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The paper's aim is to consider the value of medicolegal telephone help‐lines for doctors.

This is a brief review as to how members of a medical protection organisation use a medicolegal telephone help‐line by analysing 100 random calls during a two week period in March 2008. The range of themes and concerns are compared with annual figures from 2007. Recommendations with regard to the need for national advice are considered.

The nature of the service provided gives doctors an additional opportunity to explore matters of concern. Doctors appear to need guidance to support decision making in a variety of ways where a clinical or professional situation needs resolving within an appropriate ethical and legal framework.

Health care organizations should reflect on what if any additional ethical / medicolegal training is required for their employees to assist in difficult professional decisions. There appears to be a significant need for doctors to be able to access independent telephone advice and the use of such services may need to be encouraged.

The paper highlights the benefit for health professionals to have access to independent, objective advice and discussions to support ethical decision making.

“Support a lawyer. go to med school” The above message on the car bumper stickers of members of the medical profession reflects their reaction to the current escalation of malpractice suits filed by attorneys against doctors and hospitals. The impact of these suits against medical personnel and institutions is not limited to patients, doctors and lawyers; the ripple‐effect reaches the entire community, because the rising incidence of malpractice suits tends to increase the cost of malpractice insurance and ultimately the total cost of health care to all members of society. Malpractice is but a small, though highly visible, part of a broader spectrum of interaction between medicine and law. “The complexities of modern society are causing law and medicine to interface with increasing frequency to the extent that contact with the legal process has become an inescapable aspect of the physician's life.” In recognition of this increasing frequency of contacts between medicine and law, a correspondingly increasing number of medicolegal reference works have been published, as exemplified by the selective list which follows this introduction. These should be of direct interest to doctors and members of allied health professions, to attorneys and paralegals and, indirectly, to all who deal with medical personnel and institutions. Traditionally, attorneys, particularly members of the trial bar, have demonstrated a continuing interest in medical literature. For example, the Merck Manual and Goldstein's Medical Trial Technique are familiar to most trial lawyers. They are expected to be well acquainted with anatomy charts, texts on internal medicine, eye, ear, nose and throat, orthopedics, obstetrics, and pediatrics, to name but a few generic medical works of interest to trial lawyers. It should be noted that the lawyer's interest in medical literature is not necessarily motivated by a desire to harass doctors, nurses and hospitals. Attorneys are bound by their Code of Professional Responsibility to represent their clients competently and zealously. In discharging this ethical obligation, the attorney frequently calls upon a physician to testify as an expert witness concerning the cause of a personal injury or death. Consequently, the attorney should be knowledgeable in medical theory and terminology. Furthermore, in pursuit of interdisciplinary competence, a significant number of individuals in the United States have earned both the medical degree and the law degree and appropriate licenses to practice, e.g., Cyril Wecht, M.D., J.D., Director, Pittsburgh Institute of Legal Medicine, Duquesne Law School, member, Faculty of the Pittsburgh School of Medicine and Dentistry, Coroner, Allegheny County, Pennsylvania.

The purpose of this paper is to consider the medicolegal aspects of working as a GP trainer.

A brief review of the legislation and guidance affecting GP trainers. From this, an analysis of the major risks GP trainers face, and the steps they should take to minimise those risks, is conducted.

There are a number of high‐risk areas for GP trainers. Lack of awareness of a GP registrar's competencies can lead to problems. There is risk in a GP registrar being unfamiliar with the practice, its procedures and physical layout. Out‐of‐hours training is particularly hazardous. A GP registrar who is poorly performing can present a serious risk to patient safety.

GP trainers should put in place procedures to mitigate these risks. A realistic assessment of a GP registrar's skills; a comprehensive induction; adequate supervision out of hours and systems for dealing with poor performance are essential elements of a GP trainer's role.

The paper highlights the benefit for GP trainers in considering the risks they may face and taking steps to address them.

The purpose of this paper is to examine changes in patients' satisfaction after their doctor has participated in a brief educational intervention on medicolegal risk management.

Questionnaire completed by ambulatory patients, measuring satisfaction with their doctor's communication skills before and three months after the doctor participated in a three hour workshop on medicolegal risk management. 75 obstetrician/gynaecologists (O&Gs) and 99 general practitioners (GPs) were each rated by 60 of their patients following a consultation in their clinical rooms.

Patient satisfaction as evidenced by change to “complete satisfaction” with doctor's communication skills and overall satisfaction with the clinical encounter.

Participants had high initial patient satisfaction ratings and these were found to have improved across all parameters three months after the educational intervention.

The educational intervention was successful in improving doctors' communication skills as evidenced by enhanced patient satisfaction in all key areas, including those most frequently associated with patient complaint, litigation and adverse outcome.

To implement a safe and effective intravenous iron infusion protocol to prevent skin staining.

Mixed methods approach was utilised including education, auditing, self-reported survey, patient information leaflet and patient feedback. In total 25 healthcare professionals completed the survey and 15 patients provided feedback.

No skin staining or severe adverse reactions were observed over eight weeks. Audit results found 53 per cent of staff were compliant with the recommended IV iron infusion protocol and 46 per cent informed patients of skin staining risk. Self-report surveys indicated 92 per cent flushed the cannula with sodium chloride before starting the infusion, 88 per cent flushed the cannula after the infusion and 76 per cent informed patients of skin staining risk. Patient feedback was largely positive and constructive.

Limitations include self-reported bias, short audit time interval, missing data and discrepancy between audit and survey results.

This quality improvement project was developed following two skin staining incidences at our maternity hospital. Although rare, skin staining after intravenous iron infusion is potentially permanent and may be distressing for some patients. Intravenous iron is considered safe and effective to treat anaemia during pregnancy and is often prescribed for this patient cohort. To avoid medicolegal action and patient dissatisfaction, it is essential that patients are informed of potential skin staining and an evidence-based administration protocol is utilised.

Error reporting by healthcare staff, patient-derived complaints and patient-derived medico-legal claims are three separate processes present in most healthcare systems. It is generally assumed that all relate to the same cases. Given the high costs associated with these processes and strong desire to maximise quality and standards, the purpose of this paper is to see whether it was indeed the case that most complaints and claims related to medical errors and the relative resource allocation to each group.

Electronic databases for clinical error recording, patient complaints and medico-legal claims in a large NHS healthcare provider organisation were reviewed and case overlap analysed.

Most complaints and medico-legal claims do not associate with a prior clinical error. Disproportionate resource is required for a small number of complaints and the medico-legal claims process. Most complaints and claims are not upheld.

The authors have only looked at data from one healthcare provider and for one period. It would be useful to analyse other healthcare organisations over a longer time period. The authors were unable to access data on secondary staffing costs, which would have been informative. As the medico-legal process can go on for many years, the authors do not know the ultimate outcomes for all cases. The authors also do not know how many medico-legal cases were settled out of court pragmatically to minimise costs.

Staff error reporting systems and patient advisory services seem to be efficient and working well. However, the broader complaints and claims process is costing considerable time and money, yet may not be useful in driving up standards. System changes to maximise helpful complaints and claims, from a quality and standards perspective, and minimise unhelpful ones are recommended.

This study provides important data on the lack of overlap between errors, complaints and claims cases.

This paper seeks to present an analysis of the literature examining objective information concerning the subject of customer service, as it applies to the current medical practice. Hopefully, this information will be synthesized to generate a cogent approach to correlate customer service with quality.

Articles were obtained by an English language search of MEDLINE from January 1976 to July 2005. This computerized search was supplemented with literature from the author's personal collection of peer‐reviewed articles on customer service in a medical setting. This information was presented in a qualitative fashion.

There is a significant lack of objective data correlating customer service objectives, patient satisfaction and quality of care. Patients present predominantly for the convenience of emergency department care. Specifics of satisfaction are directed to the timing, and amount of “caring”. Demographic correlates including symptom presentation, practice style, location and physician issues directly impact on satisfaction. It is most helpful to develop a productive plan for the “difficult patient”, emphasizing communication and empathy. Profiling of the customer satisfaction experience is best accomplished by examining the specifics of satisfaction, nature of the ED patient, demographic profile, symptom presentation and physician interventions emphasizing communication – especially with the difficult patient.

The current emergency medicine customer service dilemmas are a complex interaction of both patient and physician factors specifically targeting both efficiency and patient satisfaction. Awareness of these issues particular to the emergency patient can help to maximize efficiency, minimize subsequent medicolegal risk and improve patient care if a tailored management plan is formulated.

The purpose of this study was to contribute to the evidence base by analysing the characteristics and motives of homicides involving acts of dismemberment.

The current study explored offence, victim and offender characteristics and the motives for 71 homicides involving dismemberment using open source data. All cases included in this study were investigated in the UK between 1970 and 2016. A non-metric multi-dimensional scaling procedure smallest space analysis (SSA) was used to explore the characteristics and motives derived from a content analysis of homicide data sourced online.

A distinction between expressive and instrumental characteristics was observable with three thematic regions identified: instrumental – defensive, instrumental – predatory and expressive – affective. Support was found for previously identified motives for criminal dismemberment, with defensive being the most common motive identified in 63% (N = 45) of the cases.

The implications of the findings are discussed with suggestions made for future research. The findings have practical implications for assisting law enforcement and forensic and clinical practitioners in further understanding offenders who engage in homicidal dismemberment. This includes aiding homicide investigations, in terms of supporting investigators to draw upon offence, victim and offender characteristics and motives for homicides involving acts of dismemberment. Differentiation between cases of dismemberment and understanding of motives also has practical implications for the development of interventions and treatment pathways for homicide offenders who dismember victims.