospital Units/legislation & jurisprudence , Liability, Legal , Physician Executives/legislation & jurisprudence , Renal Replacement Therapy , Humans , Malpractice , Medicaid , Medicare , Nephrology/legislation & jurisprudence , United StatesSubject(s)
Contract Services/legislation & jurisprudence , Employment/legislation & jurisprudence , Hospitals, Pediatric/legislation & jurisprudence , National Health Programs/legislation & jurisprudence , Physician Executives/legislation & jurisprudence , Confidentiality/legislation & jurisprudence , Cross Infection/prevention & control , Cross Infection/transmission , Disease Notification , Germany , Humans , Infant, Newborn , Infant, Premature, Diseases/prevention & control , Infection Control Practitioners/legislation & jurisprudence , Job Description , Male , Organizational Policy , Risk Management/legislation & jurisprudenceSubject(s)
Communication , Malpractice/legislation & jurisprudence , Medical Errors/legislation & jurisprudence , Physician-Patient Relations , Urology/legislation & jurisprudence , Compensation and Redress/legislation & jurisprudence , Cross-Sectional Studies , Documentation/standards , Expert Testimony/legislation & jurisprudence , Female , Germany , Humans , Malpractice/statistics & numerical data , Medical Errors/statistics & numerical data , Medical Records/legislation & jurisprudence , National Health Programs/legislation & jurisprudence , National Health Programs/statistics & numerical data , Negotiating , Patient Education as Topic/legislation & jurisprudence , Patient Education as Topic/standards , Physician Executives/legislation & jurisprudence , Pregnancy , TrustABSTRACT
Medical directors of cardiac rehabilitation/secondary prevention (CR/SP) programs are responsible for the safe and effective delivery of high-quality CR/SP services to eligible patients. Yet, the training and resources for CR/SP medical directors are limited. As a result, there appears to be considerable variability throughout CR/SP programs in the United States in the roles, responsibilities, and engagement of CR/SP medical directors. Since the publication of the 2005 scientific statement from the American Heart Association and American Association of Cardiovascular and Pulmonary Rehabilitation regarding medical director responsibilities for outpatient CR/SP programs, significant changes have occurred. This statement updates the responsibilities of CR/SP medical directors, in view of changes in federal legislation and regulations and changes in health care delivery and clinical practice that impact the roles and responsibilities of CR/SP medical directors.
Subject(s)
Cardiac Rehabilitation , Health Personnel/legislation & jurisprudence , Physician Executives/legislation & jurisprudence , Secondary Prevention/legislation & jurisprudence , American Heart Association , Cardiovascular Diseases/prevention & control , Humans , Outpatients , Societies, Medical , United StatesSubject(s)
Advisory Committees/legislation & jurisprudence , Health Priorities/legislation & jurisprudence , Patient Safety/legislation & jurisprudence , Physician Executives/legislation & jurisprudence , Research Report/legislation & jurisprudence , State Medicine/legislation & jurisprudence , Waiting Lists , Bullying , Female , Health Services Accessibility/legislation & jurisprudence , Hospital Bed Capacity , Hospital Mortality , Humans , Standard of Care/legislation & jurisprudence , United Kingdom , Whistleblowing/legislation & jurisprudenceSubject(s)
Employee Grievances/legislation & jurisprudence , Employment/legislation & jurisprudence , Negotiating/psychology , Nurse Administrators/legislation & jurisprudence , Nurse Administrators/psychology , Physician Executives/legislation & jurisprudence , Physician-Nurse Relations , Female , Humans , Salaries and Fringe Benefits/legislation & jurisprudence , SwitzerlandABSTRACT
The article reports about a medical malpractice case against the director of a psychiatric University Hospital, who was convicted for breach of secrecy by the Oberlandesgericht in Munich. The court found him guilty of issuing and giving to the plaintiff's wife an unauthorised psychiatric certificate, stating that the plaintiff, a carpet dealer for oriental rugs, who was caught in a war of roses with his wife at this time and was never a patient of the psychiatrist, let alone properly examined by him or his staff, suffered from an acute and severe psychosis with immediate need for compulsory admission. This all happened behind his back and enabled the wife to spread rumors of the alleged mental illness of her husband. Banks and trading partners therefore shunned him, which nearly caused his bankruptcy. This is why this unusual case led to the decision that the psychiatrist had to reimburse Euro 15000 for pain and suffering and additionally cover all material damages resulting from the tort.