Journal of Oral Medicine and Pain

Korean Academy of Orofacial Pain and Oral Medicine (대한안면통증구강내과학회)
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A Survey on the Perception of the Counterplans of Medical Accident and Dispute of Dental Hygienist

의료사고 및 의료분쟁에 대한 치위생사의 인식도 조사

  • Oh, Jin-Ho (Department of Oral Medicine, College of Dentistry, Yonsei University) ;
  • Kwon, Jeong-Seung (Department of Oral Medicine, College of Dentistry, Yonsei University) ;
  • Ahn, Hyoung-Joon (Department of Oral Medicine, College of Dentistry, Yonsei University) ;
  • Kang, Jin-Kyu (Department of Oral Medicine, College of Dentistry, Yonsei University) ;
  • Choi, Jong-Hoon (Department of Oral Medicine, College of Dentistry, Yonsei University)
  • 오진호 (연세대학교 치과대학 구강내과학교실) ;
  • 권정승 (연세대학교 치과대학 구강내과학교실) ;
  • 안형준 (연세대학교 치과대학 구강내과학교실) ;
  • 강진규 (연세대학교 치과대학 구강내과학교실) ;
  • 최종훈 (연세대학교 치과대학 구강내과학교실)
  • Published : 2007.03.30
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Abstract

In the field of dentistry, there existed relatively few emergency patients or patients who need intensive care and thus had low medical dispute rates. However, these days, there is a general tendency of increased medical disputes. Although many medical disputes are caused by medical accidents of the dentists, because dental assistants are also lawfully involved in practicing dentistry, there is a possibility of medical disputes or medical accidents caused by dental assistants. Therefore, the role of the dental assistants cannot be ignored. This study consists of a survey given to dental hygienists currently working in general hospitals, dental hospitals and private dental clinics. Following is the results of the analysis of 275 respondents' backgrounds, medical disputes rates including patients' complaints, their understanding of medical regulations and their general understanding of overall dental practice and medical disputes. 1. 251 of 274(91.6%) respondents doubted the risk of medical accident and dispute. 2. 81(29.5%) dental hygienist experienced complaint from patients. They have been working in the private dental clinic, the rate of this experience was high. 3. 349 case of 1805(19.3%) the complaints by patients, highest percentage among its category, were those regarding dental fees and poor service. 4. 129 case of 1805(7.1%) patients' complaints, highest percentage among it's subcategory, were those regarding the absence of explanations of precautions or request of agreements before dental treatment. 5. 252 of 267 (94.4%) dental hygienists chart after a scaling treatment. However, only 55(20.7%) dental hygienists chart the fact of explaining the precautions. 6. 6(2.2%) dental hygienists do not inspect patients' medical history, if patients don't mention it. 7. 104 of 274(38.0%) dental hygienists responded to be capable of administering first aid treatment. 8. 115(41.8%) dental hygienists have a first aid kit and equipment. 9. In case of medical dispute, 268(97.8%) dental hygienists respond that, charting plays a big role in resolving the dispute. 10. In case of medical dispute, 272(93.3%) dental hygienists respond that, explanation and agreement before treatment have an important role in settlement of dispute 11. Only 160(58.4%) dental hygienists responded correct answer that the duration of keeping medical records is 10 years. 12. 124(45.3%) respondents thought that it is legal for a dental hygienist to take a panoramic dental X-ray, 71(25.9%) respondents thought that it is legal practice cervical resin treatment by dental hygienist, and 37(13.5%) respondents thought that it is legal extract primary teeth by dental hygienist. 13. 24(18.76%) respondents thought that it doesn't matter to tell patient's state to others 14. 272(99.27%) responded that receiving education for the prevention of medical disputes was needed and of them, 61.0% thought it was urgent. 15. 186(64.2%) has never had classes regarding the prevention of medical disputes while in school and 212(77.4%) has not had the same type of classes after graduating from school. 16. 256(93.4%) responded that there will be even more of an increased number of medical disputes. Among them, 83.3% of respondents though that due to the increased opportunity of acquiring information through the internet and mass media. The study shows that 29.5 percentage of dental hygienists have experienced the medical disputes and complaints and they are lack of recognition of medical regulations and dental hygienist's official duty. So, there is a big potential of the percentage to increase. Therefore, the correct understanding of explaining precautions and requesting agreement before dental treatments and performing them are mandatory. Moreover, classes regarding the prevention and counterplans of medical disputes need to be widely offered.

치의학계에서는 의료사고를 일으킬만한 중환자나 응급환자의 빈도가 상대적으로 낮아 의료분쟁에 휘말리는 경우가 적었으나 요즈음은 의료분쟁이 증가하고 있는 추세이다. 치과진료의 특성상 항상 보조인력이 한, 두명씩 치과의사의 진료를 도와주어야 하고, 치과의사의 의료사고로 인해 의료분쟁으로 발생하는 경우도 있지만 의료법에서 정한 치과 보조인력의 진료영역에서 의료사고 및 분쟁이 발생할 수 있다. 또한 의료기관의 친절도, 서비스 불만 등 진료외적인 요인은 치과 보조인력의 역할을 무시할 수 없다. 본 연구는 2006년 현재 종합병원, 치과병원 및 의원에서 치과진료 보조업무를 하고 있는 치과위생사를 대상으로 설문조사를 하였다. 회수된 275명의 설문분석을 통하여 응답자에 관한 기본적인 자료조사 및 환자의 불평, 불만 및 의료분쟁 경험도와 함께 의료관계법의 이해도를 측정하고, 치과진료 및 의료분쟁에 대한 전반적인 의식성향을 비교분석하여 다음과 같은 결과를 얻었다. 1. 설문응답자 중에서 향후 의료사고 및 분쟁이 발생할지도 모른다는 불안감 또는 의구심을 어느 정도 가지고 있는 경우가 274명 중 251명(91.3%)이었다. 2. 치과위생사의 업무, 진료에 대한 환자의 불평, 불만 경험률은 29.5%(81명)으로 나타나 치과관련 의료분쟁의 원인이 될 수 있는 것으로 조사되었다. 3. 전체유형별 항목에 따른 환자의 문제제기 건수를 보면 직접적인 진료행위와 관련된 문제보다 불친절 및 진료비 등의 진료이외의 문제 제기가 1805건 중 349건(19.3%)으로 가장 높게 나타났다. 4. 세부유형별 항목에 따른 환자의 문제제기 건수를 보면 환자가 치료와 관련하여 충분한 사전설명이나 동의를 구하지 않았다고 문제시 한 경우가 1805건 중 129건(7.1%)으로 가장 높았다. 5. 치과위생사가 스케일링 시술 후 환자 진료기록부에 기록하는 경우는 267명 중 252명(94.4%)으로 나타났으나, 스케일링 시술 후 주의사항 설명 사실을 진료기록부에 기록하는 경우는 55명(20.8%)에 불과했다. 6. 치과진료에 있어서 환자가 언급하지 않으면 특별히 전신질환 유무를 조사하지 않는 경우가 6명(2.2%)으로 조사되었다. 7. 환자 진료와 관련되어 응급상황 발생 시 응급조치를 시행할 수 있다고 생각하는 치과위생사는 104명(38.0%)으로 조사되었다. 8. 근무지에 응급상황 발생 시 조치에 필요한 장비 및 약품을 구비해둔 경우는 115명(41.8%)으로 나타났다. 9. 의료분쟁 발생 시 문제해결에 있어 의무기록이 중요한 역할을 한다고 응답한 경우는 268명(97.81%)으로 나타났다. 10. 의료분쟁 시 문제해결에 있어서 치료 전 설명 및 동의의 의무의 이행 여부가 중요한 역할을 한다고 응답한 경우가 272명 (99.3%)으로 나타났다. 11. 의무기록의 의무보관연도가 10년이라고 옳게 응답한 경우는 160명(58.4%)에 불과했다. 12. 치과위생사의 업무를 벗어난 파노라마사진 촬영을 해도 된다고 응답한 경우가 124명(45.3%), 치경부 레진수복을 해도 된다고 응답한 경우가 71명(25.9%), 유치발치를 해도 된다고 응답한 경우가 37명(13.5%)으로 나타났다. 13. 환자의 비밀누설 금지와 관련하여 환자의 상태를 다른 사람에게 이야기하는 것은 큰 문제가 되지 않는다고 응답한 경우가 24명(8.8%)으로 나타났다. 14. 의료분쟁의 예방 및 대책에 관한 교육의 필요성에 대해서 272명(99.3%)이 필요하고, 167명(61.0%)이 시급하다고 답하였다. 15. 재학 중 의료분쟁의 예방 및 대책에 관한 관련교육을 수료한 적이 없다는 경우가 186명(64.2%), 졸업 후 의료분쟁의 예방 및 대책에 관한 보수교육을 수료한 적이 없는 경우가 212명(77.4%)으로 나타났다. 16. 향후 의료분쟁이 증가할 것으로 생각된다는 응답은 256명(93.4%)이었고, 그 원인으로는 83.3%가 인터넷, 방송 등의 매체를 통한 정보습득 기회의 확대를 꼽았다. 이상의 결과를 종합해보면 치과위생사와 관련한 환자의 불평, 불만 및 분쟁도 경험률이 응답한 치과위생사의 29.5%를 차지하고 있으며, 의료법에서 정한 의료인의 의무와 치과위생사의 직무범위에 대한 인식이 부족한 것으로 조사되어 앞으로 의료분쟁이 더욱 증가할 수 있는 가능성을 내포하고 있다. 그러므로 주의의무, 설명 및 동의의무 등의 의무를 다함은 물론, 이에 대한 인식을 제고하여야 하며, 의료법과 의료분쟁에 대한 예방 및 대책과 관련된 교육기회를 확대하여야 할 것이다.

Keywords

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