The medical complaint in orthopedics and traumatology

Abstract

Introduction: Orthopedics is one of the specialties with a high risk of lawsuits due to professional responsibility; this is so mainly because road, industrial and home accidents have dramatically increased. Yet, some variables inherent to the personnel, patients, equipment, supplies, medical units and health institutions, among others may be the cause for this. This investigation aimed at studying the medical complaints in Orthopedics and Traumatology, submitted for arbitration process in the National Medical Arbitration Commission (CONAMED) during the period 2002-2008. Material and Methods: The study design was retrospective, transversal and descriptive, a sample of 51 arbitration cases was analyzed, obtained by the formula of finite populations, where the population corresponded to a total of 62 arbitration cases, attended by CONAMED during the period from January 2002 to December 2008, pertaining to controversies in Orthopedics and Traumatology. An instrument containing 20 items was made by means of which information regarding the cases was obtained, as well as their resolution, which determined as either attachment to medical lex artis or as malpractice. The patient’s age, gender, state, level of care and type of service, reason for dissatisfaction, alimony, anatomical region affected, compliance with the obligations of diagnostics and treatment, type of damage and repair, and the clinical file adherence to the guidelines established by the Mexican Official Norm NOM-168-SSA1-1998, for the clinical file (NOM-168-SSA1-1998) were analyzed. Results: Of the 51 arbitration cases analyzed, a total of 30 women (59%) and 21 men were found (41%), being the age group with the highest proportion the one between 45 and 64 years-old in both sexes. The attention provided at public institutions accounted for the highest percentage with 41.18%, followed by private institutions 35.29%. The care was provided mainly in the second level (94.12%) with a frequency of 48 cases, predominating the attention of surgical type with 76.47%. The main reasons for nonconformity were due to irregularities in diagnosis and treatment in 23 cases (45.1%), treatment anomalies in 17 cases (33.3%). In 20 cases (39.22%), the care provided was according to the scientific and ethical principles that guide the practice of the specialty; in the remaining 31 cases (60.78%) there was malpractice for negligence. The lumbar spine was the most affected anatomical region with 21.57%. In cases of malpractice, property damage was proved in 17 (54.84%), physical damage in 12 (38.71%) and there was no damage in 2 cases (6.45%). As for the integration of the medical record, 36 cases (70.59%) were within the guidelines established by NOM-168-SSA1-1998. Conclusions: The correct medical care is not only related to the application of knowledge and professional skills, but also the performance of the duties imposed by the lex artis, the successful implementation of technological resources, and compliance with applicable legal standards. Deviations in health care should be observed in a new culture as a fundamental tool, since its identification should aim at improving the patient’s care.