To err is human: Quality management practices in surgical oral pathology, a safety net for medico-legal complications

Abstract

Reading a slide and rendering a diagnosis is not only a science but also requires us to appreciate the constant artifact that is introduced in a controlled manner by tissue processing and obtaining a stained tissue section. There are a number of steps involved in getting the final stained tissue section and all these procedures if not performed properly have the potential to give rise to erroneous picture on the slide. Simple errors in judgments can lead to wrong diagnosis and unwarranted treatment. Such mistakes can put us at risk for Medico-Legal problems. The subject of Medico-Legal issues and practice of pathology has been neglected and amount of information available to the practicing professional in India is scarce. This paper focuses on standardized procedures for the various histopathology laboratory exercises. The paper highlights the importance of proper record maintenance with reporting protocols. A list of do's and don’ts for an Oral Pathologist is provided to help him/her in reducing the probable Medico-Legal issues. It does not in any way address the issue of individual competence and diagnostic abilities: That is an aspect for each individual to introspect upon and take remedial action.

Storage, Retention, and Use of Leftover Pathology Specimens: The Underestimated Treasures

“…The ethical and legal acceptability of continued storage must be reviewed, where material storage is no longer required for clinical purposes but is desirable for teaching, quality assurance, audit, research, or other purposes of public benefit. It is nevertheless good practice, when practical, to check that the patients have not lodged a specific objection to such use during the normal consent processes for the procedure(s) they have undergone [ 6 ].…”

The post-analytical phase of histopathology practice: Storage, retention and use of human tissue specimens

“…[ 3 ] The Royal College of Pathologists, UK recommends preservation of blocks permanently, histology slides and smears for 10 years and wet tissue for at least 4 weeks after despatch of the report. [ 4 ] In general, a period of 10–20 years is considered as a lower limit guideline for retention. [ 5 ] It is routine for major institutions in India to preserve slides and blocks for 10 years and for 25 years in cancer referral centers.…”

“…The medical category ranked at the ninth position in all consumer cases filed in India as on March 2010. [ 4 ] It is important for all persons affiliated to a histopathology laboratory to have thorough knowledge of the standard of practices in their regulatory environment and remain cognizant of local laws and any possible medico-legal issues that may arise, for, e.g., incorrect trimming of specimen, incorrect diagnosis etc. [ 15 ] In such instances, the pathologist has the moral responsibility to immediately inform the physician and patient.…”