Difficult (sophisticated) case in doctor’s activities. Limits of the feasability of legal demans to a physician

Viktoras Justickis, Ilona Aleksiūnienė

Abstract


Complicity of tasks doctor meets in his everyday activities are very different: both most simple and highly sophisticated ones. However the legal regulation of doctor’s responsibility neglects the degree of complicity of his task and addresses an abstract standard case that is free of any complicity. This paper addresses this problem and discusses its practical and legal implications.
A sophisticated case is such one in which doctor meets especially high intellectual, physical, psychic, and etc. demands that reach or overpass the limits of his abilities and there are no clear ways to deal with these difficulties.
The difficulties that doctor meets diagnosing arise from especially high demands to doctor’s medical knowledge, which mostly exceeds his real abilities. This problem can in some degree can be solved by the modern “prompting” technologies (DiagnosisPRO6, Isabel, Dynamed, UpToDate, DXplain ir kt.). The legal situation in which correct diagnosis could be done using one of these technologies but was not done because they were not used is discussed.
A sophisticated case demands the wide and very intensive cooperation with other specialists. The main problem met here is that the organization of an efficient cooperation demands doctor’s knowledge that exceeds limits of his specialty. The most radical solution of the doctor’s cooperation problem is Multi-Disciplinary Medical Team (MDMT).
The sophisticated case is highly resource - demanding. It needs much more doctor’s time and other medical resources that the regular one. The organization of the health care usually tends to ignore this demand or to vest responsibility for arranging additional time on doctor.
The most efficient way to solve this problem is to recognize both the very existence of sophisticated cases and the high work load it demands. Large-scale privatization seems to be another prospective way to solve the problem.
The need to reform doctor’s liability system and obstacles for such reform are discussed.

Keywords


difficult medical case; sophisticated medical case; feasability of law; standards of health care service; doctor‘s liability

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"Health Policy and Management" ISSN online 2029-9001 / ISSN print 2029-3569