Medico-legal Aspects of Invasive Diagnostic Cardiovascular Procedures

Abstract

Incidence of using invasive diagnostic cardiovascular procedures (IDCP) has been greatly increased due to their major role in diagnosis and decision taking in cardiovascular diseases. Worldwide, many thousands of patients now undergo these procedures every day with an overall average increase of 1.3% per year and the incidence is expected to increase over the next years.

However there are a variety of complications and pitfalls can ensue during performing these procedures. Even if you are the best trained person to perform these procedures, yet you may be confronted with allegations of malpractice or misconduct, at the least.

These legal implications are usually occurred due to non-adherence to medico-legal responsibilities and duties during performing these procedures which can be accomplished by observing rules of medical ethics together with maintaining high quality of medical care.

To solve health problems with high degree of satisfaction to both patients and their families and to protect one-self from legal allegations, the physician has to observe and adhere strictly to combination of group of ethical and legal principles. Every day, physicians performing IDCP are required to make ethical decisions.

By reviewing of literature and analysis of retrieved data, it was found that these medico-legal duties and responsibilities could be classified by several forms or approaches into: I) Duties and towards the patient: A. General duties: They necessitate adherence to the main pillars of medical ethics and include proper communication with the patients, respecting patients' rights, treating them in dignity and honesty, obtaining an informed consent from the patient before any procedure to respect his autonomy, respect patient's right of privacy and confidentiality, doing the very best for the patient in an application of the concept of "Beneficence and Non-maleficence", dealing with the patients in justice and treating them equally without any discrimination, avoiding conflict of interest and futility in his practice and properly documenting his patients' medical records and keeping them safe.

B. Specific duties: They are specific to IDCP and include: 1) Pre-procedural duties: They can be accomplished by proper selection of the indicated procedure for the suitable patient through assessment of the indications and contraindications of the procedure with specific establishment of the patient's risks resulting from these procedure pitfalls. It is very important to verify the correct patient and site, review his laboratory investigations, take into consideration the precautions of contrast agent use and other medications and ensure availability of all required or potentially required equipment.

This is done using the appropriate medical devices that must be approved, clinically evaluated, properly decontaminated and to be used in its approved use before its expiry date.

2) Intra-procedural duties: They include planning for intra-procedural patient management with special attention to certain items in order to minimize patient's risk like proper performance, proper selection of technique and equipment suitable to every patient, using anesthesia with certain patients, minimizing patient dose of radiation and contrast agent, and good handling of complications.

3) Post-procedural duties: Planning for post-procedural management care and follow up is essential to achieve good patient's care in order to decrease incidence of risks and for better handling of complications. These risks and complications range widely from minor problems with short term sequelae to life threatening situations that may cause irreversible damage, if urgent care is not provided.

II) Duties towards colleagues and paramedics: Duties towards colleagues and other medical staff members include dealing respectfully with them and working as a team with qualified persons.

III) Duties towards the community: Duties towards the community involve abiding by laws of the country, ideal utilization of health resources, maintaining continuous medical education (CME), teaching and training of students and residents to increase skill and experience, participating in research work, refraining from any harmful act to the community, and accepting to be an expert witness if the cardiologist has the skills, ability and expertise to do so.

IV) Duties towards the medical profession: These include duty to protect the nobleness of the profession, duty to refrain from any unethical practice, duty to protect the patients from irresponsible acts of any healthcare practitioner, and duty to maintain the highest standards of care and observe quality control measures.

Not fulfilling all these responsibilities and duties may increase patients' morbidities and mortalities resulting from these procedures and also expose the cardiologist to medico-legal pitfalls and a cause for accusing him with medical malpractice.