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Israeli Medical Association defies High Court
"defensive medicine" in making treatment decisions and documenting their cases. These internal reports had been strictly Dr Yoram Blachar, IMA chairman, confidential, open to self and professional stressed that the union’s desire was not to review but closed against publication orcover up any alleged medical negligence, other disclosure, which assures but that there are legal channels to investidetail and candor. When the lawyer repregate accusations of medical malfeasance. senting the family asked to see the report, He referred to the IMA’s recommendathe hospital refused on the grounds that tion against a guideline provided by Attorsuch information was "privileged". When ney General Michael Ben-Yair that would the District Court Judge ordered the hosbar government hospital physicians from to the the pital report, provide providing a paid medical opinion to a administration stood on principle and patient suing a government institution for appealed the lower court ruling to the negligence. Blachar stated that a physi: cian’s committment to his patient surSupreme Court. The precedent-setting legal judgment of passes his allegiance to his employer. Supreme Court President Aharon Barak, : Government hospital doctors must preendorsed by two other Justices, placed the sent their opinion in court if they are sumpatient’s right to all information about moned to testify, but if there is an medical treatment-including the content alternative, then paid assessments can be of internal review-above the doctor’s obtained from doctors working outside of right to private disclosure. The medical the government hospital system. On the community, the IMA, and the Health : other hand, he said, internal committees, Ministry recognise that doctors will no as voluntary bodies, are the very basis of medical learning, mutual evaluation, prolonger be immune from legal suit-virtually unheard of in Israel until now-but fessional feedback, and self-examination. while the Health Ministry stood behind This is essential to clinical growth but will the Court ruling, the IMA strongly be destroyed if physicians are afraid to opposed it. The IMA stated that the proexpress themselves to each other for fear fession has improved and excelled internathat it could later be used against them tionally solely because of internal review later in a damage suit. and self-criticism; if doctors lose this tool, : the IMA said, they may be forced to adopt Rachelle H B Fishman
Israeli Medical Association defies Israeli doctors are concerned that Israeli medicine is becoming "Americanised", that doctors are going to have to be as worried about malpractice suits as about medical practice. A recent Supreme Court ruling that allows testimony of doctors during internal investigations of patients’ treatment to be used against them in a court of law has sparked an unprecedented move on the part of the Israeli Medical Association, the physicians’ union. The IMA has taken a stand against the High Court decision by suggesting to its more than 12 000 members that they should be judicious and even take legal counsel if they feel that they may self-incriminate when giving evidence in any internal investigation launched by a hospital or medical centre into alleged negligence or malpractice. The case was initiated by a negligence suit brought in Jerusalem District Court against a local hospital by the family of a psychiatric patient who, 12 days after surgery that saved his life following a suicide attempt, sneaked out of his ward and leaped to his death from a nearby open window. As is routine, an internal investigating committee prepared a report based upon interviews with staff and evidence collected to elucidate the suicide.
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Experts endorse family-planning method this week begin to use another contraceptive method if she wishes to prevent pregfamily-planning for 1: breastfeeding mothers, giving them nancy. another option to help them achieve 24 and scientists policy-makers1 desired birth spacing. The meeting, co- 1 analysed results from studies that confirmed that LAM is an effective familysponsored by WHO, Family Health Interand the national, Georgetown University planning method. The research was based . Institute for Reproductive Health, was on data from several thousand women in held at the Rockefeller Study Center in Australia, Chile, Ecuador, Egypt, : Guatemala, India, Nigeria, Pakistan, Peo- 1 Bellagio, Italy, on Dec 11-14. This action was hailed by the group as 1 ple’s Republic of China, the Philippines, : An
international
endorsed
a
group
form of
milestone for the health of mothers and children. In most of the world, a child born less than 2 years after his or her older sibling has more than twice the risk of dying, compared with a child born more than 2 years after the sibling. If this family-planning method is : offered by policy-makers and health providers, said the group, the health of mothers and infants will improve. They added that family planning and child survival programmes should consider making this method available to postpartum women, together with good counselling, guidance, and access to other family: planning methods. The group said that the lactational amenorrhoea method (LAM) is very safe and more than 98% effective. To use LAM correctly, a woman must be amenorrhoeic, fully or nearly fully breastfeeding her infant, and within the first 6 months after delivery. When any of these conditions changes, the woman should a
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AMA
fees resolution rescinded A resolution by the Australian Medical Association to limit members’ fees (Lancet 1995; 346: 958) has been rescinded. The original resolution was made in September, 1995, and rescinded by a resolution at an AMA council meeting after reported "heated discussion" of the motion put by surgeon Don Sheldon, chair of the Council of Procedural Specialists. Some councillors Rwanda, Sweden, the UK, the USA, and that the original resolution be preferred several other countries. In 1988, scientists set aside for additional discussion. It was issued a consensus statement (see Lancet ; decided to reconsider the fees limitation 1988; ii: 1204-05) that set in motion the issue at the Association’s national clinical research on LAM that followed. A conference in 1996. new consensus statement was issued on Dec 14. : Breastfeeding contributes significantly Prion prize The prize committee for to child survival, child nutrition, and to medicine of the Wolf Foundation has healthy birth spacing. Some experts worry decided unanimously to award the 199596 Wolf Prize in Medicine to Dr Stanley B that the intensity and duration of breastPrusiner of the University of California are because of urban declining feeding factors. It School of and other has Medicine, San Francisco. 16 lifestyles long been known that breastfeeding can delay of the 165 Wolf Prize recipients have subthe return of fertility and, says the statesequently received the Nobel Prize for ment, LAM provides a reliable temporary the same scientific achievement (in Medifamily-planning method after childbirth. cine, Chemistry, and Physics; there is no Copies of the new consensus statement Nobel Prize for Agriculture and Mathecan be obtained from Special Programme matics). Prusiner will receive the$100 of Research, Development and Research 000 award of the Israel-based Wolf FounTraining, World Health Organization, dation for discovering prions, a new class 1211 Geneva 27, Switzerland. : of infectious agent that causes neurodegenerative diseases such as CreutzfeldtWilliam Finger Jakob disease.
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recent
Israeli Medical Association defies Israeli doctors are concerned that Israeli medicine is becoming "Americanised", that doctors are going to have to be as worried about malpractice suits as about medical practice. A recent Supreme Court ruling that allows testimony of doctors during internal investigations of patients’ treatment to be used against them in a court of law has sparked an unprecedented move on the part of the Israeli Medical Association, the physicians’ union. The IMA has taken a stand against the High Court decision by suggesting to its more than 12 000 members that they should be judicious and even take legal counsel if they feel that they may self-incriminate when giving evidence in any internal investigation launched by a hospital or medical centre into alleged negligence or malpractice. The case was initiated by a negligence suit brought in Jerusalem District Court against a local hospital by the family of a psychiatric patient who, 12 days after surgery that saved his life following a suicide attempt, sneaked out of his ward and leaped to his death from a nearby open window. As is routine, an internal investigating committee prepared a report based upon interviews with staff and evidence collected to elucidate the suicide.
: : : : : :
i : : : :
!: i : : :
i!: :: :
! : : i:: :
! : : .
High Court
complete
1
hospital
1
1
1
1
News in brief
Experts endorse family-planning method this week begin to use another contraceptive method if she wishes to prevent pregfamily-planning for 1: breastfeeding mothers, giving them nancy. another option to help them achieve 24 and scientists policy-makers1 desired birth spacing. The meeting, co- 1 analysed results from studies that confirmed that LAM is an effective familysponsored by WHO, Family Health Interand the national, Georgetown University planning method. The research was based . Institute for Reproductive Health, was on data from several thousand women in held at the Rockefeller Study Center in Australia, Chile, Ecuador, Egypt, : Guatemala, India, Nigeria, Pakistan, Peo- 1 Bellagio, Italy, on Dec 11-14. This action was hailed by the group as 1 ple’s Republic of China, the Philippines, : An
international
endorsed
a
group
form of
milestone for the health of mothers and children. In most of the world, a child born less than 2 years after his or her older sibling has more than twice the risk of dying, compared with a child born more than 2 years after the sibling. If this family-planning method is : offered by policy-makers and health providers, said the group, the health of mothers and infants will improve. They added that family planning and child survival programmes should consider making this method available to postpartum women, together with good counselling, guidance, and access to other family: planning methods. The group said that the lactational amenorrhoea method (LAM) is very safe and more than 98% effective. To use LAM correctly, a woman must be amenorrhoeic, fully or nearly fully breastfeeding her infant, and within the first 6 months after delivery. When any of these conditions changes, the woman should a
1
1
1700
AMA
fees resolution rescinded A resolution by the Australian Medical Association to limit members’ fees (Lancet 1995; 346: 958) has been rescinded. The original resolution was made in September, 1995, and rescinded by a resolution at an AMA council meeting after reported "heated discussion" of the motion put by surgeon Don Sheldon, chair of the Council of Procedural Specialists. Some councillors Rwanda, Sweden, the UK, the USA, and that the original resolution be preferred several other countries. In 1988, scientists set aside for additional discussion. It was issued a consensus statement (see Lancet ; decided to reconsider the fees limitation 1988; ii: 1204-05) that set in motion the issue at the Association’s national clinical research on LAM that followed. A conference in 1996. new consensus statement was issued on Dec 14. : Breastfeeding contributes significantly Prion prize The prize committee for to child survival, child nutrition, and to medicine of the Wolf Foundation has healthy birth spacing. Some experts worry decided unanimously to award the 199596 Wolf Prize in Medicine to Dr Stanley B that the intensity and duration of breastPrusiner of the University of California are because of urban declining feeding factors. It School of and other has Medicine, San Francisco. 16 lifestyles long been known that breastfeeding can delay of the 165 Wolf Prize recipients have subthe return of fertility and, says the statesequently received the Nobel Prize for ment, LAM provides a reliable temporary the same scientific achievement (in Medifamily-planning method after childbirth. cine, Chemistry, and Physics; there is no Copies of the new consensus statement Nobel Prize for Agriculture and Mathecan be obtained from Special Programme matics). Prusiner will receive the$100 of Research, Development and Research 000 award of the Israel-based Wolf FounTraining, World Health Organization, dation for discovering prions, a new class 1211 Geneva 27, Switzerland. : of infectious agent that causes neurodegenerative diseases such as CreutzfeldtWilliam Finger Jakob disease.
1
1
recent