Medico-legal Responsibilities Research Articles

Exploring the Impacts of Artificial Intelligence Interventions on Provider Practice practice

Abstract Background Despite the growing prevalence of AI in healthcare, there has been a lack of recent studies exploring its impact on providers’ practices and patient outcomes. This study investigates healthcare providers’ perceptions of AI interventions’ influence on their practice efficiency and patient outcomes, as well as the correlation between providers’ perceptions of AI and its effects on patient outcomes. Methods A self-administered questionnaire was mailed to 38 healthcare providers at a rural medical center in north Texas, with a 70% percent response rate (n = 27). In addition to descriptive statistics, multivariable logistic regression test was conducted to discern the relationship between their perceptions of AI and its impact on patient outcomes. Results The findings revealed that a majority of providers perceived AI to still be in its early stages, posing challenges for practice and having a limited impact on patient outcomes. Additionally, various factors such as age, gender, a user-centered design approach, AI experience, along with perceptions of workplace support and stress, significantly shape providers’ attitudes toward AI and ultimately affecting patient outcomes. Conclusions Before AI technology can fulfill its promise of transforming healthcare through integration with other technologies, the healthcare sector must address numerous hurdles. It is crucial to approach the development and testing of intricate systems like AI-integrated electronic health record (EHR) systems with caution to ensure their reliability and dependability in clinical decision-making. Additionally, navigating medico-legal responsibilities and pursuing fair distribution of benefits are equally crucial. Key messages • This study offers insights into the extent of AI interventions’ impact on healthcare. • This study specifically focuses on enhancing patient care, reducing costs, and improving the efficiency of the healthcare system.

Malpractice litigation in multidisciplinary cancer care: Navigating medico-legal challenges and shared decision making in India

Healthcare professionals participating in multidisciplinary team (MDT) cancer meetings may not have a comprehensive understanding of their medicolegal responsibilities in current times. This article aims to delineate the principal medicolegal issues pertinent to multidisciplinary cancer care and offer recommendations for future implementation. Key concerns highlighted in this literature encompass patient consent and privacy during MDT meetings, professional liability, the formal expression of dissenting views and the duty of care. The analysis of existing literature prioritizes several recommendations for addressing these issues. Given the limited precedent available for formulating recommendations, this article identifies foundational evidence that can inform the practicing clinicians of these concerns in future MDT practices.Navigating decision-making processes in cancer care poses significant challenges for patients. This article seeks to elucidate the significance of shared decision making (SDM) within the Indian clinical context while pin pointing disparities compared to Western practices. Through a systematic search conducted in Medline and Google Scholar from 2000 to 2019, approximately 400 articles were screened, resulting in the selection of 43 relevant articles (5 from India and 38 from Western sources). The literature underscores a scarcity of information on shared decision making in India as compared to Western contexts, potentially leading to adverse physical, psychological and financial consequences reported by patients. According to one study, While Western data demonstrate extensive involvement of both patients and physicians in consensus-building for treatment decisions, such engagement in India is predominantly observed in tertiary care settings, academic institutions or cases with high therapy costs. Cultural beliefs and biases further influence patient engagement, while communication breakdowns correlate strongly with medicolegal malpractice litigations. Future research endeavours are warranted to explore strategies for integrating shared decision making into routine oncology practice in India. Physicians must actively involve patients or their immediate family members in decision-making processes to ensure a patient-centric approach, thereby mitigating the risks of un-informed decision-making or mistrust in the treating physician's expertise. Efforts such as physician and patient education, tool development, policy formulation, widespread implementation and periodic assessments hold promise for advancing the practice of shared decision making.

Challenges to establishing and maintaining kidney transplantation programs in developing countries: What are the coping strategies?

Kidney transplantation (KT) is the optimal form of renal replacement therapy for patients with end-stage renal diseases. However, this health service is not available to all patients, especially in developing countries. The deceased donor KT programs are mostly absent, and the living donor KT centers are scarce. Single-center studies presenting experiences from developing countries usually report a variety of challenges. This review addresses these challenges and the opposing strategies by reviewing the single-center experiences of developing countries. The financial challenges hamper the infrastructural and material availability, coverage of transplant costs, and qualification of medical personnel. The sociocultural challenges influence organ donation, equity of beneficence, and regular follow-up work. Low interests and motives for transplantation may result from high medicolegal responsibilities in KT practice, intense potential psychosocial burdens, complex qualification protocols, and low productivity or compensation for KT practice. Low medical literacy about KT advantages is prevalent among clinicians, patients, and the public. The inefficient organizational and regulatory oversight is translated into inefficient healthcare systems, absent national KT programs and registries, uncoordinated job descriptions and qualification protocols, uncoordinated on-site investigations with regulatory constraints, and the prevalence of commercial KT practices. These challenges resulted in noticeable differences between KT services in developed and developing countries. The coping strategies can be summarized in two main mechanisms: The first mechanism is maximizing the available resources by increasing the rates of living kidney donation, promoting the expertise of medical personnel, reducing material consumption, and supporting the establishment and maintenance of KT programs. The latter warrants the expansion of the public sector and the elimination of non-ethical KT practices. The second mechanism is recruiting external resources, including financial, experience, and training agreements.

Assessment of Medico-legal Knowledge among Internees of a Medical College, Kolkata: A Cross-sectional Study

Medical professionals around the world are encountering medico-legal issues in their daily practices. This is particularly problematic as patients or consumers are becoming increasingly aware of their rights. The term "medico-legal" refers to the intersection of two professions: medicine and law. It encompasses the legal and ethical duties of physicians as well as the medico-legal assessment of patients to ensure the smooth functioning of society. The consequences of an uninformed doctor making a mistake can be severe. Therefore, it is imperative that medical professionals have a thorough understanding of their rights and responsibilities. Addressing the issue of inadequate knowledge of legal medicine and the legal aspects of medical practice is critical and should be dealt with promptly. This present study was done to evaluate the level of knowledge regarding medico-legal issues among the internees of Calcutta National Medical College, Kolkata and to make the future medical professionals aware regarding their medico-legal responsibilities. An institution based cross-sectional descriptive study was conducted among internees of Calcutta National Medical College. Internees who were absent on the days of data collection, unwilling to give consent were excluded from the study. Data were collected by using a pre-designed, pre-tested and semi-structured questionnaire. The study was conducted among 195 interns of Calcutta National Medical College, Kolkata. Among them 115 (59%) were male, 173 (88.7%) were below the age of 25 years, 16 (8.2%) belonged to middle to lower socio-economic class and 110 (56.4%) were residing in hostel. Only 60 (30.8%) students showed interest in doing internship in Forensic Medicine &Toxicology (FMT). About one-third of study subjects 55 (28.2%) had inadequate knowledge regarding medico-legal aspects. While assessing knowledge regarding medico-legal aspects overall mean score was 13.96 ± 2.67. The study revealed that upper socio-economic class (p=0.043), doing internship in FMT (p=0.041) were found to be statistically significant. Multi-nominal bivariate analysis showed that students who did internship in FMT department had better medico-legal knowledge than others.The objective of the current study was to assess the level of knowledge of medico-legal aspects among future medical professionals. The results indicated that completing a residency in the FMT department positively impacted their understanding of medico-legal issues. To address any knowledge gaps and increase awareness of legal aspects, it is recommended that the optional rotatory internship in FMT be made compulsory. This would ensure that all medical professionals have a comprehensive understanding of various legal aspects.

Impact on Medicolegal Responsibilities of High Workload of Emergency Physicians

Impact on Medicolegal Responsibilities of High Workload of Emergency Physicians

Balancing care and responsibility: The role of the general practitioner in specialist referrals.

Referrals are a critical component of the Australian healthcare system, with referrals from general practitioners (GPs) to non-GP specialists making up the majority of medical referrals. Given the key role referrals have in primary healthcare, it is important that GPs understand their legal and professional responsibilities when providing a referral and ensure they refer appropriately and effectively to provide the best healthoutcomes for patients. This article explores GP referrals to other health professionals and aims to describe a doctor's medicolegal obligations and responsibilities when making a referral. The responsibility of GPs in the referral process reflects their central coordinating role as providers of primary care, and the reliance patients place upon them to adviseand recommend treatment and investigations. Understanding the medicolegal obligations and responsibilities when writing a referral can help GPs find the right balance between respecting patient autonomy and the professional obligation to take reasonable steps to ensure referrals and investigations are acted upon appropriately. The key to an effective referral process is clear communication between practitioners and patients, to help align the expectations of all involved so they can agree and implement a shared treatment plan in the interests of the patient.

Radiologists’ perceptions of knowledge and training required by radiographers in the interpretation of radiographic images: An explorative study in KwaZulu-Natal province, South Africa

IntroductionThe health sector of South Africa is burdened by the shortage of radiologists leading to the under-reporting of radiographic images and ultimately mismanagement of patients. Previous studies have recommended training of radiographers in radiographic image interpretation in order to improve the reporting. There is paucity of information regarding the knowledge and training required by radiographers to interpret radiographic images. The purpose of this study was therefore to explore the knowledge and training required by diagnostic radiographers, according to radiologists, for the interpretation of radiographs. MethodA qualitative descriptive study employing criterion sampling to select qualified radiologists practicing in the eThekwini district of the KwaZulu Natal province, was conducted. One-on-one and in-depth, semi-structured interviews were used to collect data from three participants. The interviews were not carried out face to face as a result of the Covid 19 pandemic and the regulation of social distancing. This did not permit engagement with research communities. The data from the interviews were analysed using Tesch's eight steps for analysing qualitative data. ResultsFindings revealed that radiologists supported the interpretation of radiographic images by radiographers in rural settings, and for the radiographer's scope of practice to be restructured to include the reporting of chest and the musculoskeletal system images. The themes that emerged from the analysis included knowledge, training, clinical competencies and medico-legal responsibilities required by radiographers in the interpretation of radiographic images. ConclusionAlthough the radiologists support the training of radiographers in the interpretation of radiographic images, radiologists think that the scope of practice should be limited to the interpretation of the chest and musculoskeletal systems in rural areas only.

Anti-Coronavirus Disease 2019 Vaccines: Need for Informed Consent.

Vaccines are among some of the most efficacious medical and public health methods ever employed to contain a pandemic, in addition to providing protective and preventive measures. Evaluation of vaccineassociated adverse events through experimentation and empirical evidence is an integral part ofthoroughly assessing the safety of vaccines before authorization of their widespread use. History has highlighted the importance of continuous search for possible vaccine-related adverse effects and vaccine-induced immunogenicity long afterlicensure, suggesting that a primary concern with new vaccines is not only efficacy but also safety, particularly overthe long term. Many of the various anti-COVID-19 vaccines have used different types of technology, with some being introduced for the first time or rushed shortly into testing, bypassing animal experimentations. They have been adopted for use through emergency use authorizations, leading to a less than optimal collection of broad data on safety, immunogenicity, effectiveness, and time span of protection, as well as short follow-up of few months, despite many infectious disease experts arguing thatit takes 10 years to develop a vaccine. Given the valid concerns on well-recognized short-term and long-term safety issues, such as antibody-dependent enhancement and other processes like molecular mimicry and potential genomic transformation, the experimental nature of the vaccination process, the limited shortterm follow-up in the main trials, and the dismissal by law of pharma companies and health care providers from any medico-legal responsibilities, the application of an informed consent should become not only a necessity but also mandatory by law in accordance with all declarations on human rights. Such information should be provided to every potential recipient in the form of an official written digital consent prior to the registration for or the receipt of the vaccine.

Doctors' understanding of consent law.

Obtaining informed consent is an important responsibility of all doctors and is a major component of their day-to-day practice. However, little is known regarding practising doctors' understanding of consent in relation to medical law. To gain insights into current doctors' understanding of the legal requisites that underpin the consent of patients to medical procedures in Australia. A cross-sectional survey of Western Australian medical practitioners was conducted. A 15-question online questionnaire (SurveyMonkey, USA) was developed and distributed to Western Australia medical practitioners via social media, hospital-based Junior doctor society pages and through the email accounts of practitioners registered with MDA National - a large medical defence organisation. Doctors were questioned on their understanding of medicolegal responsibilities, informed consent practice and knowledge of a historically significant Australian medicolegal case (Rogers v Whitaker, 1992). A total of 172 responses was received during the survey period. The respondents came from various levels of seniority and from a variety of subspecialist areas. The survey demonstrated that among the respondents, the understanding of their medicolegal responsibilities around the issues of informed consent was deficient. Only 31% of respondents were aware that it is a court of law that defines the reasonable standard of care in relation to obtaining informed consent. Less than half of the respondents (48%) were aware of the High Court of Australia's definition by which the standard of reasonable care is defined. The results from our survey suggest that there is a requirement to enhance the education of medical practitioners to meet the medicolegal requirements and optimise consent.

A cross-sectional study on the attitude and knowledge assessment of ayurveda teachers, practitioners and students about practical application of Agadatantra

BackgroundAgadatantra is one of the eight clinical branches into which Ayurveda medicine is traditionally divided. The term Agadatantra is used specifically for the branch of Ayurvedic medicine dealing with poisons, its description, and its antidotes. The other parts of the subject include Vyavahar Ayurveda and Vidhi Vaidyaka which are comprehensible with forensic medicine and medical jurisprudence of modern medical sciences. Being one of the important subjects during the undergraduate studies of Ayurveda (BAMS), it holds a substantial position in the entire syllabus. The present study was designed to appraise the attitude and knowledge of Ayurveda graduates on the practical application of the subject in day to day professional life. Materials and methodsIt was a cross-sectional study conducted online among the students, teachers, and practitioners of Ayurveda. A pre-validated survey questionnaire was uploaded on GoogleDocs. The sharable link was made available online from 12thNovember 2018 to 31st Jan 2020 for recording the responses of the volunteers. Analysis of the responses was conducted thereafter. ResultsA total of 2128 participants expressed their opinion through this online survey which evaluated the views of scholars of Ayurveda regarding Agadatantra and contemporary allied subjects. Most of the respondents 65.27% were male and 30.83% holding BAMS as their highest qualification, 34.02% were postgraduate (MD) in Agadatantra; 55.03% (n = 1171) were academicians and 63.06% participants had an opinion that current UG& PG teaching is not sufficient to know about medico-legal responsibilities. ConclusionThe survey shows that there are few downsides in the existing teaching methodologies of Agadatantra. The existing syllabus should be revised entirely considering it as one of the clinical subjects. Concrete practical based teaching with ample clinical exposure is the need of the hour in the subject of Agadatantra to enhance its practical applicability.

The multi-disciplinary team – Who is liable when things go wrong?

The question of culpability over decisions made by the multi-disciplinary team (MDT) is a contentious one. Currently, all members present remain responsible for the MDT's decision, but it is unclear whether the onus of decision making lies with the patient's “lead clinician”, and how straight to test pathways (bypassing a consultation with a specialist prior to MDT discussion) impact on this. Additionally, should a non-consensus recommendation be reached, it remains undetermined how dissenting members of the MDT would be viewed in a court of law. Given these uncertainties, there remains a substantial risk of legal action against the MDT as a group. Until case law materialises to provide clarification on these issues, clinicians should improve their awareness over their medico-legal responsibilities and proceed with caution.

FINAL YEAR MEDICAL STUDENTS’ KNOWLEDGE, ATTITUDE AND PRACTICE OF MEDICO-LEGAL PROBLEMS: A CROSS SECTIONAL STUDY AT IBN SINA NATIONAL COLLEGE IN JEDDAH

Forensic medicine encompasses various subspecialties that involve resolving legal issues using diverse techniques. Medical students should be prepared for their near future career, in particular, the challenge of facing medico-legal cases with their consequent legal responsibilities. The aim of the study was to assess final year medical students’ knowledge, attitude and practice of medico-legal problems. This crosssectional study included randomly selected 138 6th year medical students at Ibn Sina National College in Jeddah. 56 (40.6%) were male and 82 (59.4%) were female, aged 24.46±1.45 years, and 114 (82.6%) were Saudis. A pre-designed, self-answered 23-item questionnaire in English was devised by a specialist in the field and circulated though Survey-Monkey forms from November 2018 to January 2019. Most students had good knowledge (66.27%) and positive attitude (71.47%). Some had poor (14.49%) or no knowledge (19.24%), negative (15.67%), or borderline attitude (14.31%). Poor responses were the legal value of incomplete reports (28.99%), notifications of relatives before police notification (15.94%) and informed consent before photographing (21.74%). Many students (44%) had negative attitude towards their current medico-legal overall education and knowledge. Only 14.5% had been previously involved in photographic documentation. Students thought that the main sources of stress/pressure during managing medico-legal problems were the victim’s relatives (69.79%), followed by fear of legal consequences (54.17%). They also thought that the best educational stage for medico-legal training programs should be during undergraduate years (57.25%), or less frequently during residency (55.8%) or post-graduate years (46.38%). In conclusion, final year medical students were prepared for their future practice by good knowledge and positive attitude towards medico-legal problems. However, many gaps were detected between theory and practice. Therefore, we recommend medical colleges to initiate an undergraduate clinical forensic medicine training program. Moreover, residents and post graduate emergency physicians need to know their medico-legal responsibilities and to acquire technical skills to perform forensic evaluations of victims.

Medicolegal responsibilities for the administration of intravenous contrast media by radiographers: Radiologists’ perspectives

Background. Global trends in the delivery of healthcare services have placed tremendous strain on resources, among them human and capital. With this has emerged the need to revisit the job requirements and/or scope of practice of cadres within a profession, to ensure adequate training where needed. The administration of intravenous contrast media (IVCM), a fundamental element of expertise within the radiology field, is an example of such evolution in South Africa (SA). Currently falling within radiologists’ scope of practice, it has become necessary for radiographers to extend their own scope to include this skill, owing to the national shortage of radiologists and subsequent service delivery constraints, as well as the need to close the gap with international trends. Objective. To provide a synopsis of the perspectives of radiologists on the medicolegal responsibilities related to the administration of IVCM by radiographers. Methods. A quantitative, descriptive, cross-sectional research design was conducted, targeting qualified radiologists in KwaZulu-Natal Province (KZN). An online questionnaire was administered through SurveyMonkey that provided information on the medicolegal responsibilities associated with the administration of IVCM. Results. Of a total of 97 qualified radiologists in KZN, a response rate of 48.5% ( n =47) was obtained. The majority of respondents felt that radiographers should be responsible for obtaining informed patient consent (66.0%), and deciding on the site of IVCM administration (72.3%). It was also felt that the radiologists should remain responsible for decisions regarding the type and dose of IVCM (87.2%) and managing the possible complications and adverse reactions due to the administration of IVCM (78.7%). Conclusion. Evidence-based research provides a contextualised approach towards addressing transformation in service delivery and training needs. This study, in demonstrating the importance of appropriate medicolegal responsibilities in the extension of a professional role, forms a basis for informing the future training of radiographers in SA.

Medicolegal responsibilities for the administration of intravenous contrast media by radiographers: Radiologists’ perspectives

Background. Global trends in the delivery of healthcare services have placed tremendous strain on resources, among them human and capital. With this has emerged the need to revisit the job requirements and/or scope of practice of cadres within a profession, to ensure adequate training where needed. The administration of intravenous contrast media (IVCM), a fundamental element of expertise within the radiology field, is an example of such evolution in South Africa (SA). Currently falling within radiologists’ scope of practice, it has become necessary for radiographers to extend their own scope to include this skill, owing to the national shortage of radiologists and subsequent service delivery constraints, as well as the need to close the gap with international trends. Objective. To provide a synopsis of the perspectives of radiologists on the medicolegal responsibilities related to the administration of IVCM by radiographers. Methods. A quantitative, descriptive, cross-sectional research design was conducted, targeting qualified radiologists in KwaZulu-Natal Province (KZN). An online questionnaire was administered through SurveyMonkey that provided information on the medicolegal responsibilities associated with the administration of IVCM. Results. Of a total of 97 qualified radiologists in KZN, a response rate of 48.5% ( n =47) was obtained. The majority of respondents felt that radiographers should be responsible for obtaining informed patient consent (66.0%), and deciding on the site of IVCM administration (72.3%). It was also felt that the radiologists should remain responsible for decisions regarding the type and dose of IVCM (87.2%) and managing the possible complications and adverse reactions due to the administration of IVCM (78.7%). Conclusion. Evidence-based research provides a contextualised approach towards addressing transformation in service delivery and training needs. This study, in demonstrating the importance of appropriate medicolegal responsibilities in the extension of a professional role, forms a basis for informing the future training of radiographers in SA.

Health professionals' perspectives on exercise referral and physical activity promotion in primary care: Findings from a process evaluation of the National Exercise Referral Scheme in Wales.

Background and objectives:Referring clinicians’ experiences of exercise referral schemes (ERS) can provide valuable insights into their uptake. However, most qualitative studies focus on patient views only. This paper explores health professionals’ perceptions of their role in promoting physical activity and experiences of a National Exercise Referral Scheme (NERS) in Wales.Design:Qualitative semi-structured group interviews.Setting:General practice premises.Methods:Nine semi-structured group interviews involving 46 health professionals were conducted on general practice premises in six local health board areas. Purposive sampling taking into account area deprivation, practice size and referral rates was employed. Interviews were transcribed verbatim and analysed using the Framework method of thematic analysis.Results:Health professionals described physical activity promotion as important, although many thought it was outside of their expertise and remit, and less important than other health promotion activities such as smoking cessation. Professionals linked decisions on whether to advise physical activity to patients to their own physical activity levels and to subjective judgements of patient motivation. While some described ERS as a holistic alternative to medication, with potential social benefits, others expressed concerns regarding their limited reach and potential to exacerbate inequalities. Barriers to referral included geographic isolation and uncertainties about patient selection criteria, medico-legal responsibilities and a lack of feedback about patient progress.Conclusion:Clinicians’ concerns about expertise, priority setting and time constraints should be addressed to enhance physical activity promotion in primary care. Further research is needed to fully understand decision making relating to provision of physical activity advice and use of ERS.

The medico-legal aspects of prescribing vitamin D.

Vitamin D is a particularly important sterol hormone and its effects beyond bone are increasingly recognized. Over the last decade clinical interest has grown in vitamin D, with increased recognition of deficiency and hence increased prescribing of vitamin D products. However, the increased prescription of vitamin D has generally been met with unlicensed vitamin D products which potentially expose the patient to clinical risk. This review discusses the issues relating to the clinical use of unlicensed vitamin D products, safety concerns that may arise from this, as well as discussing the medico-legal responsibilities of the prescriber and dispenser.

Employee Health in the Mental Health Workplace: Clinical, Administrative, and Organizational Perspectives.

Issues of mental health and employee health have risen to increasing prominence in recent years. However, there have been few explorations of the clinical and administrative challenges that these issues raise, particularly in settings that are themselves mental health workplaces. In order to identify and understand such challenges, a brief case of acute employee illness in a mental health workplace is described followed by a discussion of salient clinical, administrative, and organizational considerations. The case raises questions about medicolegal responsibilities and relationships between clinicians and patients in mental health settings, illuminates tensions between clinical staff and human resources processes, and draws attention to the need for illness prevention and mental health promotion initiatives in the workplace. Increased awareness of these issues, complications, and potential solutions would benefit clinicians, administrators, and mental health institutions.

Standards of Care: Medico-Legal Responsibilities

The threat of clinical negligence litigation remains a fear for all practising doctors and there has been a steady rise in the number of claims for negligence against GPs in recent years. Doctors have a statutory duty placed upon them to maintain and continuously improve clinical standards through clinical governance. Despite this, standards sometimes fall short and patients may turn to the courts for redress. The legal standard of care is currently a professionally based standard determined by the evidence provided by expert witnesses. The adoption of evidence-based guidelines in clinical practice has been increasing which helps to standardize care and reduce geographic variation. There may be a role for the use of guidelines in determining the legal standard of care, which could improve health care quality and reduce harm to patients.

Implementing a Pharmacist Charting Service in the PreAdmission Clinic

ABSTRACTAimTo implement a pharmacist charting service in the preadmission clinic (PAC) and describe a preparatory process for the initiation of this service.MethodStage 1: a proposal for a pharmacist charting service in the PA C was devised via an iterative process with an advisory panel. Stage 2: feedback on the proposal was obtained from key staff via a survey comprising 15 linear scale statements (0 = strongly disagree to 10 = strongly agree) and open–ended questions. Stage 3: baseline data were collected on existing PAC service outcomes, e.g. consultation times, accuracy of medication charts.ResultsStage 1: a service protocol was developed following positive feedback. Stage 2: most staff strongly agreed that a pharmacist charting service would improve the efficiency and workflow in the PAC (median 8; n = 19) and that PAC pharmacists were competent and skilled to chart medications (median 9). Pharmacists perceived that the proposed service would increase their workload (median 10), consultation times (median 9) and medicolegal responsibilities (median 7) while the opposite was reported by the doctors (median 2, 2, and 3, respectively). Stage 3: mean baseline consultation times for pharmacists and doctors were 18.6 and 25 minutes, respectively. Most (95%) of the 56 analysed medication charts were incomplete (at least 1 piece of information missing) while 41% had at least one or more inaccuracies.ConclusionThere are benefits of a pharmacist charting service. This is the first step toward exploring models for pharmacist prescribing.

Biopsy of the oral mucosa and use of histopathology services

Patients often present with intraoral pathology in the general dental practice setting. Therefore, it is important that dental practitioners are aware of how to deal with pathology when this occurs and have an understanding of investigative techniques that might assist in making a diagnosis. Biopsy and subsequent histological examination of the lesion is an important diagnostic tool. Even if dentists refer the patient to another practitioner for the biopsy, the referring practitioner still needs to be familiar with the procedure and results obtained so that the patient can be appropriately managed. This paper reviews clinical issues that may impact on biopsy procedures and the potential pitfalls and problems that may affect the histological assessment of tissue and therefore affect diagnosis. The medico-legal responsibilities of practitioners are also addressed.