Medicolegal Expert Core Competencies and Professionalism.

Medicolegal expert opinions can be the source of long and senseless acrimonious debates when they lack the necessary qualities to be considered good evidence. In contrast, quality medicolegal expert reports contribute significantly to the proper and prompt resolution of personal injury claims in civil litigation. To this end, expert physiatrists must develop the medicolegal mindset necessary to survive and thrive in the civil litigation arena. Medicolegal core competencies needed for this endeavor are identified and addressed for what is a lifelong learning project.

La terminología en Medicina Física y Rehabilitación / Terminology in physical medicine and rehabilitation

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PATIENT'S RIGHT TO INFORMED CONSENT IN REPUBLIC SRPSKA: LEGAL AND ETHICAL ASPECTS (WITH SPECIAL REFERENCE TO PHYSICAL REHABILITATION).

The principle of informed consent, which requires a patient's fully-informed consent prior to the medical treatment, is closely connected with the value of human dignity. The realization and protection of a patient's dignity is not possible without his/her right to choose the character and scope of medical treatment. This goal cannot be adequately achieved within the traditional model of medical paternalism characterized by the physician's authoritative position. The first part of the article deals with the content and ethical significance of the informed consent doctrine. The legal framework of informed consent in Republic Srpska (RS), one of the two Bosnia and Herzegovina (BH)entities, is analyzed. Special reference is made to the relevance of the informed consent principle within the physical rehabilitation process. Although ethical aspects of physical rehabilitation are often overlooked, this medical field possesses a strong ethical dimension (including an appropriate realization of the patient's right to informed consent).

The United States' response to the World Report on Disability.

The 2011 Annual Disability Status Report notes a disability prevalence rate of 12.1% in the United States. People with disabilities of all ages are increasing in prevalence, and the prevalence increases with age. People with disabilities are high users of health care, have less social participation, and have a higher risk for poverty. Although the United States has a robust history of policy and legislation related to disability and rehabilitation, the ratification of the United Nations Conventions on the Rights of People with Disabilities recently failed in the United States Congress. However, in general, the United States is positioned fairly well regarding most aspects of rehabilitation including a strong rehabilitation science providing a sound base for evidence-based practice. Three key areas of further development emerge: education about disability and benefits of rehabilitation to decision makers and administrators who are concerned with the implementation of the Affordable Care Act, advocacy for a more robust organized presence and acknowledgement of rehabilitation science and research, and advocacy for education about disability and rehabilitation for physicians-in-training.

Published research and physiatric opinion in life care planning.

This article outlines the use of medical literature to support a physiatrist's expert opinion in the development of a life care plan and proposes a basic ethical code of conduct in performing medicolegal work.

La troncalidad una oportunidad para la especialidad / Core subjects: an opportunity for the specialty

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Patient Protection and Affordable Care Act: potential effects on physical medicine and rehabilitation.

The objective was to review pertinent areas of the Patient Protection and Affordable Care Act (PPACA) to determine the PPACA's impact on physical medicine and rehabilitation (PM&R). The law, and related newspaper and magazine articles, was reviewed. The ways in which provisions in the PPACA are being implemented by the Centers for Medicare and Medicaid Services and other government organizations were investigated. Additionally, recent court rulings on the PPACA were analyzed to assess the law's chances of successful implementation. The PPACA contains a variety of reforms that, if implemented, will significantly impact the field of PM&R. Many PPACA reforms change how rehabilitative care is delivered by integrating different levels of care and creating uniform quality metrics to assess quality and efficiency. These quality metrics will ultimately be tied to new, performance-based payment systems. While the law contains ambitious initiatives that may, if unsuccessful or incorrectly implemented, negatively impact PM&R, it also has the potential to greatly improve the quality and efficiency of rehabilitative care. A proactive approach to the changes the PPACA will bring about is essential for the health of the field.

Physical and rehabilitation medicine section and board of the European Union of Medical Specialists. Community context; history of European medical organizations; actions under way.

The European Community is based on a series of treaties and legal decisions, which result from preliminary documents prepared long before by different organizations and lobbies. The European union of medical specialists (Union européenne des médecins specialists [UEMS]) came into being in order to address the questions raised by European directives (e.g., free circulation of people and services, reciprocal recognition of diplomas, medical training, quality improvements). The specialty sections of the UEMS contribute actively to this work. The physical and rehabilitation medicine (PRM) section is composed of three committees: the PRM board is devoted to initial and continuing education and has published a harmonized teaching programme and organized a certification procedure, which can be considered as a European seal of quality; the Clinical Affairs Committee is concerned with the quality of PRM care, and it has set up a European accreditation system for PRM programs of care, which will help to describe PRM clinical activity more concretely; and the Professional Practice Committee works on the fields of competence in our specialty. This third committee has already published a White Book, and further documents are being prepared, based on both the International classification of functioning, disability and health (ICF) and reference texts developed by the French Federation of PRM.

[Texts ruling activity in nursing homes and rehabilitation institutions in France, from the 9th March 1956 decree to the 17th April 2008 decrees. Part of physical medicine and rehabilitation]. / Les textes réglementant l'activité en soins de suite et de réadaptation du décret du 9 mars 1956 aux décrets du 17 avril 2008. Place de la médecine physique et de réadaptation.

In France, inpatient care is provided in three different sectors: "medicine, surgery and obstetrics", "follow-up care and rehabilitation" (soins de suite et de réadaptation=SSR) and "long-term care". Physical medicine and rehabilitation is involved mainly in SSR. As of April 2008, there are new regulations aiming to improve prior texts, to implement rules that will be identical for public and private sectors and to prepare for the new payment-by-the-act funding system (in place of the prior global funding). Now, all SSR structures have a common general basis in terms of purpose and means and specific rules for various specialties. For example, coordination of a multidisciplinary team in specialized facilities dealing with musculoskeletal and nervous system disorders must be conducted by a physical medicine and rehabilitation (PMR) specialist. Patient admission criteria still need to be defined, as does the assessment of therapeutic objectives. The expertise of SSR facilities is recognized by the possibility of direct admission from home for ambulatory patients. Nevertheless, many specifics are missing in these new decrees. These specifications will be elaborated on a regional basis, in future endeavours within regional healthcare organizations.

Certification in neuromuscular medicine: a new neurologic subspecialty.

Information is provided concerning the new subspecialty certificate in neuromuscular medicine of the American Board of Psychiatry and Neurology and the eligibility requirements for such certification of practicing neurologists and child neurologists. The Accreditation Council for Graduate Medical Education has approved fellowship training in the subspecialty, and it is likely that residents who wish to pursue a career in neuromuscular medicine will select this training option.

[Educational objectives in the new interdisciplinary subject "Rehabilitation, Physical Medicine, Naturopathic Techniques" under the 9th Revision of the Licensing Regulations for Doctors--consensus recommendations of the German Society for Rehabilitative Sciences and the German Society for Physical Medicine and Rehabilitation]. / Lernziele im Querschnittsbereich Rehabilitation, Physikalische Medizin und Naturheilverfahren nach der 9. Revision der Approbationsordnung für Arzte--Gemeinsame Empfehlung der Deutschen Gesellschaft für Rehabilitationswissenschaften und der Deutschen Gesellschaft für Physikalische Medizin und Rehabilitation.

In October 2003 the 9 (th) revision of the Federal Medical Training Regulations (Approbationsordnung) came into effect. The new compulsory interdisciplinary subject "Rehabilitation, Physical Medicine, Naturopathic Treatment" offers the opportunity to teach all students in comprehensive concepts of Rehabilitation such as the International Classification of Functioning, Disability and Health (ICF) of the WHO and the new book 9 of the German Social Code (SGB 9), as well as Physical Medicine and Naturopathic Treatment. Since the content of this new subject has not been defined up to date a joint task force of the German Society of Rehabilitation Science and the German Society of Physical Medicine and Rehabilitation was founded in order to recommend teaching standards. As part of these teaching standards educational objectives are introduced in this article. They should guide the persons in charge of teaching the subject in the medical faculties. In some areas the students should acquire profound abilities and skills in addition to knowledge. The medical faculties may focus on different educational targets according to their individual teaching profile.

Legislative issues. The federal financing and regulation of physical medicine and rehabilitation services.

This article describes major elements in the federal legislative system of the United States affecting the financing and delivery of rehabilitation and related services to persons with disabilities. It deals with existing federal statutory law and regulations, as well as pending legislation dealing with patients rights in health care that has been passed by both bodies in Congress but is not law as of late 2001. The recently revised federal Medicare law financing much of the inpatient hospital rehabilitation and outpatient rehabilitation services is described in detail, as is the Medicare law financing graduate medical education. The article also discusses the Americans with Disabilities Act as it affects PMR professionals and the application of the Stark Physician Referral law as it applies to typical business transactions in the field of physical medicine and rehabilitation services. This information should assist PMR professionals in better understanding the legal regulatory system in which they provide services and support to their patients.

Informed consent in physical medicine and rehabilitation. The physician/patient relationship--the doctor as a fiduciary.

This article reviews the principle of informed consent and the ethical and legal bases upon which it rests. The process of obtaining an appropriate informed consent is explored, and the elements that make a consent valid are delineated. The principles of substitute decision-making and the special rules applied to circumstances such as emergency, therapeutic privilege, refusal of consent, and medical necessity are discussed. The concept of the relationship between physician and patient as a fiduciary relationship is explored as the fundamental basis for the modern doctrine of informed consent.

Legal issues in alternative health care.

This article reviews the use of alternative and complementary health care practices by orthodox medical practitioners. Many alternative modalities such as chiropractic, acupuncture, naturopathic, and homeopathic treatments are available, and modern patients who are increasingly "consumer-oriented" and educated may inquire about these treatments. The article examines issues of informed consent, standards, procedures, and liability as they relate to a medical practice that opts to provide alternative treatments.

A proposta do Comitê de Análise de Movimento da Sociedade Brasileira de Medicina Física e Reabilitaçäo / The proposal of the Movemente Analysis Committee of the Brazilian Society of Physical Medicine and Rehabilitation

O artigo descreve o processo de criaçäo do CAMO-SBMFR e seu papel a nível nacional e internacional, seus objetivos, a composiçäo de sua Comissäo Executiva, e as atividades já realizadas, em andamento e projetos futuros.