Indian journal of medical ethics最新文献

Background: Sexual harassment (SH) and Gender discrimination (GD) faced by medical students have been neglected areas of study in India. Only a few recent studies could be found, despite frequent media reports on SH and GD. This study aimed to assess the attitudes and perceptions of sexual harassment and gender discrimination and evaluate the forms of SH and GD experienced by them.

Methods: A Google form based mixed method survey tool was distributed amongst students of 28 medical colleges in Maharashtra. Participants were assured of confidentiality and anonymity.

Results: Of the 308 students who were eligible for the present study, 14.3% (44) and 26.6% (82) reported incidence of sexual harassment and gender discrimination, respectively, while 133 (43.2%) of them reported having experienced some or the other form of SH/GD. A wide range of instances of SH and GD were described by the students.

Conclusions: The study highlights the need to create awareness about sexual harassment and gender discrimination amongst medical students, and to create an atmosphere where such abuses do not occur.

In 2023, as per the World Health Organization (WHO), India emerged as the country with the highest number of tuberculosis (TB) cases, reporting 2.8 million cases and contributing to 27% of the global TB burden [1]. Worldwide, there were 7.5 million newly diagnosed TB cases in 2022, marking the highest figure since global monitoring began in 1995 [1]. Although an estimated 410,000 people worldwide developed multidrug-resistant TB, less than half of them commenced treatment within the same year [1].

Background: Unethical provider practices in public healthcare schemes adversely impact beneficiaries' health, result in the loss of public funds, and also bring disrepute to the schemes. There is extensive literature on the typologies of unethical practices in healthcare in developed countries. This study aims to develop a typology framework which is applicable in the Indian context.

Methods: In this study, 25 media reports and research studies were analysed on unethical provider practices under public health insurance schemes in India over the past 12 years from 2010 to 2022. The reports were collated from de-empanelment orders issued by state health authorities against various erring entities, and research studies conducted on the abuse of these schemes.

Results: Based on the analysis and classification of the cases reported, an "Unethical Provider Practices" typology for healthcare fraud has been defined. Additional fraud typologies are found to be prevalent in India in addition to those captured by existing frameworks. These include patient harm, ID theft of beneficiary data to create cards for non-beneficiaries, and collusion between providers and different entities.

Conclusions: Fraud control mechanisms leveraging technology such as AI-enabled digital apps for medical audits, biometric technology at the point of care and rigourous checks of ID documents before beneficiary cards are issued as well as having more specific legal provisions in place for healthcare fraud will enable enhanced prevention, detection and deterrence of healthcare fraud.

This article highlights the importance of advance care planning (ACP) in good end-of-life care (EOLC). The judgement by the Supreme Court of India legalised Advance Medical Directives in 2018 and in January 2023, amended the procedure to make it easier. The article describes the advantages of ACP, the numerous ethical dilemmas at the end of life that it seeks to address and avoid, the latest legal procedure, the barriers, the need for awareness among healthcare providers, legal professionals as well as the public, and the need for legislation to translate the law into action. Educating citizens about their right to choose the kind of care they want at the end of life, including the right to refuse treatment, is the moral and ethical duty of all health professionals. Making death literacy and ACP a part of a public health initiative would be a major step towards meeting the obligations reflected in the World Health Organization guidelines and National Health Policy 2017, which envisage palliative care and EOLC as an integral part of Universal Health Coverage, requiring support from the government as well as the participation of civil society.

Humane and empathic care are quintessential to the medical profession. In this narrative, a psychiatrist reflects on a difficult patient encounter which highlights the influence of trauma on a patient with psychosis and how the doctor-patient relationship is paramount in the treatment of any illness.

The rape and murder of a trainee doctor in RG Kar Medical College in Kolkata on August 9, 2024, was a brutal crime but had nothing to do with patients or violence by patients or their attendants against health workers. The accused is a civic volunteer who is said to have frequented the hospital as a tout, fleecing patients by promising to get them a bed or help them get tests done for free or at discounted rates [1]. However, following the incident, the protests by doctors, mostly resident doctors' associations across the country, zeroed in on protection for doctors and health workers from violence and attacks by patients through a central law as one of their main demands [2].

This is a personal account of medical practices and healthcare behind bars, which draws on direct experiences and narrations from fellow prisoners, accumulated during eleven years in custody. It touches on issues of the relationship of medical professionals with the torture of detenus, the anarchy of everyday prison medication, frailty and death among older inmates and the proposals and prospects for prison healthcare reform. It sees a need for systemic change, but the prognosis is not optimistic.

A researcher in a Hyderabad-based science institution, Roshni (name changed to preserve anonymity) started identifying as a transgender woman in 2018, and wanted to start her medical transition - the process by which transgender people seek to affirm and express their gender using medical interventions.

Background: Misconduct in the publication of research articles is a serious concern for the scientific community. This study was conducted with the objective to assess various reasons for retraction of clinical research articles published in PubMed indexed journals from all over the world since 2012 to 2022.

Methods: A search was performed on the PubMed database for retracted research articles using filters for "retracted publication". A total of 314 eligible research articles were assessed for studying basic details. The study outcome measures were to evaluate the reasons for the retraction and authors' and journal editors' responses to retractions.

Results: Of the original research articles retracted, 150/242 (61.98%) were clinical trial publications. Of the total 314 retracted research articles, the most retractions were in 2014 (47, 14.96%) and 2013 (40, 12.73%) while the fewest retractions were in 2012 (3, 0.95%) and 2022 (9, 2.86%). The most common reasons for retraction were data errors or data analysis errors (120/314, 38.21%) followed by plagiarism (37/314, 11.8%), duplicate publication (35/314, 11.1%), ethical concerns (23/314, 7.3%) and methodological flaws (22/314, 7%). These concerns were raised mainly by the editor or editor-in-chief (228/314, 72.61%), followed by authors (29/314, 9.23%). Out of 228 editorial concerns on publications, authors of only 91/228 (39.91%) agreed and 17/228 (7.45%) completely disagreed with the editorial decision.

Conclusion: Authors need to be more careful about data analysis errors, fabricated or falsified data, and plagiarism while submitting their research papers. On the part of editors, detecting misconduct at the submission and peer review stages will help lower the retraction rate and avoid citation of such articles by other authors.

Background: It is challenging to teach the complexity of the doctor-patient relationship through attitude, ethics, and communication (AETCOM) modules, particularly without being formally trained and especially to first-year medical students who do not interact directly with patients. The present study was undertaken to assess the effectiveness of trigger films (TFs) or short movie clips as a teaching-learning tool to train undergraduate medical students on various aspects of doctor-patient relationships.

Methods: Two modules on various aspects of the doctor-patient relationship were developed using TFs and written case studies and implemented on Phase Ⅰ medical students. Quantitative and qualitative feedback were collected from learners. Perception, understanding, and knowledge were assessed using pre- and post-questionnaires. The results of the feedback and questionnaires collected after using TFs were compared with those collected after using written case studies.

Results: There was a gain in knowledge and understanding after TF sessions, and TF sessions were rated much higher by the students than traditional methods. Most students found TFs to be an innovative and interesting tool. The satisfaction index calculated for TFs from the feedback of both students and teachers was above 96%.

Conclusions: TFs engaged the students' affective domain, promoted reflective attitudes, and linked their learning to experiences. It was reported not only to be interesting and engaging but also effective as a teaching tool.