• This article defines medical errors and medical responsibility from a Brazilian perspective. • This article calls attention to the risks of medical liability and the unethical use of defensive medicine. • The authors propose some procedures and attitudes to avoid medical errors like the use of technology at the bedside and computer-based protocols. • The authors state that a good and ethical medical practice can avoid medical liability.

Introduction: The medical literature reports child and adolescent maltreatment since the 8th century. Unfortunately, even today, the incomplete knowledge of this event persists. Several forms of violence are applied to children and adolescents, mainly sexual violence including rape and sexual assault. Forensic medical examinations routinely include the genital area, anus, and the body of the victims for signs of a recent or old injury. The main goal of this study is to show the results of physical and sexual examinations regarding confirmation of rape in children and adolescents, based on the medicolegal reports. Methods: We made a descriptive cross-sectional study conducted by collecting data from Medicolegal Institute (IML-São Paulo, Brazil) in 2017. We examined 13,870 reports of sexological examinations of victims of the alleged rape. The variables analyzed were age; sex; physical examination; sexological examination; and direct search for sperm in the vaginal, anal, or oral cavity. We selected 11,725 reports from victims under 18 years. Results: As for the medical-legal findings, only 1735 reports (14.8%) confirmed sexual abuse. The most affected ages were between 3 and 5 years in the male group and 11 to 14 years in the female group. The most frequent injuries were bruises and abrasions, fissures in the anal region. In 96.2% of the examined males and 85.8% of the females under 14 years old, the examination was inconclusive, and somebody cannot prove the alleged rape. Only 1735 reports (113 from men and 1622 from women) concluded beyond any doubt the alleged rape (14.8%). The search for sperm was positive in only 1582 cases (13.5%). Conclusion: This study shows that the results of the medicolegal examinations were quite limited in recording evidence. Sexual violence against children and adolescents reaches mostly females under 13 years of age. Besides, it is a complicated crime to prove, as 85.8% of female examinations and 96.2% of male exams revealed: “no supporting elements” or “undetermined” to characterize the felony. Therefore, to prevent it, the communication of the alleged rape must be made as quickly as possible.

A medical error is a preventable adverse effect of medical care. These errors are usually avoidable. They are a vast source of ethical, financial, and even mental problems affecting patients, physicians, and healthcare organizations. The negative impact on patients can be physical, generating sequelae or disability. It could lead to a loss of trust in the patient and his family in the doctor or the hospital where he has been treated. On the other hand, doctors resist disclosing their errors to the patient, fearing lawsuits and financial losses. Disclosure errors are also an imperative moral duty. In this narrative review, the authors discuss obstacles that exist and prevent an adequate open disclosure, including flaws in medical education, and propose ten steps to proceed with an open disclosure if a medical error occurs.

O Pênfigo Vulgar (PV) é uma doença vesicobolhosa caracterizada pela presença de auto-anticorpos contra moléculas de adesão intraepidérmicas. OBJETIVO: Identificar as características do PV em cada sexo, formas de apresentação, idade de acometimento, métodos de diagnóstico e tratamento utilizado. FORMA DE ESTUDO: coorte histórica. CASUÍSTICA E MÉTODO: Pacientes com PV acompanhados no Ambulatório de Otorrinolaringologia do HC-FMUSP entre 1990 e 2001. RESULTADOS: Dos 23 pacientes, 91,3% foram mulheres e 8,7% homens (p<0,01), relação de 9:1. A idade ao diagnóstico variou entre 26 e 80 anos, com média de 53 ± 18,4 anos. Nos homens, o PV manifestou-se 24,6 ± 5,9 anos mais precocemente do que nas mulheres (p=0,026). Os principais achados ao exame foram lesões exulceradas na mucosa oral, semelhantes a aftas. Biópsia foi utilizada em 95% dos casos, imunofluorescência direta em 17,4% e indireta em 8,7%. A prednisona foi a opção terapêutica em 78% dos pacientes, enquanto o deflazacort foi usado em 22%. A dapsona foi associada em 4 casos. Obtivemos controle da doença em 74% dos casos e perda do seguimento após melhora parcial em 13% dos pacientes. Observamos maior dificuldade no controle da doença no sexo masculino (p=0,04). CONCLUSÕES: O sexo feminino prevaleceu sobre o masculino. A idade ao diagnóstico foi maior nas mulheres. O tratamento de escolha foi a prednisona. O PV foi mais facilmente controlado nas mulheres.