7. Haridas SV, Pawale DA. A retrospective study of the model of clinical forensic cases registered at the Kolhapur District Tertiary Health Centre. J Forensic Med Sci Law. 2014;23:1-5. Traditionally, a few clinical specialties, such as obstetrics and gynecology, are considered areas of medical practice to be particularly at risk with respect to medical negligence litigation. There is growing evidence that clinical negligence litigation is becoming more common in primary and ambulatory care.1–3 Like other areas of clinical practice, travel medicine also carries medico-legal risks. The potential for unrecognized medico-legal risks and the lack of risk management practices in travel medicine are worth considering. Medico-legal risk awareness helps promote high standards of clinical practice. A prudent approach to informed consent, rigorous clinical notes, and ongoing professional development are important recommendations to mitigate the risk of clinical neglect. The adoption of these medico-legal recommendations will improve patient safety and optimize standards of care. Caring for patients who travel when they become ill abroad and for travellers who have returned ill are another source of medico-legal risk.
While travel physicians commit to consulting with a traveller by phone or email, there is always a duty of care. The travelling physician should be aware of the limitations associated with a consultation that does not allow for an in-person interview and physical examination. Caution should be exercised during remote telemedical consultations. Referral to a local health care provider may be the preferred option if possible. Most clinical negligence litigation involves either non-diagnosis or delay in diagnosis. This is particularly relevant for the care of the returning traveler. Depending on the itinerary, it may be important to ensure that the patient is advised prior to travel to consult a physician in case they become ill upon return.21 There are many medico-legal risks associated with the administration of travel vaccines. The travel physician should have a well-formulated consent procedure to promote informed consent. It may be necessary to complement the discussion about the risks and benefits of vaccination by providing reading materials and time for the patient to make an informed decision.
In some cases, it may be necessary to postpone vaccination to a later consultation to give the patient sufficient time to consider available options. While the use of informed consent is recommended, a signed informed consent form does not automatically mean that informed consent has been obtained.8 Careful documentation of the patient`s decision-making process is recommended. This is especially important if a patient refuses vaccinations or other treatments that the travel physician deems necessary. The extent to which pre-existing conditions are taken into account in light of vaccination decisions is of concern. Failure to consider an immunocompromised disease, such as prior to yellow fever vaccination, could have serious consequences and, after weighing the probability, would likely be considered negligent practice if an adverse patient outcome occurs. If in doubt, the pregnancy status should be questioned and/or effectively verified in the travellers prior to administration of the vaccine. Management of breastfed travellers also poses a potential medico-legal risk, particularly with respect to failure to vaccinate due to concerns about vaccine safety for the breastfed child. It is generally accepted that breastfeeding is not a contraindication to vaccination, except for smallpox vaccine.9 11. Jadoon OK, Shireen F, Seema N, et al.
Types of forensic cases reported to the emergency department of Ayub Abbottabad University Hospital. J Ayub Med Coll Abbottabad. 2020;32(1):51–53. The definition of “patient” is interpreted broadly; A duty of care may exist between physicians and future patients, and even between medical administrators and inpatients. A medico-legal case (MLC) refers to any case of injury or medical condition in which law enforcement agencies attempt to investigate and remedy responsibility for the injury or health condition.1 From a medical perspective, an MLC is a medical or clinical case with legal implications.