Preface
In the practice of medicine, there are many occasions where the doctor must make decisions that compromise the life of patient and in which few times wondering if them will bring negative consequences. This attitude is intimately linked to medical ethics and one of its most important aspects as it is, the responsibility of the profession. In times of danger to life the ideal behavior adopted should be always obey the principles of respect for life, human integrity, preservation of moral, health and law. If the conduct that was chosen is not correct, it can be concluded in error or medical malpractice, with negative consequences for patient and physician. (1)
It´s imperative to understand that error is a logical possibility in different human activities and medicine is not exempt from this. Therefore, the possibility of being wrong should be assumed as a professional responsibility. Mistakes in medicine are usually associated with medical malpractice, but the medicine is an inaccurate science, since the doctor works between uncertainty and risk, sometimes risky treatments are needed to save a life. However, is supposed to be who practice with scientific expertise and experience, able to protect the health of a human being; the trust and good faith deposited by the patient must therefore prevail.
The term "medical dispraxis" includes all the alterations that occur during medical practice, that is, errors, adverse events, iatrogenic and malpractice. A medical error is considered as such and is not punishable must lack fraud and elements that correspond to negligence, recklessness, incompetence, failure to comply with the rules and regulations and this must be determined by a judge, on the basis of the elements of conviction. (1,2)
In the context of elements that can disrupt a good medical practice, factors such as a poor doctor-patient relationship, inadequate preparation of medical history, failures in the academic and interpersonal relations between doctor and health care team, are designated deficiencies of inputs as well as lack of stimulus for wages low and unworthy.(1-3)
Since the early days of the creation of humanity, the history picks up the existence of legal provisions for the exercise of medicine dating from 1700 B.C. Hammurabi, King of Babylon promulgated a code of laws relating to the medical practice, and Hippocrates of Cos (460-360 B.C.) developed the “Hippocratic Oath” until our days. Venezuela have the “Law of the Practice of the Medicine” which regulates the performance and liability of the physician to third parties.(1-4)
Industrialized countries annually reported comorbidity caused by errors, adverse events and malpractice. In Latin America the information is precarious due to lack of epidemiological statistics.
HISTORICAL background
"The cautious seldom are wrong." Confucius
Around 1770 B.C. Hammurabi, King of Babylon, issued a code of laws and provisions to regulate the conduct of the physician that included a large number of provisions relating to the legal professional practice. Curiously, there is not spoken morality or immorality, but the possible ill effects of an intervention, without greater discussion was passed to the imposition of a penalty. For example, the code not contemplated any appearance of ethical reasoning or moral responsibility, putting immediate legal coercion to leave well regulated and specified situations to consider. "The Code of Hammurabi, establishing clear rules on the practice of medicine:..." If a doctor causes serious injury to a patient with a surgical knife and kills him; you shall cut the doctor hands". In Egypt and Greece, there were secret medical colleges, where is stipulated the rules about the healing art and were structured regulations characterized by the severity of the sanctions, including even the death penalty. As recorded in assyrian clay tablets, the physicians of that time never accepted the incurable sick care. In terms of severe corporal punishment which specified the code of Hammurabi to medical errors, and most extraordinary that they seem to us, they were in concordant with those established in other professions in order to regulate the faults of people against others.
In China, initially the medical care was perform by humanitarianism, without any social or economic incentives, there was exercised by rulers, scholars, nobles, and priests. Medical knowledge were considered as a secret power, and could only be transmitted from fathers to sons or very qualified people socially and morally. (5,6)
The medical act is in essence an ethical act, but its controversies and its foundations could be different according the historical moment, religious beliefs and social conventions. The physician in his healing work should be guided by two principles man love and the love of his art. He is responsible for complying their duties with the patient, their colleagues and the society. Hippocrates of Cos (460-370 B.C.) who was born in the Ionian island of Cos, son of Heraclides and Minarets, learned the art of healing from his father and although history has doubt on the existence of Hippocrates, references of Plato and Aristotle assert that not only lived, but it was the outstanding physician of his time. In such a way that the Hippocratic oath includes ethical matters, surgery, professional secrecy and commitment within their philanthropy , egalitarian condition of care regardless of nationality, status and fortune; the comfort of the adjuvant patient's medical treatment, free charity to the poor sick and support the moral and therapeutic assessment of living with pain, considerations that are contained in the ethical code of medicine. (7,8,9)
MEDICAL ETHICS IN THE RENAISSANCE
“We are all very ignorant, what happens is that not all ignore the same things." Albert Einstein
During the Renaissance, it repudiated all kinds of medical practice that does not pass through the filter of university education. On the other hand, epidemics of "morbo gallico" (syphilis recrudecence) forcing doctors to think, that not everything was in the knowledge of the ancients, but that nature hiding secrets that could make evident at different times and even more, led them to propose a possible degeneration in humanity, by making it susceptible to suffer new and terrible evils. As a result joined knowledge, the contribution of personal experiences of physicians, concluded that if indeed, the medical art included in its general premises, also should enrich the individual scientific knowledge. During the Renaissance, a good percentage of the social reputation of the good doctor, was closely related to the type of clientele that had and his way of handling the collection of fees. He should be cautious and precise when charging, and appeasing recovery in chronic diseases, not so acute evils or possible quick outcome, this criterion was changed with the passing of time, the innovation of technologies and the emergence of new medical specialities. (10,11,12)
Likewise, in antiquity the quasi-sacred nature of medicine, was symbolically implicit during the first approach of the doctor to his patient, where was a priestly formality and its appearance should make you remember the patient the image of Christ and his Holy healers disciples; the doctor should be benign, merciful and charitable even to not charge to poor patients, practice that - in some cases - has remained with the passage of the years.(13,14)
The responsibility of the physician begins with the Hippocratic Oath when he graduated, which means it should be the good performance of the medical profession, enrollment in a school and the relationship with the patient which is contractual in nature, existing in her duties of loyalty, professional secrecy and compensation where a damage. In general, it is accepted that the doctors who most make mistakes are the newest, those newly graduates, primarily those who are in the first years of training and conducting autopsies and anatomoclinical sessions allow the recognition of the error through continuous learning, on the control of medical failures and the behavior of diseases. There is scientific evidence, that one of the main factors associated with the error is the age of the patient, occurring most frequently in the extreme age
s of life (pediatric and elderly patients); as well as complex surgical procedures. (15,16,17)
In almost all medical errors involving his performance, the accompanying equipment and other factors, for example, has found that sleep deprivation doctor during the guards, the possibility of serious errors after more than 24 continuous hours of work. Failure to sleep or the impossibility of proper rest affect the psychomotor performance of a professional, is similar to an individual who has ingested alcohol (blood alcohol level> 0.08%). Similarly noted as a risk factor for fouling, poor communication between doctor and patient when it distorts the information provided in medical history during the care process, however; traditional techniques of anamnesis and physical examination remain key in the control of misdiagnosis. (18,19,20)
All medical specialties are likely to make mistakes, however, those specialties where diagnostic uncertainty is evident and where a delay or error in diagnosis is most obvious is surgery, emergency medicine, intensive care, anesthesiology and internal medicine. During the course of medical practice, errors often occur in prescribing a certain drug, it is part of the medical act and involves the prescribing physician with other professionals, errors that occur in this "chain" are potentially harmful to the patient for the damage they can cause by management or not the right medicine, toxic effects generated by these drugs, the absence of the expected benefit and cost to the patient. (21,22,23)
why the doctors are wrong? Page 2
