Pathology Expert Witness Testimony and Pathology Practice: A Tale of 2 Standards

2005 ◽  
Vol 129 (10) ◽  
pp. 1268-1276
Author(s):  
Elliott Foucar
Keyword(s):  
Literature Review ◽  
Expert Testimony ◽  
Medical Literature ◽  
Expert Witness ◽  
Critical Role ◽  
Standard Of Care ◽  
Background Information ◽  
Malpractice Litigation ◽  
Expert Opinions ◽  
Mesh Terms

Abstract Context.—Pathologists work in an environment in which, to the extent possible, diagnostic decisions are based on scientific principles. It can therefore be a rather shocking experience when a pathologist finds one of his or her diagnostic decisions being evaluated by a legal system developed and controlled by lawyers and judges rather than by scientists or pathologists. This experience can be even more troubling when a key participant in the proceedings is a fellow pathologist guiding a jury toward an unfamiliar interpretation of the pathology standard of care. Objective.—To provide the interested pathologist with the background information necessary to (1) understand the role of expert testimony in malpractice litigation and (2) understand why there can be a gap between expert opinions expressed in court and expert opinions expressed in a medical care context. Data Sources.—Medical literature review supplemented by review of subspecialty position papers, selected articles from newspapers and magazines, and legal decisions. The medical literature review was limited to articles published in English and was based largely on articles retrieved using the MeSH terms expert testimony/legislation & jurisprudence, and pathology/legislation & jurisprudence. Conclusions.—Medical error has become an increasingly important topic for pathologists, and although errors or allegations of error are evaluated in many ways, the evaluation with the most impact on the individual pathologist is a malpractice case. During the last decade physicians have increasingly become aware of the critical role played by expert testimony in malpractice litigation. Some physicians have asserted that providing expert testimony is the practice of medicine, and that it is unacceptable for juries to be presented with expert testimony that incorrectly describes medical practice standards. However, this opinion has been vigorously opposed by attorneys who feel that juries are best able to come to a correct conclusion if they base their deliberations on a broad spectrum of opinion. Gaining an increased role in the oversight of expert testimony would allow physicians to establish a closer alignment between opinions expressed in court testimony and opinions expressed in clinical practice. However, despite some physician success in inserting themselves into the oversight process, both physicians and physician organizations attempting to take action against misleading expert testimony continue to be vulnerable to legal attack.

A Trial Consultant's View of the Medical Expert Witness

2013 ◽  
Vol 18 (4) ◽  
pp. 7-10
Author(s):  
Deborah Rutt ◽  
Kathyrn Mueller
Keyword(s):  
Nonverbal Communication ◽  
Expert Testimony ◽  
Medical Literature ◽  
Expert Witness ◽  
Personal Injury ◽  
Expert Witnesses ◽  
Good Teacher ◽  
Medical Expert ◽  
Medical Terms ◽  
Medical Issues

Abstract Physicians who use the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) often serve as medical expert witnesses. In workers’ compensation cases, the expert may appear in front of a judge or hearing officer; in personal injury and other cases, the physician may testify by deposition or in court before a judge with or without a jury. This article discusses why medical expert witnesses are needed, what they do, and how they can help or hurt a case. Whether it is rendered by a judge or jury, the final opinions rely on laypersons’ understanding of medical issues. Medical expert testimony extracts from the intricacies of the medical literature those facts the trier of fact needs to understand; highlights the medical facts pertinent to decision making; and explains both these in terms that are understandable to a layperson, thereby enabling the judge or jury to render well-informed opinions. For expert witnesses, communication is everything, including nonverbal communication that critically determines if judges and, particularly, jurors believe a witness. To these ends, an expert medical witnesses should know the case; be objective; be a good teacher; state opinions clearly; testify with appropriate professional demeanor; communicate well, both verbally and nonverbally; in verbal communications, explain medical terms and procedures so listeners can understand the case; and avoid medical jargon, finding fault or blaming, becoming argumentative, or appearing arrogant.

Medicolegal Issues in Pathology

2008 ◽  
Vol 132 (2) ◽  
pp. 186-191
Author(s):  
Timothy Craig Allen
Keyword(s):  
Medical Records ◽  
Medical Malpractice ◽  
Expert Witness ◽  
Standard Of Care ◽  
Tort Law ◽  
Malpractice Litigation ◽  
Litigation Process ◽  
Risk Managers ◽  
Medicolegal Issues

Abstract The various methods used by risk managers to assist clinicians in handling medicolegal risk, including improving communication with patients and better dealing with medical records issues, are not particularly of benefit to pathologists. An understanding of tort law, the theory of negligence, the principle of standard of care, and the role of the expert witness helps the pathologist generally assess and manage risk and put it into context with daily pathology practice. An understanding of the litigation process and techniques to better handle a deposition and high-risk specimens or diagnoses are of practical value in avoiding a lawsuit or increasing the likelihood for good outcome in medical malpractice litigation.

The Role of Forensic Medicine in Medical Errors

2017 ◽  
pp. 144-170
Author(s):  
Grigorios Leon
Keyword(s):  
Forensic Medicine ◽  
Medical Errors ◽  
Crucial Role ◽  
Expert Witness ◽  
Standard Of Care ◽  
Medical Liability ◽  
Court Cases ◽  
Doctor Who ◽  
Malpractice Litigation

This chapter presents the importance of Legal and Forensic Medicine in medical malpractice and explains how autopsies have a crucial role for the evaluation and the prevention of medical errors. Health systems vary from country to country; however, experts are indispensable in each system. In fact, experts' opinions are asked for resolution of specific court cases. Standard of care is often assessed by expert medical witnesses who testify for one of the litigants. The physician who acts as an expert witness is one of the most important figures in malpractice litigation. Therefore, a doctor who is an expert witness has to have certain training and qualifications and to act under common recommendations. The ideal medical expert seems to be the forensic doctor. In the future, a harmonization of practices could be applied in medical liability cases and the guidelines provided by the medico-legal community could constitute a stable base for their evaluation.

Practice Guidelines

1998 ◽  
Vol 15 (1) ◽  
pp. 57-62
Author(s):  
Melvin A. Shiffman
Keyword(s):  
Practice Guidelines ◽  
Cost Containment ◽  
Medical Malpractice ◽  
Medical Literature ◽  
Standard Of Care ◽  
Malpractice Litigation

Developing clearly written, scientifically valid, and flexible practice guidelines can aid in cost containment and in the resolution of medical malpractice litigation. Practice guidelines should keep in mind both clinicians and patients and should focus on specific clinical circumstances. Deviation from the guidelines should be supported by peer-reviewed medical literature. These guidelines, if properly researched and prepared, may serve as the standard of care.

scholarly journals Inhibition of Glycine Re-Uptake: A Potential Approach for Treating Pain by Augmenting Glycine-Mediated Spinal Neurotransmission and Blunting Central Nociceptive Signaling

Biomolecules ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. 864
Author(s):  
Christopher L. Cioffi
Keyword(s):  
Spinal Cord ◽  
Dorsal Horn ◽  
Therapeutic Potential ◽  
Opioid Analgesic ◽  
Critical Role ◽  
Analgesic Efficacy ◽  
Standard Of Care ◽  
Current Standard ◽  
Glycine Transporters ◽  
Pathological Pain

Among the myriad of cellular and molecular processes identified as contributing to pathological pain, disinhibition of spinal cord nociceptive signaling to higher cortical centers plays a critical role. Importantly, evidence suggests that impaired glycinergic neurotransmission develops in the dorsal horn of the spinal cord in inflammatory and neuropathic pain models and is a key maladaptive mechanism causing mechanical hyperalgesia and allodynia. Thus, it has been hypothesized that pharmacological agents capable of augmenting glycinergic tone within the dorsal horn may be able to blunt or block aberrant nociceptor signaling to the brain and serve as a novel class of analgesics for various pathological pain states. Indeed, drugs that enhance dysfunctional glycinergic transmission, and in particular inhibitors of the glycine transporters (GlyT1 and GlyT2), are generating widespread interest as a potential class of novel analgesics. The GlyTs are Na+/Cl−-dependent transporters of the solute carrier 6 (SLC6) family and it has been proposed that the inhibition of them presents a possible mechanism by which to increase spinal extracellular glycine concentrations and enhance GlyR-mediated inhibitory neurotransmission in the dorsal horn. Various inhibitors of both GlyT1 and GlyT2 have demonstrated broad analgesic efficacy in several preclinical models of acute and chronic pain, providing promise for the approach to deliver a first-in-class non-opioid analgesic with a mechanism of action differentiated from current standard of care. This review will highlight the therapeutic potential of GlyT inhibitors as a novel class of analgesics, present recent advances reported for the field, and discuss the key challenges associated with the development of a GlyT inhibitor into a safe and effective agent to treat pain.

Bezlotoxumab: Could This be the Answer for Clostridium difficile Recurrence?

2017 ◽  
Vol 51 (9) ◽  
pp. 804-810 ◽  
Author(s):  
Ryan W. Chapin ◽  
Tiffany Lee ◽  
Christopher McCoy ◽  
Carolyn D. Alonso ◽  
Monica V. Mahoney
Keyword(s):  
Monoclonal Antibody ◽  
Clostridium Difficile ◽  
English Language ◽  
Adverse Drug Events ◽  
Data Extraction ◽  
Standard Of Care ◽  
Phase Iii ◽  
Relative Reduction ◽  
Two Phase ◽  
Mesh Terms

Objective: To review the pharmacology, pharmacokinetics, efficacy, safety, and place in therapy of bezlotoxumab (BEZ), a novel monoclonal antibody against Clostridium difficile toxin B. Data Sources: A PubMed search was conducted for data between 1946 and April 2017 using MeSH terms bezlotoxumab, MK-6072, or MDX-1388 alone and the terms Clostridium difficile combined with monoclonal antibody or antitoxin. Study Selection and Data Extraction: The literature search was limited to English-language studies that described clinical efficacy, safety, and pharmacokinetics in humans and animals. Abstracts featuring prepublished data were also evaluated for inclusion. Data Synthesis: BEZ is indicated for adult patients receiving standard-of-care (SoC) antibiotics for C difficile infection (CDI) to prevent future recurrence. Two phase III trials—MODIFY I (n = 1452) and MODIFY II (n = 1203)—demonstrated a 40% relative reduction in recurrent CDI (rCDI) with BEZ compared with placebo (16.5% vs 26.6%, P < 0.0001). The most common adverse drug events associated with BEZ were mild to moderate infusion-related reactions (10.3%). Conclusions: In patients treated with SoC antibiotics, BEZ is effective in decreasing rCDI. BEZ has no apparent effect on treatment of an initial CDI episode. In light of increasing rates of CDI, BEZ is a promising option for preventing recurrent episodes. The greatest benefit has been demonstrated in high-risk patients, though the targeted patient population is yet to be defined.

Healthcare supply chain management: literature review and some issues

2018 ◽  
Vol 15 (3) ◽  
pp. 265-287 ◽  
Author(s):  
Bhavana Mathur ◽  
Sumit Gupta ◽  
Makhan Lal Meena ◽  
G.S. Dangayach
Keyword(s):  
Supply Chain ◽  
Supply Chain Management ◽  
Literature Review ◽  
Organizational Performance ◽  
Critical Role ◽  
Sample Survey ◽  
Future Research ◽  
Chain Management ◽  
Content Type ◽  
Potential Benefits

PurposeThe purpose of this paper is to examine the causal linkages among supply chain practices, effectiveness of supply chain performance (SCP) and organizational performance (OP) in Indian healthcare industries.Design/methodology/approachThis paper is helpful in developing a framework for linking a healthcare supply chain practice to its OP, and thus identifies how such a linkage can be connected to the effectiveness of SCP. Such effort also enables the authors to derive a set of recommended supply chain practices for SC performance.FindingsFrom the literature review, this paper finds that, in the context of Indian healthcare industries, efficient SC performance may play a critical role for overall OP improvement, as there is a close interrelationship between supply chain management (SCM) practices and SCP that may have a more significant effect on OP improvement.Research limitations/implicationsThe principle limitation of the paper is that it is performed only in a particular industry and with a questionnaire survey which could be extended in future for other industries also. Another limitation of the paper is that it is focused only on the SCP of medical device and equipment supply chain which is a small portion of the whole healthcare supply chain, and therefore requires further research covering various other domains of healthcare supply chain. Another limitation of the study is that the sample survey has been taken from only one respondent per company at one point of time which may create biasness in the results. Thus, future research should collect data through multiple members from the organization.Practical implicationsThis study contributes to know the effect of SCM practices on healthcare SCP and provides a practical and useful tool to evaluate the extent of effectiveness of SCP and finally their impact on the healthcare OP. Finally, this study provides conceptual and descriptive literature regarding SCM practices that leads to improvement in healthcare performance.Social implicationsThis study adds to the knowledge on healthcare SCM performance by exploring the relationship between supply chain practices, healthcare SCP and healthcare OP and by developing and testing a research framework thus help in improving patient satisfaction.Originality/valueThis study attempts to show how the potential benefits of supply chain practices can no longer be ignored in healthcare supply chain.

Medication errors associated with oral administration of methotrexate. Data from spontaneous reporting and medical literature review

2017 ◽  
Vol 148 (7) ◽  
pp. 330-332
Author(s):  
M. Esther Salgueiro-Vázquez ◽  
María Sáinz Gil ◽  
Silvia Fernández Peña ◽  
Luis H. Martín Arias
Keyword(s):  
Literature Review ◽  
Oral Administration ◽  
Medication Errors ◽  
Spontaneous Reporting ◽  
Medical Literature

Acute Herpetic Nasopharyngitis in an Adult Patient: A Case Report and Literature Review

2022 ◽  
pp. 000348942110701
Author(s):  
Cathleen C. Kuo ◽  
Ellen M. Piccillo ◽  
Jason C. DeGiovanni ◽  
Matt Kabalan ◽  
Gregg Zimmer ◽  
...  
Keyword(s):  
Literature Review ◽  
Adult Patient ◽  
Soft Palate ◽  
Case Reports ◽  
Nasal Congestion ◽  
English Literature ◽  
Immunohistochemical Analysis ◽  
Anatomical Location ◽  
Posterior Aspect ◽  
Mesh Terms

Objective: To report a case of herpes virus-associated nasopharyngitis in an adult patient. Methods: The patient’s medical record was reviewed for demographic and clinical data. For literature review, all case reports or other publications published in English literature were identified using Pubmed with the MeSH terms “herpes,” “nasopharyngitis,” and “upper respiratory infection.” Results: A 40-year-old male presented for nasal congestion and a suspected nasal mass. Computed tomography of the sinuses revealed edematous changes in the nasopharynx which exerted a downward mass effect at the right aspect of the soft palate. Flexible fiberoptic laryngoscopy (FFL) revealed a lesion arising from the posterior aspect of the soft palate with extension into the posterior nasal cavity as well as copious mucopurulent secretions consistent with a superimposed acute sinusitis. Rigid nasal endoscopy demonstrated a friable and ulcerated lesion arising from the aforementioned anatomical location. Biopsy of this lesion and subsequent immunohistochemical analysis revealed a diagnosis of herpetic nasopharyngitis. Conclusions: Herpetic infection should be in the differential diagnosis of patients presenting with atypical symptoms of nasopharyngitis. Early accurate diagnosis and appropriate specific management can limit the duration of disease course and prevent further complications.

scholarly journals Spirituality review on mental health and psychiatric nursing

2018 ◽  
Vol 71 (suppl 5) ◽  
pp. 2323-2333 ◽  
Author(s):  
Gabriel Lavorato Neto ◽  
Larissa Rodrigues ◽  
Diego Alexandre Rozendo da Silva ◽  
Egberto Ribeiro Turato ◽  
Claudinei José Gomes Campos
Keyword(s):  
Mental Health ◽  
Literature Review ◽  
Psychiatric Nursing ◽  
Clinical Approach ◽  
Theoretical Problem ◽  
Human Being ◽  
Research Education ◽  
Professional Boundaries ◽  
Mesh Terms ◽  
Spirituality And Religion

ABSTRACT Objective: Gather the concepts, theories and interventions about spirituality, its nature and functions in mental health and psychiatric nursing. Method: A literature review proceeded on February 2016. It has integrated 214 studies published until December 2015 by crossing Spirituality and Psychiatric Nursing mesh terms in databases. Results: Conceptualization about spirituality and religion, their complexity in nursing research, education, and clinical approach; their functions to human being correlated to the purpose of life, transcendental connections, and support in mental health; the professional boundaries in address to spirituality in mental health scenery, and a descriptive literature recommendations and a instruments catalog. Conclusions: Spirituality in nursing mental health and psychiatry remains a theoretical problem, and has a clinical mischaracterized approach; recently publications try to promote a human and holistic trend in the practice, as a challenge to lead the current circumstances to valid nursing bases.

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