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MDs: [missing doctors?].

Hospitals in places as varied as West Virginia, Missouri, Arizona and southern California say recruiting and keeping physicians are big problems, and getting bigger. But the evidence and the experts differ over whether a nationwide physician shortage on the scale of the nursing shortage is emerging or whether it is limited to specific markets.

Decision Making↗

Medical records can win or lose a malpractice case.

This article illustrates for the physician the pitfalls of making poor medical records and how good medical records can make the difference in winning or losing a medical professional liability lawsuit. The article includes seven suggestions to enable the physician to create and maintain good patient medical records.

Ethics, Medical↗

Processing the tort deterrent signal: a qualitative study.

Medical mistakes often are responsible for patient injury and suffering, but not all such mistakes are negligent. In the United States, injured patients have recourse to legal action under the common law. The medical malpractice tort trial system is intended to provide compensation for patients who have been negligently injured and to deter future negligent acts by physicians. The deterrent function of torts largely rests on practitioners' capacity and willingness to internalize, or 'process', the lessons of tort trials. However, physicians' willingness or ability to process the tort deterrent signal, while widely assumed in much contemporary legal writing on medical malpractice, has never been empirically verified. This study is a qualitative assessment of how practicing physicians process the tort deterrent signal. We interviewed a random sample of 47 internists, surgeons, and obstetrician/gynecologists from New York State as part of the Harvard Medical Practice Study. The interviews reveal three notable findings: physicians in our sample largely define medical negligence by reference to moral qualities of the practitioner; they claim that lawyers and the legal process of tort trials lack the moral authority to guide medical practice; and finally, while they consequently reject the lessons of lawyer-dominated, confrontational tort trials, they indicate that they would respond more favorably to hospital-based, physician-led, educational quality-control measures. Based on these findings, we identify several potential impediments to the receipt and processing of the tort deterrent signal by individual physicians and we suggest that the interview results support the notion of institutional liability for medical malpractice.

Attitude of Health Personnel↗

Call 911: psychiatry and the new Emergency Medical Treatment and Active Labor Act (EMTALA) regulations.

The Emergency Medical Treatment and Active Labor Act (EMTALA), enacted in 1986 as part of the Consolidated Omnibus Budget Reconciliation Act of 1985, aims to prevent "patient dumping" by requiring hospitals to screen and stabilize patients who come to an emergency room seeking medical attention. For many reasons, recovery under EMTALA is rare, especially when psychiatric treatment is called for. New regulations of EMTALA went into effect on November 10, 2003. These new regulations helpfully clarify the applicability of EMTALA. However, the bias against recovery in cases involving psychiatric emergencies is likely to remain.

Emergency Service, Hospital↗