Litigation in obstetrics and gynaecology

Article Abstract:

The debate over medical malpractice issues continues, particularly in the specialty of obstetrics and gynecology. Both physicians and patients consider the current system to be inadequate, but in Britain recent changes have been made that should help both the plaintiff and the defendant. A change in standard procedure has required that both sides now produce written reports before the trial begins revealing the expert evidence they plan to present; in the previous system, neither side could prepare to respond to the evidence that would be presented by the other side during the trial. This new approach is fairer to both plaintiff and defendant, and saves time as well. Other reforms are being advocated, one of which would be a no-fault system similar to that used for motor vehicle accidents. A recent publication of the Royal College of Obstetricians and Gynaecologists, 'How to Avoid Medico-Legal Problems in Obstetrics and Gynaecology', is described. Covered in the book are the claim process, legal concepts, and standards of clinical care that define competent medical practice. In the clinical area, the most attention is given to the two areas most often involved in malpractice suits, namely sterilization and birth-related injuries. These clinical standards are currently very useful to the physician, but may also prove informative for the plaintiff seeking a definition of competent care. While the book suggests repeatedly that the motivation of plaintiffs is simply to be awarded monetary damages, their actual motives are more complicated; some plaintiffs may simply seek an explanation and an apology regarding the injury. (Consumer Summary produced by Reliance Medical Information, Inc.)

Reports, Study and teaching, Malpractice, Actions and defenses, Litigation, Obstetricians, editorial

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Audit of workload in gynaecology: analysis of time trends from linked statistics

Article Abstract:

The trends in the patterns of workload for gynecologists were assessed in six health districts in the south of England. The medical records of patients admitted to the hospital between 1975 to 1985 were reviewed. The number of gynecological patients admitted to the hospital increased by 23.5 percent, whereas outpatients in gynecology increased by 13.1 percent over the 10-year period. Ninety percent of the increase in workload was due to an increase in new patients treated, whereas the remaining 10 percent of increase in workload was due to readmission of former patients. Strike action among health professionals caused a decrease in the gynecologic workload in 1971 and between 1981 and 1982. The duration of hospitalization has consistently shortened over the past 11 years, whereas the number of readmissions to the emergency department has increased each year by an average of 2.7 percent. The rate of admission increased for 10 of 11 surgical procedures performed on 85 percent of gynecologic patients. The yearly rate of admission increased 1.0 percent for sterilization, 1.9 percent for termination of pregnancy, 8.2 percent for biopsy of the cervix, and 1.4 percent for dilatation and curettage (D & C). These findings show that the rise in gynecologic workload is mainly due to the increase in number of patients treated, possibly due to increased expectations of patients and physicians, technological innovations, and increased number of available beds due to shortened hospital stays. (Consumer Summary produced by Reliance Medical Information, Inc.)

Hospitals, Gynecologic and obstetric, Gynecologic and obstetric hospitals, Hospital admission and discharge, Gynecology, Operative, Gynecological surgery

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Outcomes of referrals to gynaecology outpatient clinics for menstrual problems: an audit of general practice

Article Abstract:

The rates of referral and outcomes of 205 patients aged 15 to 59 years with menstrual disorders were assessed. The patients were referred by their general practitioners between 1983 and 1984 to 19 gynecology outpatient clinics, and followed-up between 1988 and 1989. Among 18,754 patients referred by 33 practices over a six-month period, only 2,513 attended a gynecology clinic. Of patients attending a gynecologic clinic, 539 were diagnosed with menstrual disorders. Different practices varied widely in their rate of referral. Among 205 patients followed over several years, 167 were hospitalized; 94 underwent a hysterectomy, surgical removal of the uterus; and 98 required dilatation and curettage, which involves widening the cervix and scraping of the inner lining of the uterus to remove tissue. In addition, 25 patients were treated with drugs and 10 patients received no treatment. Only 29 of the 205 patients had sought medical attention for menstrual problems in the year before the study. The decision to make a referral of a patient should be guided by specific regulations. Such guidelines should be formed with consideration of the patients' anxieties and preferences and proper use of diagnostic and treatment procedures. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Medical care, Physicians (General practice), General practitioners, Menstruation disorders

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