Defensive medicine: It is time to finally slow down an epidemic

Defensive medicine is widespread and practiced the world over, with serious consequences for patients, doctors, and healthcare costs. Even students and residents are exposed to defensive medicine practices and taught to take malpractice liability into consideration when making clinical decisions. Defensive medicine is generally thought to stem from physicians’ perception that they can easily be sued by patients or their relatives who seek compensation for presumed medical errors. However, in our view the growth of defensive medicine should be seen in the context of larger changes in the conception of medicine that have taken place in the last few decades, undermining the patient–physician trust, which has traditionally been the main source of professional satisfaction for physicians. These changes include the following: time directly spent with patients has been overtaken by time devoted to electronic health records and desk work; family doctors have played a progressively less central role; clinical reasoning is being replaced by guidelines and algorithms; the public at large and a number of young physicians tend to believe that medicine is a perfect science rather than an imperfect art, as it continues to be; and modern societies do not tolerate the inevitable morbidity and mortality. To finally reduce the increasing defensive behavior of doctors around the world, the decriminalization of medical errors and the assurance that they can be dealt with in civil courts or by medical organizations in all countries could help but it would not suffice. Physicians and surgeons should be allowed to spend the time they need with their patients and should give clinical reasoning the importance it deserves. The institutions should support the doctors who have experienced adverse patient events, and the media should stop reporting with excessive evidence presumed medical errors and subject physicians to “public trials” before they are eventually judged in court

Liver cirrhosis in sub-Saharan Africa: neglected, yet important

Clinical efforts and research on liver diseases have been scarce in sub-Saharan Africa. The first Conference on Liver Disease in Africa (Nairobi, Sept 13–15, 2018), gathering all stakeholders from the continent, is a welcome step towards greater attention to the problem, and the important issue of liver cirrhosis

Tuberculosis-immune reconstitution inflammatory syndrome

Abstract Tuberculosis-immune reconstitution inflammatory syndrome is an excessive immune response against Mycobacterium tuberculosis that may occur in either HIV-infected or uninfected patients, during or after completion of anti-TB therapy. In HIV-infected patients it occurs after initiation of antiretroviral therapy independently from an effective suppression of HIV viremia. There are two forms of IRIS: paradoxical or unmasking. Paradoxical IRIS is characterized by recurrent, new, or worsening symptoms of a treated case. Unmasking IRIS is an antiretroviral-associated inflammatory manifestation of a subclinical infection with a hastened presentation. The pathogenesis is incompletely understood and the epidemiology partially described. No specific tests can establish or rule out the diagnosis. Treatment is based on the use of anti-tuberculosis drugs sometime with adjunctive corticosteroids. Mortality is generally low

Cerebral palsy: a multidisciplinary, integrated approach is essential

Cerebral palsy, a syndrome of motor impairment resulting from a lesion in the developing brain, has a worldwide prevalence of 1·0–3·5 per 1000 livebirths.A life-course perspective needs to be adopted as more children live into their adolescence and adulthood. Individuals' participation in life and availability of family-centred services are very important and differ between countries. In low-income countries, most treatments are provided by families and multidisciplinary assessment is done in rural clinics

Patient-reported Satisfaction with Current Clinical Management of Systemic Lupus Erythematosus in Kazakhstan

BACKGROUND: Over the past decades, patient satisfaction has been increasingly recognized as a powerful tool to measure the quality of health-care services. AIM: This study evaluated the satisfaction of systemic lupus erythematosus (SLE) patients with current clinical management in Semey, East Kazakhstan, and explored the factors associated with dissatisfaction. METHODS: All adult SLE patients registered at health-care facilities of Semey were enrolled in a cross-sectional study. RESULTS: Out of 67 patients, 66 were females and their mean age was 39 years. Symptoms associated with the musculoskeletal system were the most commonly reported (95.5%), followed by fatigue (88.1%) and neurological symptoms (53.7%). None of the patients were very satisfied or satisfied with current clinical management and the overall rate of patient dissatisfaction was 83.6%. Education (p = 0.04), monthly income (p = 0.01), SLE disease activity index score (p = 0.031), therapy with biologic agents (p = 0.029), immunosuppressants (p = 0.01), and corticosteroids (p = 0.01) were predictors of patient dissatisfaction in multiple logistic regression analysis. CONCLUSION: This real-world study is the first effort to understand the experience of SLE patients within the health-care system of Kazakhstan and the results may facilitate doctor-patient discussions on the initiatives that need to be taken to improve the quality of the medical services provided