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临床解剖学与医疗事故——一项具有方法学意义的叙述性综述

Clinical Anatomy and Medical Malpractice-A Narrative Review with Methodological Implications.

作者信息

Porzionato Andrea, Macchi Veronica, Stecco Carla, Boscolo-Berto Rafael, Loukas Marios, Tubbs Ronald Shane, De Caro Raffaele

机构信息

Section of Anatomy, Department of Neuroscience, University of Padova, Via Gabelli, 65, 35127 Padova, Italy.

Department of Anatomical Sciences, True Blue Campus, St. George's University, St. George 1473, Grenada.

出版信息

Healthcare (Basel). 2022 Sep 30;10(10):1915. doi: 10.3390/healthcare10101915.

Abstract

Anatomical issues are intrinsically included in medico-legal methodology, however, higher awareness would be needed about the relevance of anatomy in addressing medico-legal questions in clinical/surgical contexts. has been defined as "the practical application of Clinical Anatomy to the ascertainment and evaluation of medico-legal problems". The so-called (normal anatomy, anatomical variations, or anatomical modifications due to development, aging, para-physiological conditions, diseases, or surgery) may acquire specific relevance in medico-legal ascertainment and evaluation of cases of supposed medical malpractice. Here, we reviewed the literature on the relationships between anatomy, clinics/surgery, and legal medicine. Some methodological considerations were also proposed concerning the following issues: (1) relevant aspects of individual anatomy may arise from the application of methods of ascertainment, and they may be furtherly ascertained through specific anatomical methodology; (2) data about individual anatomy may help in the objective application of the criteria of evaluation (physio-pathological pathway, identification-evaluation of errors, causal value, damage estimation) and in final judgment about medical responsibility/liability. Awareness of the relevance of individual anatomy (risk of iatrogenic lesions, need for preoperative diagnostic procedures) should be one of the principles guiding the clinician; medico-legal analyses can also take advantage of its contribution in terms of ascertainment/evaluation.

摘要

解剖学问题本质上包含在法医学方法中,然而,在临床/手术背景下解决法医学问题时,需要提高对解剖学相关性的认识。 已被定义为“临床解剖学在法医学问题的确定和评估中的实际应用”。所谓的 (正常解剖结构、解剖变异或由于发育、衰老、准生理状况、疾病或手术导致的解剖学改变)在涉嫌医疗事故案件的法医学确定和评估中可能具有特定的相关性。在此,我们回顾了关于解剖学、临床/手术和法医学之间关系的文献。还针对以下问题提出了一些方法学上的考虑:(1)个体解剖学的相关方面可能源于确定方法的应用,并且可以通过特定的解剖学方法进一步确定;(2)关于个体解剖学的数据可能有助于客观应用评估标准(生理病理途径、错误的识别评估、因果价值、损害估计)以及对医疗责任/义务的最终判断。认识到个体解剖学的相关性(医源性损伤风险、术前诊断程序的必要性)应该是指导临床医生的原则之一;法医学分析也可以利用其在确定/评估方面的贡献。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/05ce/9601975/1ed8aa4ea152/healthcare-10-01915-g001.jpg

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