BrazJOtorhinolaryngol.2016;82(1):1---2
www.bjorl.org
Brazilian
Journal
of
OTORHINOLARYNGOLOGY
EDITORIAL
The
judicialization
of
the
medical
act
夽
A
judicializac
¸ão
do
ato
médico
Sinceitsbeginningand,moreeffectively,sincetheMiddle Ages, medical practice has been the subject of relent-lesssocial controland,consequently,oftheLaw itself.In thissense,MedievalMedicinewassubjectedtothe practi-cal analysis of obtained results, whether with the use of medications or surgical interventions, thus defining what therapeutic success, accidental result,unforeseeable cir-cumstancesorinexorablecourseofthediseasewere.1
From theXIX century on,therewasan increase in at-risksurgical proceduresand,simultaneously,therewasan increase in patients’ complaints and their resistance to submittothe proceduresindicated by physicians.2 It was
observedthat sucheventsoccurred preciselyata timeof increasinginvestmentinmoreeffectivesurgicaltechniques andstrategiesthatculminatedinthedecreaseofhospital infectionrates.
In the early XX century, due to the growth in legal complaintsdue tomedical malpractice,there was ample discussion on the fact that the bad results that occurred shouldnotbeattributedexclusivelytothesurgeonor clini-cianwhodirectlyworkedonthecase.Itisquestioned,then, that the responsibility should be shared by other profes-sionalswhohadtheopportunitytoactonor influencethe assumedbehaviors.
At the end of the XX century, medical malpractice became a public health problem, as the human and material resources used for the purpose of correction of ‘‘malpractice’’ increased considerably, amounting to approximately100,000cases/yearintheUnitedStates.3
James Reason, a researcher at the University of Man-chester, has discussed ‘‘medical malpractice’’ in several publications,andmainlyrecommencingthediscussionthat this malpractice could be systemic and organizational,4
intensifyingtheconcernforasafermedicalpractice. In Brazil, with the advent of the Consumer Protec-tion Code and the considerable increase in demands for
夽 Pleasecitethisarticleas:Campos RAC,CamargoRAE,Neves
LR.Thejudicializationofthemedicalact.BrazJOtorhinolaryngol. 2016;82:1---2.
compensation based on alleged medical malpractice, the doctor---patientrelationshipgainedaprominentplaceinthe legalandacademiccirclesandintheCourts.
Medical procedures have never been as formalized as theyaretoday,withtheprevailingobjectiveof document-ing the decisions and protect the interests, rights and duties of the parties involved, inexorably changing the doctor---patientrelationship.
Someoftheseproceduresthatshouldbemaintainedin medicalpracticearedescribedbelow:
- DraftingoftheFreeandInformedConsent(IFC)form; - Photographicevidenceorvideorecordingofthepre-and
postoperativestatus;
- Performance ofthe‘‘checklist’’and‘‘timeout’’inthe SurgicalCenterandpreparationofdetailedreports when-everrequestedbythepatient;
- Descriptioninthemedicalrecordsoftheestablished diag-noses,aswellastreatmentoptionsandtheirrisks,always inthepatient’spresenceafterhisorherconsent; - Inallmedicalchartnotes,accuratelyrecordthedateof
consultationandtimeofassessment,especiallyincaseof hospitalization;
- Undernocircumstancestocommentaboutthecasewith personnelnotcommittedtotheethicaldutyof confiden-tiality;
- Incaseofunexpectedevents,thephysicianshouldshare such events with the patient, family or guardians, fol-lowedbyinformationregardingalternative proposalsfor casemanagement;
- Keep up todate withthe Medical EthicsCode, Resolu-tionsandOpinionsissuedbytheMedicalCouncil, tonot practiceproscribedproceduresorthosenotyet scientifi-callyapproved;
- Whether a specialist or not, the physician should be updatedastotheprogressofMedicine,seekingtooffer thebestoftheknowledgeofdiagnosisandtreatmentin favorofthepatient.
Regardlessofthestrengthofthesaidmaterialevidence, according to our Law, one cannot interpret it alone or
http://dx.doi.org/10.1016/j.bjorl.2015.12.002
2 EDITORIAL
overestimateit,consideringthatitcouldavoidpossible mis-understandings.Furthermore,thereisariskoftransforming thedoctor---patientrelationshipintoacool,formalcontract, settingasidethedialog,attentionandempathy, character-isticsthatguidethepracticeofmedicine.
Anotheraspect tobeconsideredreferstotheso-called Defensive Medicine, i.e., the change in medical conduct fromthe usual behavior or that considered good medical practicetoanattitudeaimingtoreduceorpreventquestions orcriticismsfromtheirpatientsandrelatives.Suchpractice canoccurthroughtwomechanisms---positiveandnegative. The first occurswhen there is excessive test ordering or conductsforthetreatment andthelastbythewithdrawn attitudeonthepartofthephysician,byproposingreferrals andtakingevasiveactions.
Isthereapointofequilibriumforsuchsituation? Wethinkthereisone,inwhichphysiciansshouldalways adequately document the care given to their patients, whereas they continue to advise them, using accessible, frank language,tailored toeach patient, respectingtheir capacitytounderstand, favoringtheautonomyofdecision intruepartnership,sharingtherisksandpossiblepoor out-comes.
Conflicts
of
interest
Theauthorsdeclarenoconflictsofinterest.
References
1.Cosman MP. Medieval medical malpractice:the dicta and the dockets.BullNYAcadMed.1973;49:22---47.
2.BroockC.Risk,responsabilityandsurgeryinthe1890sandearly 1900s.MedHist.2013;57:317---37.
3.ReasonJ.Humanerror.Cambridge:CambridgeUniversityPress; 1990.
4.ReasonJ.Managingtherisksonorganizationalaccidents. Burling-ton:AshgatePublishingLimited;1997.
RobertoAugustodeCarvalhoCamposa,b,c,∗,
RosmariAparecidaEliasCamargoc,
LucianoRodriguesNevesa,b
aEscolaPaulistadeMedicina,UniversidadeFederaldeSão
Paulo(UNIFESP),SãoPaulo,SP,Brazil
bDepartmentofOtorhinolaryngologyandHeadandNeck
Surgery,UniversidadeFederaldeSãoPaulo(UNIFESP),São Paulo,SP,Brazil
cDepartmentofCriminalLaw,ForensicMedicineand
Criminology,FaculdadedeDireito,UniversidadedeSão Paulo(USP),SãoPaulo,SP,Brazil
∗Correspondingauthorat:EscolaPaulistadeMedicina,
UniversidadeFederaldeSãoPaulo(UNIFESP),SãoPaulo, SP,Brazil.
