Organized Medicine Research Articles

The medical liability litigation industry and how to defeat it - A challenge for management science

Suspicion of fault is toxic to a trusting relationship between physicians and patients. It is even more toxic to the interest of justice. A medical liability litigation industry rises from this suspicion of fault and prospers at the expense of physicians, patients and justice. Lawyers are part of the medical liability litigation industry; so, too, are expert witnesses, who are also physicians. Byrom vs. Johns Hopkins Bayview Medical Center is illustrative of the impact of suspicion of fault. Inductive reasoning is the conventional way lawsuits are argued. It is the critical success factor used by lawyers and expert witnesses on both sides to showcase their most favorable evidence. However, deductive reasoning is also an acceptable form of legal reasoning. It is completely consistent with the ethical requirement of doctors acting in the capacity of medical experts to remain objective. It analyzes all evidence, favorable or not. Although organized medicine has authority over doctors who are expert witnesses, until now, it does nothing to hold expert witnesses accountable to ethical obligations. The consequences are verdicts like that of Byrom vs Johns Hopkins. Healthcare management science offers a solution to this dilemma. A methodology of deductive reasoning, which is used as a best practice for medical experts, is a means to hold experts accountable to the highest principles of jurisprudence and professional ethics and separates experts from the interests of the medical liability litigation industry.

The medical liability litigation industry and how to defeat it - A challenge for management science

Suspicion of fault is toxic to a trusting relationship between physicians and patients. It is even more toxic to the interest of justice. A medical liability litigation industry rises from this suspicion of fault and prospers at the expense of physicians, patients and justice. Lawyers are part of the medical liability litigation industry; so, too, are expert witnesses, who are also physicians. Byrom vs. Johns Hopkins Bayview Medical Center is illustrative of the impact of suspicion of fault. Inductive reasoning is the conventional way lawsuits are argued. It is the critical success factor used by lawyers and expert witnesses on both sides to showcase their most favorable evidence. However, deductive reasoning is also an acceptable form of legal reasoning. It is completely consistent with the ethical requirement of doctors acting in the capacity of medical experts to remain objective. It analyzes all evidence, favorable or not. Although organized medicine has authority over doctors who are expert witnesses, until now, it does nothing to hold expert witnesses accountable to ethical obligations. The consequences are verdicts like that of Byrom vs Johns Hopkins. Healthcare management science offers a solution to this dilemma. A methodology of deductive reasoning, which is used as a best practice for medical experts, is a means to hold experts accountable to the highest principles of jurisprudence and professional ethics and separates experts from the interests of the medical liability litigation industry.

Broken Promises to the People of Newark: A Historical Review of the Newark Uprising, the Newark Agreements, and Rutgers New Jersey Medical School's Commitments to Newark.

Many have referred to the coronavirus disease 2019 crisis and intertwined issues of structural racism as “twin pandemics”. As healthcare workers in Newark, New Jersey, a city heavily affected by the twin pandemics, we recognize that health workforce changes must be grounded in our community’s recent history. The objective of this essay is to briefly describe the relationship between organized medicine, state and local leaders, and the people of Newark. We begin with a discussion of Newark in the 1950s and 1960s: its people experienced poor socioeconomic conditions, terrible medical care, and the many sequelae of abhorrent racism. Plans to establish a New Jersey Medical School in Newark’s Central Ward also threatened to displace many residents from their homes. We then describe the Newark Agreements of 1968, which formalized a social contract between the state, business leaders, and people of Newark. In part, the Medical School committed to indefinitely promoting public health in Newark. We share progress towards this goal. Finally, we document key healthcare administrative decisions facing our community today. Stakeholder opinions are shared. We conclude that the Newark Agreements set an important standard for communities across the country. Creative solutions to healthcare policy may be realized through extensive community collaboration.

What Doctors Want: A Comment on the Financial Preferences of Organized Medicine.

Organized medicine's persistent demand for high payments is one factor that contributes to the rising costs of health care. The profession's long-standing preference for private and fee-for-service practice has pressured payers to increase reimbursement rates in fee-based systems; and it has stalled, thwarted, or otherwise co-opted attempts to contain costs in other payment systems. Yet what doctors want in fact varies. This article revisits classic comparative studies of organized medicine in advanced democracies to highlight two underemphasized findings: (1) physicians' financial preferences can deviate from traditional expectations, and (2) the structure of the organizations that represent doctors can shape whether and how those preferences are expressed. These findings remain relevant today as a discussion of contemporary American health politics illustrates.

Living Histories of Structural Racism and Organized Medicine.

This article reassesses and recontextualizes findings of an independent writing group commissioned in 2005 by what was then known as the Institute for Ethics of the American Medical Association (AMA). The authors were members of this group, which uncovered a paradigm case of structural racism that has perpetuated health inequity since the issue of admitting African Americans was first raised at the AMA's national meetings immediately after the Civil War ended, in 1868. Upon publication of the writing group's findings, the AMA publicly apologized for its social, cultural, and political roles in the racist history of organized medicine. Now, in 2021, the authors of this article seek to situate this aspect of the AMA's history as it prepares itself for antiracist leadership in the health care sector.

The Introduction and Localisation of Traditional Chinese Medicine in Malaysia

This thesis discusses how traditional Chinese medicine was introduced to Malaysia. History records show that traditional Chinese medicine was first introduced to Malaysia in the year 1405 while 1796 saw the establishment of Malaysia's first Chinese medicine shop. With the popularization of Chinese medicine, Chinese medicine education and organizations were established. Traditional Chinese Medicine has gradually been recognized by the Malaysian government due to the efforts of the practitioners of traditional Chinese medicine. In 2004, the Traditional and Complementary Medicine Department was established at the prestigious National Cancer Institute to improve quality of life as well as provide opportunities for cure to cancer patients.

Trends in Poly Drug Use-associated Deaths based on Confirmed Analytical Toxicology Results in Tehran, Iran, in 2011-2016.

BackgroundPoly drug use is a public health threat causing morbidity and mortality all over the world. Combined use of licit and illicit drugs is among the possible causes of death. In this retrospective analytical study, we evaluated forensic toxicology analysis results from 2011 to 2016 in Tehran province, Iran.MethodsAll deaths related to poly drug use and referred to the Legal Medicine Organization, Tehran during the 6-year study period were evaluated. Postmortem samples were analyzed to detect alcohols, and prescription and illicit drugs using headspace gas chromatography (HSGC), high performance liquid chromatography (HPLC), and gas chromatography/mass spectrometry (GC/MS) in a forensic toxicology laboratory. Manner of death, demographic characteristics, and different drug categories in postmortem samples were analyzed.FindingsA total of 1388 poly drug use-associated deaths were investigated during the 6-year study period. Overall, victims were mostly young men of 20-40 years of age (56.8%). The male to female ratio was 7:16. Methadone (n = 660; 47.6%) and amphetamine type stimulants (ATS) (n = 657; 47.3%) were in the highest category for poly drug use-associated deaths. Moreover, in some cases, opium (n = 458; 32.9%), tramadol (n = 389; 28.0%), and tricyclic antidepressants (n = 151; 10.9%) had been used with other drugs.ConclusionThe present study provides information about poly drug use-associated deaths in Tehran and highlights the major role of substance abuse in death.

Continued Counseling for the Relationship Between State-Level Medicine and Public Health

Public health and organized medicine have operated somewhat independently of each other since the early 1900s. In the wake of the COVID-19 pandemic, the necessity of healing any divide between organized medicine and state and local health officials seems self-evident. Using the recommendations abstracted from a 2005 article by Dr. Ronald Davis, "Marriage Counseling for Medicine and Public Health," this cross-sectional study explores the formal relationships that existed between state-level public health and medical practice across the U.S. at the end of 2019. A questionnaire was distributed to every state's senior public health official and medical society executive (N=104) between August and December 2019 to examine the extent of these entities' partnerships. Analysis was completed in January 2020. Among the respondents, 40%-63.1% (n=65) currently engage in the recommended activities, with 1 exception: state health departments infrequently invite medical society executives to speak at major conferences or meetings (26.2%). The majority of respondents (71.1%-85.9%) judged that each recommended activity would improve the practices of medicine and public health. Survey results illustrate a desire for reconciliation, but poor implementation of recommended strategies aimed at building a healthy marriage between the 2 sectors. More formal efforts are needed among state medical and public health organizations to capitalize on the current climate of rapprochement. The burden of COVID-19 on the national health system could provide a worthy cause around which these efforts would coalesce.

Profile of Fatal Suicide in Iran: A Report From the Iranian Forensic Medicine Between 2016 and 2018

The suicide rate among the Iranian population has increased over the past few decades. Descriptive information about this public health challenge could inform health policymakers to prioritize prevention strategies. We described the last updated data from the Iranian forensic medicine between 2016 and 2018. We obtained the data on the fatal suicide cases from the national suicide registry of the Iranian Forensic Medicine Organization (FMO), validated by death certificates and harmonized for epidemiologic studies. This study included 9,021 nationally registered suicide deaths from March 21, 2016, to March 20, 2018. A descriptive statistical approach was used to present the findings. Of 9,021 registered suicide deaths with age range between 10 to 94 years [median=31], 44.6% [n=4,015] was in the category of ≤ 29, 48.0% [n=4,328] between 30 to 59, and 7.4% (n=666) in the category of ≥ 60 years old. The percentage of fatal suicide was obviously higher in men (71.2%, n=6,424). Hanging was the most common method of suicide, both among men (57.7%, n=3706) and women (37.6%, n=976). The frequency of fatal suicide was significantly higher in married than single cases (52.6% vs. 42.9%). Overall, at the national level, the most common suicide method was hanging (51.9%), followed by self-poisoning (25.8%) and self-immolation (6.8%). We found evidence of age- and gender differences in suicide mortality across the country. Men, people in younger age groups, and married couples could be considered as the target population for preventive interventions in Iran.

Addressing Mental Health Needs of Health Care Workers through Peer Support Groups During the COVID-19 Crisis

Background: 
 The COVID-19 pandemic has placed a high psychological burden on frontline healthcare workers. Often quarantined away from their families and with little downtime to process their experiences, those on the frontlines of the pandemic are experiencing pronounced levels of distress and significantly elevated rates of burnout. Although many wellness and psychological resources are available to providers, there is low uptake and little is known about their effectiveness. In this study, we assess the impact of group-based peer support sessions on symptoms of acute distress, anxiety and depression, and provider burn out. 
 
 Methods: 
 An established peer support model is adapted for use with groups of frontline healthcare workers that will participate in 6 to 8 weekly group sessions using videoconferences. The study approach is a phased feasibility to research design. During the feasibility phase, we will initially test the intervention in 3 groups of 8 providers using a quasi-experimental, pre- post analysis of change. If preliminary results are positive, we will scale the intervention and progress to a more rigorous study design using a differences-in-differences approach to assess change over time between exposure and non-exposure groups. Outcomes will be measured at baseline, intervention completion, and 3- and 6- month follow ups. During the feasibility phase we will assess intervention fidelity and conduct qualitative analysis to assess the effects of the pandemic on work, family and social life. 
 
 Results: 
 This is a work in progress. At present we have recruited 28 emergency medicine physicians and residents with a target start date of August 1, 2020. 
 
 Potential Impact: 
 We anticipate the results of this study will provide evidence in support of a recent call for “the use of non-clinical mental health support, such as social or peer support” from the American College of Emergency Physicians in conjunction with 42 leading professional organizations in medicine. In addition, results may lead to advocacy for improved policies that mitigate against “fear of resultant loss of licensure, loss of income, or other career setbacks” for seeking mental health support.

The first military hospitals in Saint Petersburg

Abstract. The documentary materials from the funds of the Russian State Archive of the Navy, other archives, published letters and documents of Peter the Great, his Daily Note and other sources about the history of the first military hospitals (infirmaries) of Saint Petersburg are studied. At the same time, the history of the first military hospitals is reflected against the background of the difficult events of the Northern War of 17001721, with which the establishment of hospitals for the Russian army and the navy and the development of military medicine are inextricably linked. The organization of military medicine became aggravated immediately with the outbreak of hostilities, with the first wounded and sick. The fight against the plague epidemic and other infections during the war, the shortage of doctors, healers, infirmaries, hospitals and their own national staff greatly complicated the provision of medical care. Numerous documents and facts prove that the events before 1715 can be attributed to the first stage in the development of military medicine in Saint Petersburg. It was established that in 1704 the issue of establishing a military land hospital in the northern capital was already discussed (Peter I, A.D. Menshikov, N.L. Bidloo); hospital), and the senior physician of the Navy Yang Govi served in it with zeal In 1713, by the decree of the Great Sovereign Y. Govi, he was appointed head of the Admiralty Hospital, doctors, apprentices and medical students in it. By that time, Dr. R. Erskine actually assumed the office of archiatrist (until 1712). A detailed statement of Lieutenant General R.V. Bruce on the number of sick and wounded who received medical care in hospitals and hospitals in Saint Petersburg from 1713 to 1715. The decree of Peter I on the construction of a complex of General hospitals with anatomical theaters on the Vyborgskaya side (1715) according to Dr. Areskins drawing, and the establishment of a medical school (until 1719) are the next stage in the development of military medicine in Saint Petersburg, prepared by all previous events.

Principals’ involvement in comprehensive school physical activity programmes: A social-ecological perspective

To support school physical education, United States (US) national organizations in medicine, health, and education recommend that schools adopt comprehensive school physical activity programmes (CSPAPs). An important factor in successful CSPAP implementation is the involvement of the school principal. The purpose of this study was to examine relationships between principals’ self-reported CSPAP involvement and their social-ecological-based perceptions about CSPAPs. We analysed survey responses from a national sample of principals in the US who indicated their school had a CSPAP ( n = 198). Exploratory structural equation modelling supported a single-factor solution for CSPAP involvement (12 items) and three social-ecological factors, which we labelled ‘intrapersonal’ (nine items mainly focused on expected outcomes of CSPAPs), ‘interpersonal’ (five items focused on parents’ and teachers’ support of the CSPAP), and ‘environmental’ (12 items focused on the support of the overall school environment, the community surrounding the school, and public policy for the CSPAP). Path analysis showed involvement factor scores are predicted by intrapersonal factor scores, which, in turn, are predicted by interpersonal and environmental factor scores. The results of this study are helpful in identifying targets for future research and practice related to CSPAP implementation and can inform efforts to prepare and support principals with respect to their CSPAP involvement.

PROSAFE: a European endeavor to improve quality of critical care medicine in seven countries.

Long-lasting shared research databases are an important source of epidemiological information and can promote comparison between different healthcare services. Here we present PROSAFE, an advanced international research network in intensive care medicine, with the focus on assessing and improving the quality of care. The project involved 343 ICUs in seven countries. All patients admitted to the ICU were eligible for data collection. The PROSAFE network collected data using the same electronic case report form translated into the corresponding languages. A complex, multidimensional validation system was implemented to ensure maximum data quality. Individual and aggregate reports by country, region, and ICU type were prepared annually. A web-based data-sharing system allowed participants to autonomously perform different analyses on both own data and the entire database. The final analysis was restricted to 262 general ICUs and 432,223 adult patients, mostly admitted to Italian units, where a research network had been active since 1991. Organization of critical care medicine in the seven countries was relatively similar, in terms of staffing, case mix and procedures, suggesting a common understanding of the role of critical care medicine. Conversely, ICU equipment differed, and patient outcomes showed wide variations among countries. PROSAFE is a permanent, stable, open access, multilingual database for clinical benchmarking, ICU self-evaluation and research within and across countries, which offers a unique opportunity to improve the quality of critical care. Its entry into routine clinical practice on a voluntary basis is testimony to the success and viability of the endeavor.

The Common Causes of Death among Pregnant Women in Iran: A Study on Cadavers Referred to Legal Medicine Organization

Maternal mortality remains now as an important leading cause of death for women of reproductive age whole of the world. However, our knowledge is very little of the main causes of death among our pregnant women needing more population-based assessments. Hence, the present study aimed to determine causes of maternal death in the cases referred to Legal Medicine.

An alarming rise in the prevalence of deaths with methamphetamine involved in Tehran, Iran 2011-2018.

Methamphetamine is one of the most commonly abused illicit drugs in Iran. Despite this fact, there has been relatively little research on methamphetamine-associated deaths in Iran. The present study aimed to investigate the cause of death in methamphetamine positive cases based on forensic toxicology findings In this data base descriptive study, individuals with methamphetamine-associated deaths that were referred to the Legal Medicine Organization, Tehran, Iran (2011-2018) were assessed. Deaths including those from natural causes, toxicity, accident and suicides with positive forensic toxicology analyses for methamphetamine and its metabolite amphetamine in postmortem samples were investigated. All cases were examined to determine trends in methamphetamine-associated deaths, and in the manner and causes of deaths. During the eight year study there were 1389 methamphetamine-associated deaths. The mean age was 37.47±10.87 years, with a male/female ratio of 12.36:10. The methamphetamine-associated death rate increased significantly during the study period (2.05 vs. 21.93 per 106 Tehran province populations). The most common cause of death was cardiac arrest due to stimulant abuse with supportive histologic findings of acute myocardial infarction, myocardial fiber hypertrophy, aortic dissection and perivascular fibrosis (25%). Opioids (methadone, tramadol and morphine), tricyclic antidepressants and benzodiazepines were frequently present in postmortem samples of study cases. Methamphetamine-associated deaths significantly contribute to illicit drug-associated deaths in Tehran and represent a substantial clinical and public health problem.

Infanticides: The unspoken side of infantologies

Infanticides is the third article in a collective writing project that includes ‘Infantologies’ and ‘Infantasies’. It is designed to develop a philosophy of the infant, which is not tied to either developmental psychology or neuroscience but rather links itself to history and philosophy. It looks to develop a perspective on the world, beginning from the infant, that is critical, historical, and from the bottom up, so to speak. At the same time, the series of articles aims to create a thematic philosophical view that does not take for granted the normal set of conventions and assumptions made about the infant and about infancy, an important aspect given that infants and babies have a huge number of experts in medicine, law, education, religion, social work, and baby organizations like Plunket that have developed accepted bodies of knowledge, procedures, and routines about the infant and what is in the infant’s best interests. Historically, we have good reason to doubt this expertise. Also, women who give birth and parents, and other family members, all assume opinions and practices based on actual lived experience. Everyone, it seems, speaks for the infant saving the infant herself who cannot speak or, at least, is not able to articulate verbally their experiences or their expectations or requirements. This series has tried to provide fresh perspectives on these matters through the process of collective writing based on an approach to educational philosophy.

What Triage Issues Reveal: Ethics in the COVID-19 Pandemic in Italy and France.

In today’s pandemic, many countries have experienced shortages of medical resources and many healthcare providers have often been faced with dramatic decisions about how to allocate beds, intensive care, or ventilators. Despite recognizing the need for triage, responses are not the same everywhere, and opinions and practices differ around what guidelines should be used, how they should be implemented, and who should ultimately decide. To some extent, triage issues reflect community values, revealing a given society’s moral standards and ideals. Our goal is to study two countries which share many common features—Italy and France—as they deal with the pandemic, revealing the moral organization of medicine and healthcare, the power structures, and the nature of the disruptions in each context.

Transformation During Crises

Executive Report| November 2020 Transformation During Crises Paul Pomerantz Paul Pomerantz Search for other works by this author on: This Site PubMed Google Scholar ASA Monitor November 2020, Vol. 84, 9. https://doi.org/10.1097/01.ASM.0000722088.77482.55 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Cite Icon Cite Get Permissions Search Site Citation Paul Pomerantz; Transformation During Crises. ASA Monitor 2020; 84:9 doi: https://doi.org/10.1097/01.ASM.0000722088.77482.55 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search Dropdown Menu toolbar search search input Search input auto suggest filter your search All ContentAll PublicationsASA Monitor Search Advanced Search In this column, I wanted to share perspectives on how the current triple crises (COVID, recession, social unrest) have reflected on two critical aspects of ASA: our leadership strength and our digital transformation. A unique atribute among physicians within anesthesiology is leadership. So many of our members have risen to leadership positions in their health systems, in their communities, in public office, and in organized medicine. The nature of your specialty requires daily interaction with multidisciplinary teams and complex systems in high-pressure situations. One can see how natural leaders are attracted to the specialty and, in turn, how the specialty can strengthen leaders. Leadership is such an important part of ASA's culture that it has been recognized since 2017 as a pillar in our Strategic Plan, now framed as “Leadership and Professional Development.” This time of crisis, where there is no roadmap, has tested leadership in all domains, but especially... You do not currently have access to this content.

On Soviet therapeutic elite: Miron Semenovich Vovsi, the head therapist of the Red Army - portrait without retouch

The article is devoted to the biography and scientific contribution of Miron Semyonovich Vovsi, the eminent Soviet internist, organizer of army internal medicine. For the first time, the materials of his personal records from the Yuriev (Tartu) University and verified date of his birth are publicly introduced. Miron Semyonovich (Meer Simonovic) Vovsi was born on May 12 (24) 1897, in the township of Kreslavka (actually Kraslava, Latvia). In 1915, he entered the medical faculty of Yuriev (actually Tartu) University. In 1918 he was transferred to the Moscow University. He, after serving as military doctor, studied and worked under the guidance of D. D. Pletnev, I. M. Wiechert and V. F. Zelenin. In 1934, he moved to the Botkin hospital and after defending his doctoral thesis, became the head of the Department of internal medicine in the Central institute of advanced medical training, where he worked for more than 30 years. During the Second World War, he was the chief internist of the Red Army. He was engaged in the organization and improvement of army internal medicine. In 1952, during the so-called "physicians case", he was arrested and tortured for 5 months. After his release, he returned to teaching, medical and scientific activities. He died in 1960. His major areas of scientific contribution to medicine are nephrology, cardiology and army internal medicine.

Investigating the relationship between personality disorders and intelligence quotient in offenders of intention homicide referred to the Khorasan Razavi Forensic Medicine Organization in 2018-2020

Investigating the relationship between personality disorders and intelligence quotient in offenders of intention homicide referred to the Khorasan Razavi Forensic Medicine Organization in 2018-2020