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In the Name of Allah the Compassionate, the Merciful

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????? ?????? ????? ???????????? ???? ?????. Medical Malpractice. M.H.Ghadiani,M.D. ... The Holy Qur'an, Surah: Al-M idah(Part of 32) ???? ????? ????? ?????. 5 ... – PowerPoint PPT presentation

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Title: In the Name of Allah the Compassionate, the Merciful


1
  • In the Name of Allah the
    Compassionate, the Merciful

2
?? ??????The God Is Healing
3
Medical MalpracticeM.H.Ghadiani,M.D.Internist
Fellowship of NephrologyAssistant Professor of
Legal Medicine Organization of Iran
4
  • And he who saves a man,s life shall be considered
    as one who has saved the life of mankind as a
    whole.
  • (?? ??? ??????? ????????? ??????????? ???????)
  • The Holy Quran,
    Surah Al-Mâidah(Part of 32)

5
Every physician must be answerable to three
judges
  • Allah almighty or divine justice court
  • His/her conscience or internal judge
  • External judge or authorized courts

6
  • The main principle in medicine is that whatever a
    physician does for a patient is to be a benefit
    but not to be harm for him/her. So, when a harm
    is created by physician, it has occurred against
    his/her will. In condition that the physician
    does it according to medical and scientific
    rules, has not made a mistake or error and he/she
    will not be considered as culpable.

7
  • Physician is free to do whatever
  • is deemed to be right and justified and hence
    he is not obliged to act without knowledge or
    insight, if he/she is not certain about what to
    do, he/she can consult with his/her colleagues or
    refer to valid scientific centers. Whenever there
    is freedom, the responsibility is also with it,
    therefore the physician is liable for his/her
    deeds (right or wrong).

8
When a physician doesnt do whichever of
diagnosis and remedial stages well, he/she
commits a medical malpractice, such
asHistory taking, Clinical and Para clinical
examinations, On time diagnosis, Correct remedy,
Post- treatment follow- up, Counseling and
necessary guidance according to medical
scientific rules
9
Authorized courts which considering complaints
and medical errors in Islamic Republic of Iran
  • Medical council organization
  • Legal Medicine organization (L.M.O)
  • Inspection organization of Iran-subunit of the
    judiciary
  • Governmental punishments organization- subunit of
    Ministry of Justice
  • Ministry of Health, Treatment and Medical
    training
  • University of Medical Sciences
  • Judicial courts of justice

10
  • Types of medical malpractice
  • Carelessness
  • Improvidence
  • Lack of proficiency
  • Inattention to governmental rules
  • Mixed

11
  • Carelessness
  • Abandonment of an indispensable action such as
  • Not to give Oxygen or Salbutamole spray to the
    asthmatic patient in emergency situation
  • Not to take ECG in a patient with sustained
    chest pain suspected to IHD (Ischemic Heart
    Disease)
  • Not doing Necessary consultation
  • Not taking blood pressure in hypertensive patient

12
  • Improvidence
  • Commit a wrong action without careful attention
    such as
  • Administration of Prostaglandin instead of
    Progesterone in a pregnant woman with spotting
  • Ureter is blocked instead of uterine artery in
    the course of hysterectomy
  • Remain sterile gas in abdominal cavity during
    surgery
  • Operation on normal leg instead of injured one

13
  • Lack of proficiency
  • 1. Scientific
  • Unawareness regarding to the routes of drug
    administration
  • Unawareness regarding to a specific method of
    surgery
  • 2. Practical
  • Mismanagement of normal vaginal delivery
  • Using wrong cast or splint resulted in
    compartment syndrome

14
  • Inattention to governmental rules
  • Non acceptance of emergency patient
  • Establishment of clinic without license
  • Performing some of the surgical operations which
    must not be done in private offices
  • Not sending biopsy sample to pathologist

15
  • Conditions of negligence attribution to the
    physician act
  • The duty of patient's treatment would be with
    him.
  • The scientific rules and technical methods in
    diagnosis and treatment of patient would not be
    obeyed.
  • Followed by these, the patient would be injured
    physically, psychologically, financially or
    spiritually.

16
  • Physician with having large scale of great
    knowledge, sufficient information, proficiency in
    his/her specialty, good intention in his/her
    manners and with respect to related laws and
    rules, he/she is sometimes, unsuccessful in
    his/her patient's management.

17
  • Despite of advances in diagnostic
  • and therapeutic fields of medicine,
    dissatisfaction of the patients from physicians
    is increasing.
  • This subject has a significant role in health and
    medical care systems in all of the world.

18
  • An investigation in England showed that there are
    one hundred oral complaints for every written
    complaint and 4 dissatisfied patients for every
    oral complaint, Consequently every written
    complaint is followed by nearly 400 dissatisfied
    patients.

19
  • A study at New York hospitals shows that 1 of
    hospitalized patients suffer from physical
    injuries arising from medical malpractice.

20
  • Physician
  • Patient
  • judge
  • form a triangle.

21
  • Different types of relationship
  • between physicians and the law
  • Forensic medicine specialist
  • Consultant (usually specialist in other fields of
    medicine)
  • Witness
  • Defendant
  • Plaintiff

22
The causes of increasing of complaints against
physicians
  • Increase in population
  • Increasing of physicians
  • Inattention to medical ethics and relationship
    between physician and patient
  • Inattention to proper history taking and
    physical examination
  • Increasing of patient's awareness about their
    rights
  • Complexity and diversity of diseases
  • Use of invasive diagnostic and treatment
    procedures

23
The causes of increasing of complaints against
physicians
  • Lack of proficiency of physicians
  • Inattention to governmental rules
  • Not explanation of patients by physicians about
    diagnostic and treatment procedures

24
  • Some of the complications are both predictable
    and preventable
  • Some of them are predictable but not preventable
  • Some of them are neither predictable nor
    preventable

25
  • Complication is different from malpractice.
    Malpractice means the errors which have been
    caused to avoidable injuries and damages.
  • Complaint can be against physician, remedial
    system or medical staff.
  • Non ideal conclusion on treatment of a patient,
    is not necessarily meaning malpractice

26
  • The physicians legal responsibility may
    have various aspects
  • Patients motive for complaining is only
    compensation of financial loss. In these cases
    the physician can benefit from insurance that
    covers such losses.
  • physician may be criminally liable in cases such
    as illegal abortion that would be punishable and
    is not covered by insurance contracts.
  • Both legal and criminal liability cases exist,
    for example when a patient dies because of
    illegal abortion. In these cases the legal part
    can be covered by insurance, but the criminal
    part is not covered.

27
Main topics for medical malpractice prevention
  • 1. Notice to medical ethics especially based on
    teaching of Islam
  • 2. Improvement of relationship between physician
    and patient
  • 3. Increase of knowledge and practical skills of
    physicians
  • 4. Necessity of organizing the retraining
    seminars and congregations for quantity and
    quality promotion of medical services

28
  • 5. Increasing constant supervision on medical
    measures
  • 6. Paying attention to governmental rules
  • 7. Promotion of technical and medical equipments
    of hospitals, remedial and diagnostic centers
  • 8. Patients education regarding to the
    complications of diagnostic and therapeutic
    procedures

29
  • The surveys show that, among different kinds of
    malpractices, inexperienced physicians most
    involved in carelessness and lack of proficiency
    Whereas, experienced physicians most involved
    in improvidence and inattention to governmental
    rules.

30
  • Whatever you can, be in the service of the needy,
  • With a bit of advice, or a help or a penny
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