Interestingly, by the end of the communist era in China there were only 10 000 lawyers serving the needs of that entire nation. But that did not mean people were without justice. Confucius said a lot of things, and his take on the legal side of life was spot on. Adherence to Confucianism, with the core values of 'perfect virtue, middle ground and authority admiration [respect]', is still part of Chinese culture today. Positioned in every community were people whose task it was to resolve conflict as it arose. Reportedly, there was one counsellor for every 100 souls throughout the country. While one can speculate as to how these disputes were resolved, what is interesting is that the community developed a system that essentially ensured justice for all.
We recently admitted a young immunocompetent man with cryptococcal meningitis. He presented alone, and a combination of language barrier and blunted cerebral function hampered history taking. He described 1 week of headache and fever, and gave a vague account of a penetrating head injury 6 months previously.
There currently seems to be a view among managers in the Department of Health that the best way to improve the clinical performance of staff, particularly in peripheral clinics, is to increase the bureaucratic demands upon them.
We are researching and writing a book on my late aunt, Dr Mary Gordon. When she immigrated to South Africa (SA) from England in 1917, she became the first woman doctor to be appointed to Johannesburg Hospital. She was later to establish a large private practice in Johannesburg while also teaching at the then newly founded medical school at the University of the Witwatersrand, where she remained one of the members of staff until 1946.
As the 8-month West African Ebola outbreak death tally accelerated beyond 4 500 (of 9 000 people infected) by mid-October, Spain and the USA became the first non-African countries to record secondary domestic infections after entry by Ebola-infected people.
It's virtually impossible to calculate whether South Africa (SA) has a shortage of emergency care doctors and nurses until they are properly deployed to where the greatest needs are - and have sufficient ancillary support to ensure that they don't spend chunks of their time doing 'other people's jobs'.
He's the guy who 'makes and loves the coffee' - which is probably just as well, because he's one of only two emergency medicine specialists on night duty at Khayelitsha Hospital, and will soon have to hyper-focus; it's pay-day weekend.
Doctors who discard the placenta after a newly born infant dies or is permanently impaired - seemingly during the birth process - could potentially be throwing away their last chance of a legitimate defence should the angry and grieving parents decide to sue.
Certain tenets of traditional medical education and practice are under review. Best practice tended to focus on scientific fact alone, discarding the complex story and emotional detail of a patient's circumstances as either falling outside the domain of medicine or being irrelevant to care. The relationship between patient and medical practitioner was left unexamined, except by a few pioneers like Balint.
This is the 4th edition of this important book, which was first published in 1976, and a far thicker tome than the original. As implied by the title, the scope of the publication is huge - medicine in Africa, arguably one of the more interesting continents in terms of pathology. And that pathology is not always driven by disease-causing organisms, as the opening section of the book reminds us, covering people and the environment, food and nutrition, refugees and disasters, and how to manage a health service.
The risks associated with infection of healthcare workers and students with blood-borne pathogens, specifically HIV, hepatitis B virus and hepatitis C virus, are often neglected. South Africa (SA) currently has no official policies or guidelines in place for the prevention and management of these infections. This article reviews the available data and international guidelines with regard to infected healthcare practitioners and makes minimum recommendations for the SA setting.
From a litigation perspective, neurosurgery is considered a 'super high-risk' field, and this has been associated with rapidly increasing malpractice cover costs. In 2013 the annual Medical Protection Society fee for cover was R250 900. We wished to determine whether high malpractice cover was influencing how neurosurgeons managed patients. A 40-question online survey asking questions on defensive medicine was distributed to determine perceptions around liability risk and whether these influenced how patients were managed. Eighty-four per cent of respondents agreed that a medicolegal crisis existed, and over half (53.8%) had been sued for malpractice during their career. Altering practice behaviour to minimise the risk of a lawsuit is common. The increasing number of legal claims against respondents in this survey has resulted in most neurosurgeons practising defensive medicine. Arguably this will result in increased healthcare costs, inferior patient care and decreased access to skilled surgeons.
The Consumer Protection Act of 2008 has had far-reaching consequences for suppliers of goods and services in South Africa. The implementation of the Act has important implications for all suppliers who enter into 'consumer transactions'. This article aims to stimulate awareness of the legal consequences of the Act arising from day-to-day situations occurring in the pharmacy, and to highlight the compliance obligations that the Act creates for pharmacists.
In the face of interference with their clinical independence in hospitals with a shortage of resources, what should doctors do? The question can be answered by considering: (i) the constitutional right to healthcare and emergency treatment; (ii) the common-law position regarding unlawful homicide and the doctrine of 'superior orders'; (iii) the ethical rules of the Health Professions Council of South Africa; and (iv) whether there is any protection for doctors who refuse to carry out unprofessional, unethical or unlawful directives from their superiors. While this article focuses on the public sector, some of the legal principles, where relevant, apply equally to doctors in the private sector.
The spectrum of sickle cell disease (SCD) encompasses a heterogeneous group of disorders that include: (i) homozygous SCD (HbSS), also referred to as sickle cell anaemia; (ii) heterozygous SCD (HbAS), also referred to as sickle cell trait; and (iii) compound heterozygous states such as HbSC disease, HbSβ thalassaemia, etc. Homozygous or compound heterozygous SCD patients manifest with clinical disease of varying severity that is influenced by biological and environmental factors, whereas subjects with sickle cell trait are largely asymptomatic. SCD is characterised by vaso-occlusive episodes that result in tissue ischaemia and pain in the affected region. Repeated infarctive episodes cause organ damage and may eventually lead to organ failure. For effective management, regular follow-up with support from a multidisciplinary healthcare team is necessary. The chronic nature of the disease, the steady increase in patient numbers, and relapsing acute episodes have cost implications that are likely to impact on provincial and national health budgets. Limited resources mandate local management protocols for the purposes of consistency and standardisation, which could also facilitate sharing of resources between centres for maximal utility. These recommendations have been developed for the South African setting, and it is intended to update them regularly to meet new demands and challenges.
Attend any meeting of obstetricians, spinal surgeons, neurosurgeons or neonatologists, and talk soon turns to the burgeoning costs of cover for negligence claims. Local medical academic and trade journals are increasingly addressing the issue: the whys, the consequences, and possible solutions. Although there are regular newspaper headlines and articles on litigation costs, seldom if ever does an article in the lay press address the consequences of increasing medical negligence litigation. Is the public unknowingly sleep-walking into a dystopian future with regard to obstetrics, spinal surgery, neurosurgery and neonatology?
The outbreak of Ebola virus disease (EVD) in West Africa has been raging for nearly a year at the time of writing. The likely index case of the outbreak was a 2-year-old child who died on 6 December 2013, having acquired the infection late in November 2013, although the outbreak was only formally announced in March 2014. On 13 October 2014, a total of 8 400 suspected and confirmed cases of EVD, culminating in more than 4 000 deaths, has been reported. This case count is nearly three times the total number of cases of EVD reported in 20 earlier outbreaks from 1976 to 2013. Although it may seem logical to believe that the present virus has mutated to become more lethal and transmissible since previous outbreaks, this epidemic is widely recognised to be fuelled by socioeconomic and public health-related issues that have complicated conventional containment efforts. Full genome characterisation of Ebola virus isolates from Guinea and Sierra Leone has revealed that they are Zaire ebolavirus. This strain has been associated with haemorrhagic fever outbreaks in central African countries since 1976, with case fatality rates of up to 90%. The current fatality rate is estimated to be between 60% and 70%; describing it as 'the most lethal outbreak of EVD to date' therefore relates more to the scale of the epidemic than the actual death rate.
The Venter case for research injury compensation following a clinical trial is the first I am aware of in South African (SA) courts during my service on research ethics committees (RECs) since 1974. Moreover, of the several thousand clinical trials approved in the past 40 years by the Human Research Ethics Committee (Medical) at the University of the Witwatersrand, there has been only one claim for compensation for a research injury of an enduring nature. In this case, about a decade ago, a participant in a clinical trial developed idiopathic hypertension; the sponsor agreed that this was trial related, and has provided long-term care for the hypertension without a need to approach the courts.
The pharmaceutical industry has filled a vacuum. A few decades ago, medical leaders would set research directions and would lobby for products to treat problems faced by their patients. Today, in an era of disease mongering and priority setting by pharmaceutical firms, leaders often react to industry rather than setting clear priorities in worthwhile diagnostic and therapeutic spend.