Diagnostic error in medical education: where wrongs can make rights

This paper examines diagnostic error from an educational perspective. Rather than addressing the question of how educators in the health professions can help learners avoid error, however, the literature reviewed leads to the conclusion that educators should be working to induce error in learners, leading them to short term pain for long term gain. A variety of literatures are reviewed that suggest errors in performance are necessary pre-conditions for learning to occur such that an aversion to errors, while more comforting to the learner, is counter-productive. Similarly, research is reviewed that suggests strategies aimed at avoiding heuristic-driven diagnostic errors may successfully reduce those types of errors, but may do so at the expense of inducing errors of comprehensiveness. Taken together, the variety of studies contained suggest that diagnostic errors are often beneficial and that we as an educational community should strive to determine how to harness their pedagogical and diagnostic benefits rather than simply trying to eliminate mistakes entirely.     

Reproductive rights in contraceptive practices

In India, impoverished and illiterate women suffer from such low social status that they are unaware of their right to 1) experience a fulfilling sexual relationship free from fear of infection and disease; 2) choose whether or not to have children; and 3) receive family planning services, including safe abortion services. With only 37% married women of reproductive age using contraception, unwanted pregnancy is a major public health problem that leads to 5-6 million abortions each year, with many procedures carried out in unhygienic conditions. India's maternal mortality rate is 1/50 (as compared to 1/2700 in developed countries), and children under age 5 years have a doubled chance of death if their mothers die. Also, in order to promote healthy birth spacing and delay first births in young mothers, the practice of prolonged breast-feeding must be encouraged while appropriate contraceptives to increase birth intervals are introduced and new methods are developed for lactating women. Another challenge is to increase the use of male methods and develop a vaccine for male fertility regulation. Unmet need for contraception exists among 80% of married women in India, and efforts should be made to understand and respond to barriers to contraceptive adoption. In light of the rapid spread of sexually transmitted diseases and HIV/AIDS, it is also important to study sex behavior, especially among adolescents, in order to devise appropriate prevention policies and programs.     

'There are no rights and wrongs in these situations': identifying interactional difficulties in genetic counselling

Abstract The rapid scientific and technological advances in the field of human genetics have created an ever‐widening gap in knowledge and understanding between those specialists who are involved with them and the general public who are the intended beneficiaries. Genetic counselling is seen as an important way of addressing this gap. Whilst there is a growing literature on genetic counselling, this has tended to focus on quantitative measures of outcome. However, there is a growing recognition that genetic counselling is a communicative process, and needs to be studied as such. This paper presents extracts from a body of data collected at a regional genetic counselling centre, and analysed using a conversation analytic approach. A particular emphasis is placed upon the communication of genetic information by counsellors and the ways in which this is received by clients, and how this impacts upon the ways in which topics for discussion are arrived at. Four areas around which interactional difficulties arise are identified: achieving a client‐led agenda; knowing what is relevant for a particular client; managing different activities within counselling; and managing the multiple perspectives of clients.     

Reproductive rights and the state in Serbia and Croatia

The global reproductive rights movement arose in the late 1980s and early 1990s as a challenge to the population control paradigm that has dominated family planning policy for almost half a century. The essence of the challenge is to place women into the center of population discussions as subjects, not objects of policy, and to reorient family planning and health programs toward meeting the broad reproductive health needs of individuals, rather than the narrow population control objectives of states. Reproductive rights advocates argue that the use of family planning programs for developmentalist-oriented population control objectives is illegimate, and inevitably relegates women to the status of depersonalized policy "targets". The cases of Croatia and Serbia, the two dominant partners in the former Federal Republic of Yugoslavia, offer interesting twists on these reproductive rights issues. In Croatia and Serbia, unlike in many nations, the governments are deliberately seeking to increase rather than decrease fertility levels. Moreover, the objective concerns identity politics, more so than development: the governments have encouraged increased fertility to safeguard the survival of their nations and to strengthen national power amidst threatening internal and external environments of ethnic conflict. In this paper, we examine the dynamics of pro-natalist fertility policy in Croatia and Serbia. We do so with a view to explaining why, despite similarities, the two have followed divergent paths. While reproductive rights violations have occurred in both nations, they have been markedly higher in Serbia than Croatia. To explain this divergence we look at a series of sociopolitical factors, including the space available for groups to mobilize in each political system; the degree of nationalistic extremism present in the discourse of central political leaders; and perceptions of threats and opportunities in external geopolitical environments. In conducting this analysis we seek to drive home the point that a nation's reproductive rights situation and prospects cannot be understood divorced from its sociopolitical context. We also raise an additional impetus for promoting the reproductive rights agenda--one largely unexplored in the family planning literature-that emerges from low fertility nations facing identity issues. Women's bodies must be protected not only against those states seeking to use their reproductive capacities for developmentalist-oriented fertility control, but also against those wanting their bodies for nationalistic-oriented fertility promotion.     

Reproductive health rights and survival: The voices of mothers experiencing homelessness

ABSTRACT

Women experiencing homelessness report higher rates of reproductive health-related traumas, including unplanned pregnancy, miscarriage, and abortion than their non-homeless peers. Using phenomenological hermeneutic methods, we sought to understand the reproductive health histories of women currently experiencing homelessness (N = 20, 25–61 years old, Mage = 38.33, SDage = 9.33) analyzing data collected between June 2014 and July 2015 in north central Texas. Three key themes highlight the essence of the women’s experiences: (1) unexpected pregnancy—pregnancy just happened, (2) loss of reproductive health rights—I was broken, and (3) resilience—giving back and looking forward to good things. Many of the women became mothers through unexpected pregnancies, and overnight found that their lives were transformed irrevocably. Often unexpected pregnancy was the result or cause of a lack of ownership over their reproductive health and led to prolonged health-related traumas. Over time, though, many of the women whom we interviewed re-expressed resilience through social support, housing assistance, and a sense of giving back to society. Results indicate that reproductive health care providers require training to identify the relationship among unexpected pregnancy, reproductive health-related traumas, and housing insecurity. Providers can help preserve women’s reproductive health rights through education and empowerment.     

States' rights and wrongs. Hospitals and their state associations are trying to move their nonbilling policies for adverse events past the talking phase

While hospitals across the country are pledging to stop billing for some medical errors, some believe the initiative is more public relations than anything else. The National Business Group on Health's Helen Darling, says the premise that hospitals are already leaving out payment requests "doesn't ring true."     

The NHS and the law. Rites and wrongs

The compensation system for medical negligence fails to satisfy victims, health professionals and managers. Bridgit Dimond examines the alternatives.     

Reproductive rights of women and men in light of new legislation on voluntary sterilization in Brazil

This paper aims to analyze the impacts and possible changes that the implementation of a new Brazilian family planning law has on reproductive practices, especially voluntary sterilization, and to determine whether men's and women's reproductive rights are being respected. The methodological approach is based on a six-month follow-up survey taken monthly, applied to a sample of 159 individuals in six contextually different State capitals. Besides verifying whether the health sector is complying with the criteria set by the law, we analyze the waiting time between the request for sterilization and the surgery itself, utilizing survival analysis. We also conduct interviews with health professionals, shedding light on the procedures adopted in the practice of sterilization. For various reasons, the law has produced little change in the usual practice of sterilization, besides failing to satisfy individual reproductive rights.