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Law and medical practice: A comparative vignette survey of cardiologists in Norway and Denmark.

ABSTRACT: Objective:This article explores the implications of legal regulation for medical discretion and decision-making in Norway and Denmark. Methods:The article is based on a cross-national cross-sectional survey exploring cardiologists' assessments of patient eligibility for specialist health care. Forty-two cardiologists in Norway and 48 in Denmark were presented with two standardized case vignettes in the form of patient referrals and were asked to assess whether the patient was eligible for treatment by a specialist, and if so, what waiting time would be assigned to the patient. Results:Primarily based on descriptive statistics, our findings indicate interesting similarities and variations. While there was only minor variation across the countries in cardiologists' professional assessments about a patient with a more severe condition, judgements of eligibility for specialist treatment varied for a patient with a less severe medical condition. Moreover, Danish cardiologists distinguished between the more severe and less severe conditions to a much lesser extent when assessing eligibility for specialist treatment. For waiting times, there was considerable variation at the general level, from 1?week to 6?months. The assigned waiting times were on average double those for Norwegian cardiologists compared with their Danish counterparts. Denmark's legal standardization of waiting times appears to lead to shorter waiting times than those prescribed by Norway's legal regulations. Conclusion:For a single clear overall intention with a new policy, simpler legal regulations may be more effective than very detailed and specific requirements. If policymakers' overall intention is for medical doctors to make complex decisions involving the prioritization of patients, then more individualized regulations seem to be a better tool.

SUBMITTER: Bjorvatn A

PROVIDER: S-EPMC7476340 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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Law and medical practice: A comparative vignette survey of cardiologists in Norway and Denmark.

Bjorvatn Afsaneh A Magnussen Anne-Mette AM Wallander Lisa L

SAGE open medicine 20200902

<h4>Objective</h4>This article explores the implications of legal regulation for medical discretion and decision-making in Norway and Denmark.<h4>Methods</h4>The article is based on a cross-national cross-sectional survey exploring cardiologists' assessments of patient eligibility for specialist health care. Forty-two cardiologists in Norway and 48 in Denmark were presented with two standardized case vignettes in the form of patient referrals and were asked to assess whether the patient was elig ...[more]

PMID: 32953116

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Project description:ObjectivesThe mistreatment of medical students remains pervasive in medical education. Understanding the extent to which clinicians and students recognise mistreatment can assist in creating targeted interventions that reduce mistreatment. The objective of this study was to use clinical vignettes to assess perceptions of medical student mistreatment among medical students and clinical faculty at an Australian university.Design, setting and participantsThis cross-sectional study used a survey of medical students and clinical faculty in a Doctor of Medicine (MD) programme at Macquarie University in Sydney, Australia. Data were collected via an online survey between 13 July and 27 July 2020.Outcome measuresFourteen clinical vignettes were developed based on commonly reported themes of mistreatment. An additional control vignette was also included, and these 15 vignettes were distributed via email to all 169 MD students and 42 teaching faculty at this teaching site. Participants were asked to rate whether the vignettes portrayed mistreatment on a 5-point Likert scale (strongly disagree to strongly agree).ResultsRespondents included 83 MD students and 34 clinical faculty. On average, students perceived mistreatment in 9 of 14 vignettes and faculty in 8 of 14 vignettes. Faculty and student perceptions aligned in themes of sexual abuse, physical abuse and in the control vignette depicting a constructive teaching style. Perceptions differed significantly between faculty and students (p<0.05) for five vignettes across the themes of gender discrimination, requests of students to perform non-educational tasks, humiliation, specialty choice discrimination and requests to perform a task beyond the student's capacity.ConclusionAgreement on what constitutes appropriate behaviour is crucial to ensuring that a culture of mistreatment can be replaced with one of kindness, equity and respect. This study demonstrated the successful use of vignettes to compare perceptions of mistreatment, with faculty and student perceptions differing across a variety of themes.

Project description:ObjectiveWe surveyed a national sample of child forensic interviewers to learn the types of information they wanted to have before interviewing children, their attitudes and beliefs about forensic interviews, the characteristics of their interviews, and their professional experiences.HypothesesWe predicted (1) interviewers would want many different types of information before interviewing children, but specifically details about the child, alleged abuse, and disclosure, and that interviewers would find this information helpful and accessible; (2) interviewers would consider their own interviews to be neutral and nonleading and to yield accurate and complete information from children; interviewers' concern about false reports would be related to (3) the amount of preinterview information they wanted and (4) their years of experience and amount of training.MethodForensic interviewers (N = 781) from all 50 states and the District of Columbia completed all (n = 754) or part (n = 27) of a questionnaire that consisted of open- and closed-ended questions.Results(1) Interviewers wanted many different types of information before interviewing children, but most often information about the child, alleged abuse, and disclosure. They thought these types of information were the most helpful and very frequently had access to that information before interviewing. (2) Interviewers thought their interviews were fairly neutral, slightly leading, mostly accurate, and fairly complete. Interviewers who were more concerned about false denials (3) wanted more preinterview information than interviewers who were more concerned about false allegations and (4) had fewer years of experience.ConclusionsOur survey results underscore the need for future research examining the effects of preinterview information on forensic interviews and children's reports. They provide a current snapshot of forensic interviewing and a national benchmark to which local child advocacy centers can compare their practices. They highlight the inherent difficulty courts face when determining the admissibility of a child forensic interview based on its primary purpose. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Project description:BackgroundImportance of awareness of medical ethics and its integration into medical curriculum has been frequently highlighted. Study 1 aimed to assess the knowledge, attitude, and reported practices of medical ethics among clinicians at Patan Academy of Health Sciences, a tertiary care teaching hospital in Nepal. Study 2 was conducted to assess whether there was a difference in knowledge, attitude, and reported practices of medical ethics among doctors who received formal medical ethics education during undergraduate studies and those who did not.MethodsTwo cross-sectional surveys using self-administered questionnaires were conducted. Study 1 included 72 participants; interns, medical officers, and consultants working at Patan Academy of Health Sciences. Study 2 was a comparative study conducted among 54 medical officers who had received formal medical ethics education (Group 1) and 60 medical officers who did not (Group 2).ResultsParticipants who had completed post-graduate education had higher knowledge (p = 0.050), practice (p < 0.001), and overall combined scores (p = 0.011). Participants with ethics education had higher knowledge (p < 0.001), attitude (p = 0.001), practice (p < 0.001), and overall score (p < 0.001). Most participants preferred consulting colleagues if an ethical dilemma arose. Fewer participants had heard of the Declaration of Helsinki. Most participants thought doctors to be most capable of judging what is best for the patient (Study 1: 70.42%, Study 2 Group 1: 42.59%, Group 2: 80%). Case scenarios in which participants demonstrated poor practice were ethical issues concerning truth-telling, end-of-life decisions, treating HIV/AIDS patients, treating a minor, and reporting colleague's errors.ConclusionsThis study found that participants who have received medical ethics education have higher knowledge, attitude, and practice scores. The results further justify the need for medical ethics education to be a part of the core medical curriculum. A blame-free environment where seniors can be approached for advice should be created. Research ethics should also be given attention. During medical ethics training, ethical issues where doctors perform poorly should be given more priority and should be discussed in a country-specific context.

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Law and medical practice: A comparative vignette survey of cardiologists in Norway and Denmark.

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Law and medical practice: A comparative vignette survey of cardiologists in Norway and Denmark.

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