Vila-Nova da Silva Dione Batista, Nahas Fábio Xerfan, Ferreira Lydia Masako
Dr Vila-Nova da Silva is a graduate student in the Graduate Program in Plastic Surgery, Dr Nahas is an Associate Professor in the Division of Plastic Surgery, Department of Surgery, and Dr Ferreira is a Full Professor in the Division of Plastic Surgery, Department of Surgery, all at the Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil.
Aesthet Surg J. 2015 May;35(4):477-83. doi: 10.1093/asj/sju089.
Recently, more lawsuits have been filed by patients against their plastic surgeons, often leading to social and financial losses for the physicians involved.
The authors sought to determine the factors that influence judicial decisions against plastic surgeons.
Data from 98 malpractice claims filed between January 1 2000 and December 31 2008 were obtained from a state court of justice in Brazil. The authors selected 39 closed cases for this study. The following parameters were reviewed for each case: date of decision, complaint(s), conclusions of expert report, presence/absence of informed consent, medical records, and judicial decision. The chi-square test, Cramer's V coefficient, Fisher's exact test, and Cochran-Armitage test were utilized to compare data. Significance was defined as P ≤ .05.
Most lawsuits pertained to breast surgery (32%), abdominoplasty (24%), rhinoplasty (22%), and liposuction (22%). The most common complaints were scars and resulting contour (48.9%), general dissatisfaction (25.6%), and complications (25.2%). In all cases with medical records considered of "good quality" by the judge (n = 17), the surgeon was acquitted. There was a significant correlation between decisions favoring the surgeon and the presence of written informed consent documentation. "Not guilty" verdicts also were associated with expert report conclusions favoring the physician. Surgeons were found guilty of malpractice in cases that failed to meet at least 2 of these 3 conditions (good-quality medical record, informed consent, expert report favoring the surgeon).
Factors that heavily influenced judicial decisions were the quality of medical records, informed consent, and expert report conclusions.
最近，患者针对整形外科医生提起的诉讼增多，这常常给相关医生带来社会和经济损失。
作者试图确定影响针对整形外科医生的司法判决的因素。
从巴西一家州法院获取了2000年1月1日至2008年12月31日期间提交的98起医疗事故索赔数据。作者选择了39起已结案的案件进行本研究。对每个案件审查了以下参数：判决日期、投诉内容、专家报告结论、是否存在知情同意书、病历和司法判决。采用卡方检验、克莱默V系数、费舍尔精确检验和 Cochr an - Armitage检验来比较数据。显著性定义为P≤0.05。
大多数诉讼涉及乳房手术（32%）、腹部整形术（24%）、隆鼻术（22%）和吸脂术（22%）。最常见的投诉是疤痕及由此导致的外形问题（48.9%）、总体不满意（25.6%）和并发症（25.2%）。在法官认为病历“质量良好”的所有案件（n = 17）中，外科医生被宣告无罪。有利于外科医生的判决与存在书面知情同意文件之间存在显著相关性。“无罪”判决也与有利于医生的专家报告结论相关。在至少未满足以下三个条件中的两个条件（高质量病历、知情同意、有利于外科医生的专家报告）的案件中，外科医生被判定有医疗过失。
严重影响司法判决的因素是病历质量、知情同意和专家报告结论。
