medicolegal aspects.pptx

medicolegal aspects

1. Principles of ethics M edicolegal issues I mportance of documentation Dr Vijay kumar, Associate P rofessor

2. INTRODUCTION C riminal / Surgeon ? intentions difer

3. Principles of ethics Learning objectives Define ethics Identify the issues in surgical ethics Explain the boundaries of autonomy, informed consent and confidentiality Describe the good surgical practice

4. ETHICS The word ETHICS is derived from Greek word ethos which means character. To put it formally, ethics is the branch of philosophy that defines what is good for the individual and for society and establishes the nature of obligation or duties that people owe themselves and one another

5. Surgical ethics Ethics is essential discipline in the practice of surgery. Represent your best understanding of moral responsibility Ethical studies investigate what should be our character and conduct

6. Issues Autonomy Informed consent and difficulties Confidentiality Excellent standards

7. Autonomy Respect autonomy of patient and their ability to make choice about their Tt It recognizes right of patient to self determination So, patient have right to make choice over their surgical care

8. Attention Information accurate and reasonably complete Avoid technical language Provision of translator Clarification of doubts

9. Practical difficulties Temporary unconscious patient Children <18 y are minors and are legally incompetent Incompetence - other kind

10. Confidentiality The principle of confidentiality is that information a patient reveals to practitioner is private and has limits how and when it can be disclosed to a third party Breaking confidentiality If the patient is a threat to self or others Other team members (improving treatment options) Public interest Court order

11. Good standard To optimize success in protecting life and health to an acceptable standard Practitioner must offer specialized treatment in which they have been properly trained

12. Medico Legal Case (MLC) MLC  A case of injury or ailment etc., wherein investigation by the legal enforcing agencies is essential to fix the responsibility with regard to cause. Integral part of medical practice that is frequently encountered by Medical Officer. MLC vs Non MLC Doctor to decide

13. Examples - mainly injury and poisoning Assault and battery, including domestic violence and child abuse Road Traffic Accidents (RTA), industrial accidents etc. Any cases of trauma with suspicion of foul play Electrical injuries, Burns and Scalds Poisoning, Alcohol and other Intoxication Drug overdose and Drug abuse Undiagnosed coma Chemical injuries

14. Medical certificate Should include  Patient Name Doctor Name Illness patient is suffering Dates when patient was ill Signature of patient Signature and seal of Doctor Place of Issue Date of Issue

15. Medical Fitness Certificate Mention the title of the document clearly (bold) letters Address the certificate to the correct party (employer , insurer, etc.) State the date of examination N ame and address of the patient Also, the name, designation and address of the doctor (Clinic or Hospital) Conclude with a closing signature, registration number of doctor. Copy of the medical certificate shall be retained by the doctor x3 years

16. DEATH CERTIFICATE A death certificate is an official document issued by the government, which declares cause of death location of death time of death other personal information about the deceased . There are several reasons why you may need to obtain a death certificate. Most often it’s to serve as proof for legal purposes.

17. Medical Certificate of Cause of Death (MCCD) Issued by the attending Dr who had treated the Pt during admission in a Hosp In the last illness (prior to death) while taking Tt from a dr outside Hosp Recording and reporting death using standard Form 4 (institutional deaths) and Form 4A (non-institutional deaths) as per the rules of the Registration of Births and Death Act, 1969 Contains Part 1 to record the immediate and antecedent causes Part 2 to record the significant conditions that contributed to the death but were not part of the sequence of events leading to death.

18. AGE DETERMINATION

19. I ntroduction Why we need to learn how to estimate age ? A ge can be determined by 4 main criteria:     Teeth examination . Ossification centers. General development in children Bone examination

20. Stages of life and their main characteristics  Intrauterine life (during pregnancy)  By USG and LMP  From 0-15 days (neonatal period)  By umbilical stump examination  From 15 days - 2 years (Infancy period)  By primary dentition

21.  From 2- 6 years   Closure of metopic suture Appearance of ossific centers  From 6-12 years  Secondary dentition Childhood period: rapid dental and bony growth and development Stages of life and their main characteristics

22. From 12- 18 (Adolescence period)  Closure of epiphysial plates Adulthood   Early stage: bone remodeling and maintenance Late stage: bone wear and tear Stages of life and their main characteristics

23. Appearance of ossific centers after birth

24. Appearance of ossific centers after birth 1 year : head of humerus ,femur and tibia . 2 years : lower radius and tibia. 3 years ; Patella. 4 years ; upper fibula ,greater trochanter of femur. 5 years ; lower fibula 6 years ;head of radius , lower ulna , calcan e um

25.  Below1 year as ossific center of the head of femur not appeared .

26.  Below 2 years (no ossific centre in the wrist)

27. Ossific centre at lower radius = 2 years

28. What is the age ?  Above 2 years. Ossific center of lower radius

29. Determination of age by bone examination - Sternum

30. What is the age? < 15 y (non- united segments)

31. Determination of age by bone examination – Epiphyseal closure

32. Age from upper limb examination At the wrist and shoulder joint (lower ends of radius and ulna and head of the humerus) 19-20 years . At the elbow region: trochlea and capitulum (14 years)- trochlea and capitulum + lower end of the humerus ( 15years ) Lat.epicondyle and head of ulna(17 years ). Med epicondyles and the head of the radius ( 18years ) Metacarpals and phalanges (16 y in females and 18 years in males).

33. Age from lower limb examination Lesser trochanter ( 16y )---Greater trochanter (17y ) --- Head of femur (18y). Lower end of the femur + shaft (21y). Upper end of the tibia +shaft (21y). Lower end of the tibia +shaft (18 y ).

34. What is the age? above18ys

35. What is the age? <21 knee

36. Thank you