• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.32 no.2
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• pp.142-150
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• 2006

PURPOSE : The 3rd molar extraction of mandible is common in out-patient office of oral and maxillofacial surgery. And it is dynamic minor operation with changes of vital signs. most of patients are already sensitive about their dental treatment. The changes of emotion are reached to the highest level when patients is laid down to be treated on unit chair. It can be induced to undesirable accidents as to this fear. The undesirable complications are nausea, vomiting, hyperventilation, dyspnea, syncope, shock and so on. The severe changes of vital signs may influence their behavior and make serious medical malpractice or suit such as fracture of dental instruments and injury of proximal area. METHOD AND PATIENTS : A total of 99 selected normal patients were reviewed. Among this, 70 patients(43 men, 27 women with statistical significance) were included in this study. Each steps(pre-anesthesis, 5 minutes after anesthesis, just after mucogingival incision, just after tooth section, just after suture and gauze biting) were investigated for a change of a vital signs. It is analyzed to 2 categories,"Means" and "Tendency". The "Means" is the amount of vital signs changed in comparison with pre-step during operation. That means is the amount of vital changes by each step operation. Next, " Tendency" is changes of vital signs in comparison with step1 during operation. RESULT : This is the changing tendency of vital signs with time. That is active effect of fear and pain. Thus this "Means" and "Tendency" will present a sudden changes of vital signs and it can lead to more safe treatment. CONCLUSION : Thus, the purpose of this study is, through careful operation in each step, to less on patients' complication and increase trust between patient and OMFS. This study is a first article shown with the amount of "Means" and "Tendency" in vital signs, when a third molar of mandible is extracted. This study will be base study of patients with general diseases, because it selected only patients without general diseases.

• Journal of Preventive Medicine and Public Health
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• v.15 no.1
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• pp.17-31
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• 1982

A physician assumes toward his patient the obligation to use such reasonable care and skill as is commonly possessed and exercised by physicians in the same general line of practice in the same or similar localities and to use his best judgment at the times. Medical disputes between physicians and patients are, ever more increased in these days as human body, happens to cause a variety of changes in body unlike the function of machine. Such increased trends of medical disputes became a problem in common across the word under the influence of affluent living standard, high consciousness of life value and right by today's people. The aim of this dissertation is oriented to forming a physician's responsibilities in medicalcare accidents arising between physicians and patients. A general physician, for example, has not been negligent merely because, a specialist might have treated the patient with greater skill and knowledge. However, the fact that a physician may have acted to the best of his ability will not avoid legal problems for damages resulting from substandard treatment, that is the degree of care and skill which is to be expected of the ordinary practitioner in his field of practice. The duty of a physician who is, or holds himself out to be, a specialist is greater in the field of his specialty than one who is a general physician. A patient's consent to routine medical procedures is implied from the fact that patient comes to the physician with a medical problem and voluntarily submits to the procedures. For the more serious medical procedures and for major operations, however, it is preferable for the physician to have the patient's consent in writing, to facilitate proof of the consent in the event of a dispute or litigation. Suppose that mistakes on the part of physicians are likely to be blamed in all cases of malpractice. Then it will create a sort of shrinkage in activities of medical treatment. There should be some limitation on excessive application of 'The thing speaks for itself' on mistakes by physicians and availablity of cause and effect. It is a matter of complicity as well as a matter of importance to draw a definite boundary on responsibilities of physician. A series of further research on this particular aspect is strongly urged.

• The Korean Society of Law and Medicine
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• v.22 no.2
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• pp.3-48
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• 2021

Among the major rulings handed down in 2020, there were cases involving anaphylaxis, which is timely as a side effect of coronavirus and flu vaccine. And as a rare case, a ruling was handed down that if medical treatment was done so unfaithfully beyond the limit of patience of ordinary people, it can be an independent illegal act and a cause of compensation for emotional distress. Also, there was a ruling in the appellate court that evaluated disability rate applying the Korean Academy of Medical Sciences Guides for the Evaluation of Permanent Impairment, not McBride system. And the supreme court made it clear that telemedicine is illegitimate. In relation to duty of explanation, it is in the process of adding detail criterion on the firm principles in the individual cases. In regard of medical records, there was a case that even when a medical record is strongly suspected to be tampered with, it is not considered to be an obstruction of proof. There were cases that resulted in different conclusion between the court of first instance and the appellate court rulings. Lastly, in the face of a growing number of cases in which doctors are sentenced to prison for malpractice, we reviewed a ruling that sentenced a doctor to prison.

• Archives of Plastic Surgery
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• v.44 no.4
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• pp.283-292
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• 2017

Background Settlements between doctors and patients provide a solution to complicated disputes. However, some disputes may be renewed as a result of negligence by both parties. The purpose of this study was to review the legal issues that may potentially arise during the preparation of settlement agreements and to propose a list of requirements for ensuring the effectiveness of these settlement agreements. Methods Data from 287 civil cases concerning aesthetic surgery that took place between 2000 and 2015 were collected from a court database in South Korea. Factors that influenced the effectiveness of settlement agreements were analyzed. Results Among the 287 court precedents, there were 68 cases of covenant not to sue. Eighteen cases were dismissed because the settlement agreements were recognized as effective, and 50 cases were sent forward for judgment on their merits because the agreements were not recognized as effective. The types of surgery and types of complications were classified by frequency. We evaluated the geographical distribution of the precedents, the settlement timing, and the effectiveness and economic impact of the settlements. We found that there was no statistically significant relationship among these factors. Four major factors that made a settlement agreement legally effective were identified, and the data showed that fee-free reoperations were not considered by the court in determining the compensation amount. Conclusions When preparing a settlement agreement, it is advisable to review the contents of the agreement rather than to take the preparation of a settlement agreement per se to be legally meaningful.

• The Korean Society of Law and Medicine
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• v.24 no.2
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• pp.147-196
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• 2023

Advances in brain science have made it possible to stimulate the brain to treat brain disorder or to connect directly between the neuron activity and an external devices. Non-invasive neurotechnologies already exist, but invasive neurotechnologies can provide more precise stimulation or measure brainwaves more precisely. Nowadays deep brain stimulation (DBS) is recognized as an accepted treatment for Parkinson's disease and essential tremor. In addition DBS has shown a certain positive effect in patients with Alzheimer's disease and depression. Brain-computer interfaces (BCI) are in the clinical stage but help patients in vegetative state can communicate or support rehabilitation for nerve-damaged people. The issue is that the people who need these invasive neurotechnologies are those whose capacity to consent is impaired or who are unable to communicate due to disease or nerve damage, while DBS and BCI operations are highly invasive and require informed consent of patients. Especially in areas where neurotechnology is still in clinical trials, the risks are greater and the benefits are uncertain, so more explanation should be provided to let patients make an informed decision. If the patient is under guardianship, the guardian is able to substitute for the patient's consent, if necessary with the authorization of court. If the patient is not under guardianship and the patient's capacity to consent is impaired or he is unable to express the consent, korean healthcare institution tend to rely on the patient's near relative guardian(de facto guardian) to give consent. But the concept of a de facto guardian is not provided by our civil law system. In the long run, it would be more appropriate to provide that a patient's spouse or next of kin may be authorized to give consent for the patient, if he or she is neither under guardianship nor appointed enduring power of attorney. If the patient was not properly informed of the risks involved in the neurosurgery, he or she may be entitled to compensation of intangible damages. If there is a causal relation between the malpractice and the side effects, the patient may also be able to recover damages for those side effects. In addition, both BCI and DBS involve the implantation of electrodes or microchips in the brain, which are controlled by an external devices. Since implantable medical devices are subject to product liability laws, the patient may be able to sue the manufacturer for damages if the defect caused the adverse effects. Recently, Korea's medical device regulation mandated liability insurance system for implantable medical devices to strengthen consumer protection.

• Journal of dental hygiene science
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• v.8 no.4
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• pp.241-246
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• 2008

he purpose of this study was to examine the awareness of dental hygienists about medical malpractice and dispute. The subjects in this study were 206 dental hygienists at dental clinics, on whom a survey was conducted. After SPSSWIN 14.0 program was utilized to analyze the collected data, the following findings were given: 1. As for experiences of being complained from patients by age, the dental hygienists who were at the age of 21 to 23 made up the largest age group (39.2%) who had ever meet patients who had grievances. By career, those who had worked for less than a year constituted the greatest group (30.4%) who had the same experiences. It indicated that the dental hygienists who were younger and had a less career had been more complained from patients. 2. In terms of problems posed by patients, scaling came into question the most (14.5%), followed by diagnosis (14.4%), impression (12.9%) and radiography (11.0%). 3. Regarding perception of scaling treatment, 90.8 percent, the greatest percentage, kept records of patients about scaling. As to how to do that, 34.5 percent, the largest percentage, wrote it down and then signed their name. Concerning the way of explaining how to take care of oral health, 82.5 percent gave an explanation without any prints. 4. As to knowledge on the medical law, they got a mean of 12.34 out of possible 16 points. 5. Concerning the necessity of education about the prevention of medical accidents and countermeasures, 70.4 percent felt the strong and urgent need for that.

• The Korean Society of Law and Medicine
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• v.17 no.1
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• pp.107-135
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• 2016

Medical tour can be said to be a new high added-value tour industry of 21st century. The development of varied and distinguished medical tour products by each country will further vitalize the medical tour industry. As the interest in such medical tour increases, it is necessary to analyze the demand and interests of tourists accurately and prepare medical tour products to be provided in order to develop and promote medical tour products. The government considers the medical tour industry as an industry with high expected effects in job creation through promotion of experts in global healthcare industry and national economy development through high added-value creation, and has expanded aid policies in medical tour field with improvement of medical tour immigration system, one-stop service system for medical tourists, and medical tour labor force promotion system. Nevertheless, there are disputes between foreign patients and medical tour inviting businesses, along with medical accident disputes between foreign patients and medical staff and disputes with those working in the tourism industry. This article reviews the types of disputes occurring around the inviting businesses related to medical tours and tried to review the resolutions. Through this, it was found that medical tour inviting businesses have the responsibility to connect the mediated benefits and risks and also the responsibility to process the tasks. Thus, in case dispute occurs due to passive actions from establishing agency agreement to active mediation results, it is difficult to escape the liabilities. Also, in a medical tour agency contract, the inviting business must be aware that it bears the responsibility to explain and advise the details on benefits and risks to foreign patients. The "Guide to arbitration system for resolution of medical disputes with foreign patients" by Korea Health Industry Development Institute Act presents a method to resolve disputes according to the [laws on medical accident damage relief and medical dispute arbitration] in case a dispute due to medical accidents occurs to foreign patients when the foreign patients prepare diagnosis agreement, Whether such method is sufficient to protect foreign patients, however, is thought to require discussions from more diverse perspectives. In order to vitalize medical tourism, the development of diverse products is also important, but the countermeasures against related disputes should also be prepared. Such is expected to contribute to a greater advancement based on trust of foreign medical tourists alongside excellent medical technologies.

• Journal of Korean Medical classics
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• v.27 no.2
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• pp.109-117
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• 2014

Objectives : He Meng-Yao(何夢瑤), a doctor from Qing Dynasty, wrote Yi Bian(醫碥, Fundamentals of Medicine), in which he described many things related to Medical Medicine of divination (醫易). As the content includes a lot of teachings for the posterity, I have studied it. Methods : I have taken from Yi Bian(醫碥) the selections related to Medicine of divination(醫易) and explained them. Results : While accepting the principle of upholding yang and suppressing yin based on the understanding of the Book of Changes(周易) that takes a superior man for yang and a small man for yin, He Meng-Yao(何夢瑤), who thought of both yin and yang as Qi (energy), criticized the contemporary malpractice of uniformly applying the principle. In matching the five viscera to the Eight Trigrams(八卦), he put Qian and Dui Trigram(乾兌) to lung, Kan Trigram(坎卦) to kidney, Zhen and Xun Trigram(震巽) to liver, Li Trigram(離卦) to heart, and Kun and Gen Trigram(坤艮) to spleen, which is reasonable. He didn't fix the position of the vital gate and called it Fire in water(水中之火), and set great store by the role of Fire from Vital Gate(命門火) by calling it Water begetting tree(水生木) when the fire of the vital gate steams the kidney water and turns it into Qi to send it up to liver. He emphasized Water-ascending and Fire-descending(水升火降), which he said involves all five viscera. He also argued that mind runs on the principle of water-ascending and fire-descending. He thought that Qi and blood both originate from kidney, which I think is a significant suggestion. Conclusions : The criticism on the uniform application of upholding yang and suppressing yin, the combination of the five viscera and the Eight Trigrams(八卦), the belief that the Vital gate(命門) is Fire in water(水中之火), the excellent opinion on water-ascending and fire-descending, and the suggestion that Qi and blood both originate from kidney, as presented by He Meng-Yao(何夢瑤), are all theories that should be reasonably appreciated and further developed by the posterity.

• The Korean Society of Law and Medicine
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• v.18 no.2
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• pp.105-138
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• 2017

This is case comments of several representative legal cases regarding self- determination right of patient. In a case in which an intoxicated patient attempted suicide refusing treatment, the Supreme Court ruled that the medical team's respect for the patient's decision was an act of malpractice, and that in particular medical situations (medical emergencies) the physician's duty to preserve life supersedes the patient's rights to autonomy. Afterwards, at the request of the patient's family, and considering the patient's condition (irrecoverable death stage, etc.) consistent with a persistent vegetative state, the Supreme Court deduced the patient's intention and decide to withdraw life-sustaining treatment. More recently, regarding patients who refuse blood transfusions or other necessary treatment due to religious beliefs, the Supreme Court established a standard of judgment that can be seen as conferring equal value to the physician's duty to respect patient autonomy and to preserve life. An empirical study of legal precedent with regard to cases in which the physician's duty to preserve life conflicts with the patient's autonomy, grounded in respect for human dignity, can reveal how the Court's perspective has reflected the role of the patient as a decision-making subject and ways of respecting autonomy in Korean society, and how the Court's stance has changed alongside changing societal beliefs. The Court has shifted from judging the right to life as the foremost value and prioritizing this over the patient's autonomy, to beginning to at least consider the patient's formally stated or deducible wishes when withholding or withdrawing treatment, and to considering exercises of self determination right based on religious belief or certain other justifications with informed refusal. This will have a substantial impact on medical community going forward, and provide implicit and explicit guidance for physicians who are practicing medicine within this environment.

• The Korean Society of Law and Medicine
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• v.18 no.2
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• pp.3-46
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• 2017

Physician's Duty of Information is classified into three categories by legal function: 'Duty of Information to Report' to fulfill the patient's right to know; 'Duty of Information to Guide' patient's convalescing and staying healthy; 'Duty of Information to Contribute' to patient's self-determination. We classify the physician's duty of information because the legal effect from the breach of duty varies accordingly. The legal effect is focused on damage compensation responsibility for breach of duty. When a physician violates 'Duty of Information to Report', he subjects himself to liability of compensation for infringing on the patient's 'Right to Know'. When a physician violates 'Duty of Information to Guide', she subjects herself to liability for general medical malpractice. Finally, when a physician violates 'Duty of Information to Contribute', the physician is basically liable for violation of the patient's 'Right to Self- Determination' which refers to infringement on freedom of choice. However, in the case of situation that patient's refusal to the medical treatment would be presumed, the physician bears all liability for the patient's damage which includes both of property and mental damage.