Medical Specialties and the Locality Rule: Evidence. Physicians & Surgeons. Malpractice. Expert Witnesses

1962 ◽  
Vol 14 (4) ◽  
pp. 884
2013 ◽  
Vol 18 (4) ◽  
pp. 7-10
Author(s):  
Deborah Rutt ◽  
Kathyrn Mueller

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.


VASA ◽  
2019 ◽  
Vol 48 (3) ◽  
pp. 262-269 ◽  
Author(s):  
Christian-Alexander Behrendt ◽  
Tilo Kölbel ◽  
Thea Schwaneberg ◽  
Holger Diener ◽  
Ralf Hohnhold ◽  
...  

Abstract. Background: Worldwide prevalence of peripheral artery disease (PAD) is increasing and peripheral vascular intervention (PVI) has become the primary invasive treatment. There is evidence that multidisciplinary team decision-making (MTD) has an impact on in-hospital outcomes. This study aims to depict practice patterns and time changes regarding MTD of different medical specialties. Methods: This is a retrospective cross-sectional study design. 20,748 invasive, percutaneous PVI of PAD conducted in the metropolitan area of Hamburg (Germany) were consecutively collected between January 2004 and December 2014. Results: MTD prior to PVI was associated with lower odds of early unsuccessful termination of the procedures (Odds Ratio 0.662, p < 0.001). The proportion of MTD decreased over the study period (30.9 % until 2009 vs. 16.6 % from 2010, p < 0.001) while rates of critical limb-threatening ischemia (34.5 % vs. 42.1 %), patients´ age (70 vs. 72 years), PVI below-the-knee (BTK) (13.2 % vs. 22.4 %), and rates of severe TASC C/D lesions BTK (43.2 % vs. 54.2 %) increased (all p < 0.001). Utilization of MTD was different between medical specialties with lowest frequency in procedures performed by internists when compared to other medical specialties (7.1 % vs. 25.7 %, p < 0.001). Conclusions: MTD prior to PVI is associated with technical success of the procedure. Nonetheless, rates of MTD prior to PVI are decreasing during the study period. Future studies should address the impact of multidisciplinary vascular teams on long-term outcomes.


2008 ◽  
Author(s):  
Richard J. Hornick ◽  
Hal W. Hendrick ◽  
Robert Kennedy ◽  
Kenneth Laughery ◽  
David Thompson
Keyword(s):  

1970 ◽  
Vol 09 (02) ◽  
pp. 75-80
Author(s):  
B. G. Lamson ◽  
W. S. Russell ◽  
J. Fullmore ◽  
W. E. Nix

Total information and communication systems within hospitals have been designed, but successful complete implementation, to date, has not been achieved. Limited applications with both patient medical data, notably in the clinical laboratories, and in the hospital accounting offices have been numerous. Although total programs are not yet a reality, it is apparent that the computer will serve ultimately many communication requirements, both medical and financial, within the hospital.Sound hospital management requires that costs of all component operations be known in order that value judgments concerning worth and efficiency may be made. Accrual accounting systems which match revenue and expense over the same time period are a prerequisite. Cash and modified cash hospital accounting cannot provide current reliable data for sound decision making.Costs of hospital operations cannot be evaluated unless related to the characteristics of the patient service load. Average per diem costs mean little except when large similar populations of patients are being compared. A modern hospital accrual accounting system should be able to provide information concerning the costs of caring for specific diseases in patients with known age and sex and disease severity characteristics. Without information of this type, it will not be possible to objectively evaluate alternative systems of financing and organizing patient care.Medical record management offers the promise of prospective use of patient disease information in the planning and scheduling of facilities. The prose content of medical record summaries, such as diagnostic statements in tissue pathology, radiology, and admission and discharge diagnoses, may be susceptible to non-coded, full prose input into computer controlled diagnostic files. Thesauri in the several medical specialties will be necessary for this achievement.There is little immediate prospect for complete hospital communication systems that can be made available as a package to any hospital without substantial local alteration. Pilot projects in teaching centers should be viewed for the time being as opportunities to define objectives, evaluate feasibility, and determine degree of risk and expense.A brief survey of applications in the United States which have been successfully implemented or which appear suitable for successful implementation is recorded.Eleven general principles which have been associated with successful implementation of computer applications within the UCLA Hospital are enumerated.


2018 ◽  
Vol 69 (7) ◽  
pp. 1813-1816 ◽  
Author(s):  
Ovidiu Gabriel Bratu ◽  
Radu Dragos Marcu ◽  
Bogdan Socea ◽  
Tiberiu Paul Neagu ◽  
Camelia Cristina Diaconu ◽  
...  

Retroperitoneal space is called sometimes no man�s land�and for a good reason: this is disputed anatomical territory for many surgical and medical specialties. Their wide histological diversity and unspecific clinical presentation make them a challenge for the surgeon. In order to improve their detection immunohistochemistry seems to show promising results. Methods of detection have evolved over time to identify as much as possible the histological type of tumor. Because of this extreme variability immunohistochemistry through its various markers is the one that often sets the definitive diagnosis, the simple histopathological examination being insufficient. This paper aims to highlight the main markers used in retroperitoneal tumors. As it can be seen there is a huge histologic areal for these tumors. Some have proven some of them still not. Given the fact that there is a tendency toward personalized therapy it is imperative to identify the histological type of tumor as soon as possible.


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