• Journal of Preventive Medicine and Public Health
• /
• 제15권1호
• /
• pp.17-31
• /
• 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.

• Journal of Preventive Medicine and Public Health
• /
• 제26권4호
• /
• pp.614-627
• /
• 1993

It is well known that a physician's personal characteristic affects his practice pattern. Furthermore, a physician's specialty has powerful influences on his practice pattern. However, despite the fact that specialization has received the most attention for its influence on physician's service behavior, few studies have been conducted on the variations of contents and volume of physician's services. This study has intended to identify factors influencing the practice variations according to various physician characteristics. There are some other evidences that medical care providers are different in using of health services and resources in Korea. Four physician characteristics were selected for the analysis, two demographical factors, age and sex, and two practice factors, place of practice and medical specialty. Also, three indicators of service amount (total amount of insurance claim bill, number of visits per case, number of prescriptions per case) were selected. From the pool of insurance claims for ambulatory care received by the Korean National Federation of Medical Insurance(NFMI), 84,898 cases were randomly sampled. In the meantime using physician database of NFMI, 613 general practitioners (GP), 107 regular family physicians (FP), 483 'grandfather' family physicians(GFP), and 1,157 specialist practitioners(SP) were randomly sampled. Their different practice contents were compared concerning the specialty, age groups, sex, and practice sites (urban-rural) Specialist physicians tend to provide more costly care than do generalists. General practitioners and family physicians usually make fewer following visits and prescriptions. Age is also the important factor in determining the amount of services, which is highest at the physician's age group of 40's. Female doctors and urban practitioners use much more resources than their counterparts respectively. Research findings suggest that physician's characteristics particularly the specialty can affect practice patterns and resource utilizations. Other characteristics such as age and sex are not controllable but physician's specialty is relatively easily controllable during the entire phases of policy implementation. This is all the more true in the individual's initial decision of his specialty. Specialization therefore should receive policymaker's attention for its potential influence on medical care utilization and health care expenditure.

• 보건행정학회지
• /
• 제3권2호
• /
• pp.100-129
• /
• 1993

This study is designed to find out some intra-clinic factors affecting the content of practice provided by primary care physicians in Korea, and proposed factors in this study are characteristcs of each private clinc --- physician-related variables(age, sex, specialty), bfed-related variables for inpatient care, laboratory-related variables for precise diagnosis. We have tried to estimate the difference of disease entities cared by each primary care physician according to above factors by analyzin gdisease data claimed during one month(April, 1992) to National Federation of Medical Insurance. The diagnosis codes by ICD-9 in the research disease data were reclassified to 'diagnosis clusters' by virtue of clinical similarities for effective analyses. We have converted frequent-tsing ICD-9 codes to 86 diagnosis clusters, which incorporated 97.4 percents of all ambulatory visits to private clinics. This result means proposed diagnosis-cluster method is effective tool for analysis of the content of ambulatory medical care carried out by primary care physicians. Comparisons and analyses of multiple diagnosis-clusters made on the basis of presented factors were done and the results were as follows; - Major factors affecting the difference between diagnosis-cluster pattern by each variables were phyusician's age, sex, specialty and bed counts of each private clinic for inpatient care and the size of laboratories of each clinic. - Middle aged(30th to 40th) group physicians are providing more comprehensive care than 20th or above 50th aged groups. Male physicians are more adequate for comprehensive care than female physicians, because woman-doctors are providing narrow-spectrum care. The content of practice of obstetricians and gynecologists shows much difference from primary medical practice, and they cannot be included in primary care physician, this study suggested. Pediatricians are also providing short-spectum acre, and nearly all visits to pediatricians were incorporated only 2-3 diagnosis-clusters. General surgeons' practices are very similar to general practioners' or family physicians' practices, the means they are providing primary care rather than special surgical care. And small number of beds(under 5 beds) and only basic(2-3 sorts of)diagnostic apparatuses are sufficient for primary physicians' clinic to carry out primary care. In conclusion, to reinforce primary care department in Korea, there must be support with health policy to expand office-based primary care practice-- with small number of beds for inpatient care and only basic laboratories-- provided by general practitioner of family physician.

• Journal of Preventive Medicine and Public Health
• /
• 제24권2호
• /
• pp.171-180
• /
• 1991

Productivity analysis of physician is one of essential factors for the optimal health manpower planning. Among 690 physicians operating clinic and registered on the Kyeongsangnamdo Medical Association, 623 physicians were studied with a structural questionaire from April 1 to May 31, 1990. This study covers the general characteristics and productivity of physicians and attempts to find relevant determinants of their productivity through stepwise multiple regression analysis based on collected data. The mar results were as follows. First, physicians were more prevalent $35{\sim}44$ group (30.2%) in age, male (95.8%) in sex, specialist (76.5%) in specialization,'city (78.0%) in geographical location. Age group of 35-54 and specialist were mere prevalent in cities than in counties, while age group of 25-44 and 55 over and general practitioner in counties (p<0.001). Second, daily outpatients load of all physician were 77.1 persons on average. Age group of $35{\sim}44$ had the most outpatient load (90.3 persons) among all age group, $6{\sim}10$ years group (94.2 persons) in years of duration of practice, 11 hours per day group (83.4 persons) in working hours per day. Specialists had more outpatient load (82.6 persons) than general practitioners (61.1 persons) and physicians in cities had more (80.2 persons) than physicians in counties (66.3 persons). Daily average outpatient load of physicians were significantly different by their age, speciality, number of assistants and years of practice (p<0.001) and working location (p<0.05), but not significantly different by working hours per day of physician (p>0.1). Third, the productivity of physicians operating clinic were significantly affected by the three factors-number of assistants of physician, age of physician and duration of practice at the current clinic. Age of physician had negative regression coefficient.

• 보건행정학회지
• /
• 제5권1호
• /
• pp.31-58
• /
• 1995

The Korean government achieved the universal coverage of health insurance in July 1989, and concomitantly introduced a new measure of regulated health care delivery system in using medical care. There are three reasons why the government took the new health care delivery system. Firstly, there was ample room for improving the allocative efficiency in the use of medical facilities. And the second one was to constrain the dramatic increase of medical demand under health insurance. Thirdly, and the most important reason was to alleviate the patient crowdedness in big general hospitals, particularly tertiary hospitals. There are essentially two different ways to control the use of health care : one is to cut the demand for health care, and the other to regulate behaviors of providers through the use of incentives/disincentives, demand-side approach or supply-side approach. The objective of this study is to examine whether or not medical care utilization behaviors under health insurance scheme have been changed among medical facilities such as clinic, hospital, general hospital and tertiary hospital in comparison with those before and after the introduction, particularly whether the patient crowdedness in tertiary hospitals has been alleviated or not. In order to conduct this study, the insurance claim data during the period of January 1989 and July 1992 were analyzed by focusing on diagnosis of both inpatients and outpatients, and especially the fifteen most frequent diseases in ambulatory care and the seven most frequent diseases in hospitalizatio. In addition, the same analyses were made on the changes in medical care utilization by specialty department. This was because the five departments, such as family medicine, ENT, eye, dermatology and rehabilitation, were exempted from applying the regulated health care delivery system in tertiary hospitals. The study revealed that a remarkable alleviation effect in the crowdness was noted for tertiary hospitals. This effect was most conspicuous for the most frequent mild diseases of both inpatient and outpatient care. For example, the fifteen most frequent OPD care at tertiary facilities have decreased as much as by 40%, of which 34% belonged to the cut in initial visits. Meanwhile, the proportion of those who used general hospitals and private practitioner's clinics have increased due to the shift of patients. The cases from the five special departments were also decreased, but not so much as other departments. A problem was noted that, as time passed by, the decreasing tendencies of crowdness at tertiary hospitals due to the regulated system became slightly smaller. Therefore, through complementary remedies are needed for the future implementation.

• 대한치과기공학회지
• /
• 제34권3호
• /
• pp.303-314
• /
• 2012

Purpose: This study aimed to find overseas workplace and improve global competence through the preference survey on overseas employment by dental technology students. Methods: The survey sample consisted of 250 randomly selected dental technology students. Survey was conducted from March 1 to May 1 in 2012. Total of 245(98.0%) replies and analyzed 236 questionnaires excluding 9 incomplete questionnaires. The questionnaires used in this study consisted of 7 items for general information, overseas employment characteristics of 10 items, 7 items for overseas employment activation plane and job competency development of 7 items. Collected data were analyzed using SPSS(Statistical Package for Social Sciences) Win 19.0 statistics program. Results: Regarding general characteristics of the subjects, there were 131 third graders(55.5%), 63 first graders(26.7%) and 42 second graders(17.8%) among 130 males(55.1%) and 106 females(44.9%). 221(93.6%) of the subjects had no experience in language training. Students who had clinical training for 1-5 months were 123(52.1%), and 24(10.2%) students had more than six months. 89(37.7%) of the subjects had no clinical training. 155(65.7%) of the subjects hope to work with korean owner, and 81(34.3%) chose foreign owner. Favored working countries were Australia(41.5%), the United States(29.2%), Canada(18.2%) and other(11.0%). The field of dental ceramic was indicated to be the highest proportion of 104(44.1%). Period of training were 3 hours(40.3%) and 6 hours(35.2%). The most important training were language-centered education(54.2%), Job-oriented education(24.2%), local culture education(16.1%), other(3.0%) and Leadership Training(2.5%). The subjects chose overseas worker(44.9%), working-level practitioner (28.8%), successfully employed dental technology graduate(19.5%a) and professor(3.4%) as an instructor. The subjects get education and training information from professor(40.3%), other(28.0%), senior(14.4%), job site(8.9%) and acquaintance(8.5%). A credit exchange(2.46 points), a joint degree program(2.46 points), and a foreign professor(2.33 points) were needed to activate the overseas employment. A kind of dental prosthesis(3.58 points), carving tooth morphology(3.38 points), and majors of dental technology(3.30 points) were indicated to develop job competency for overseas employment. Age, year, clinical training experience and company owner were statistically meaningful data among the general characteristics affecting job competency development. Conclusion: The college needs to offer variety programs such as foreign language-centered education and a local job competency development program to graduates to be connected with international workplace and employment.

• 한국농촌간호학회지
• /
• 제7권2호
• /
• pp.41-50
• /
• 2012

Purpose: This study was done to identify differences in factors influencing cognitive function according to the cognition of community dwelling elders. Methods: A convenience sample of 565 community dwelling elders participated in this study and from May to June, 2010 trained research assistants collected data using structured questionnaires. Collected data were analyzed using descriptive statistics, t-test, one-way ANOVA, correlation, and multiple regression with the SPSS Win 15.0 version. Results: The elders had a slightly low degree of cognitive function. Of the 565 elders, 41.1% were in the normal group for cognitive function and 58.9% in the mild impairment group. Although there were no significant differences in general characteristics between the groups, factors influencing cognitive function were different. Factors influencing elders in the normal group were leisure activity and moderately good health status. These variables accounted for 5.7% of the variance in cognitive function. Factors influencing elders in the mild impairment group were leisure activity, depression, and education level limited to elementary school graduation. These variables accounted for 19.9% of the variance cognitive function. Conclusion: This study provides comprehensive understanding of factors influencing cognitive function in elders. Differentiated nursing interventions according to degree of cognitive function are suggested.

• 한국직업건강간호학회지
• /
• 제7권1호
• /
• pp.97-114
• /
• 1998

The occupational health services for the minor enterprises are poor comparing with that of large enterprises in Korea. In 1997, Korean government announced officially the law on joint employment system of occupational health practitioners to solve the problems. This study is to develop the model on the joint employment system of occupational nurse practitioners for minor enterprises in Korea based on the opinions of occupational health nurses (OH Ns). The data were collected by questionnares from October to November in 1997. The number of subjects was 210 occupational health nurses who had participated the mandatory nursing education program provided by the Korean Occupational Health Nurses Association(KOHNA). The response rate was 47.1%. The contents of questionnaires were general characteristics, occupational & job characteristics of OHNs, and the views on the joint employment system. The SAS-PC program was used for the statistical analysis. The results were as followed, (1) The proper number of industies was 3 and the appropriate number of workers was 448 for one joint employed occupational nurse practitioner (J EONP). (2) 44.7% of the OHNs wanted that the Ministry of Labor monitored the way and content of contraction b/w JEONP and minor emterprises, 82.6% of the OHNs wanted that KOHNA managed the employment informations. (3) The OHNs of occupational health agencies showed more positive attitude than the OHNs of private industries on the joint employment system. (4) 88.3% of the OHNs wanted the education training for JEONP. Especially in occupational hygiene and safety control. (5) The OHNs expected the role expansion of Occupational Health Nursing by JEONP system. At the same time they worried the adverse effects. For the successful execution of this system, it is necessary the cooperation among the Ministry of Labor, KOHNA, the minor enterprises, and the OHNs.

• 의료법학
• /
• 제11권2호
• /
• pp.11-74
• /
• 2010

This article analyzes legal meaning and definition of medical practice examining Korean Supreme Court cases. Until now, there is no right answer about the meaning of medical practice and it is also hard to define of it. Moreover, not only Acts and regulations containing medical practice but also many cases ruling a person who practice medicine, the concept of medical practice involves various meanings. So, it has caused confusion. In order to solve this problem, this article divides the medical practice's meaning into range and nature within prohibition article of the Medical Act about unlicensed personnel who practice medicine. After providing a explanation of the meaning of medical practice according to amendment of the Act, this article disputes the meanings of the several cases following the amendment. And then analyzing non-medical person's unlicensed medical practice and medical person's unlicensed medical practice. In order to provide more accurate legal concept of medical practice when Korean government amends the Medical Act or making policies in this field, this classifying analysis approach should be needed. Looking at the result, in general, Korean Supreme Court has interpreted unlicensed prohibition clause of the Medical Act widely; not only non-medical person's unlicensed medical practice but also medical person's unlicensed medical practice. Therefore, this article suggests that the prohibition clause needs to be careful applying to non-medical practice. Because, in fact, even though there are some necessity of non-medical practice, there are no qualificatory or license system of non-medical practitioner in the Medical Acts or regulations forbidding whole non-medical practices. Furthermore, the Supreme Court has decided medical person's unlicensed medical practice too narrowly, thus it does not keep up with rapid change of medical development and people's demands these days. Regarding this subject, in order to take advantage of medical practitioners effectively and cope with increasing people's medical demands, this article proposes that medical person's unlicensed medical practice only to be prohibited in case of endangering our public health.

• 재활간호학회지
• /
• 제12권1호
• /
• pp.16-29
• /
• 2009

Purpose: The aim of this study was to develop and to analyze the duty and the task of rehabilitation nurse in Korea. Method: The definition of rehabilitation nurse and job description was developed based on developing curriculum(DACUM) by panels who have experienced in DACUM analysis and rehabilitation nursing. 228 nurses who were working at rehabilitation centers and rehabilitation unit in general hospitals were participated. The questionnaire included frequency, importance, and difficulty of duties and tasks. The data were collected in March and April 2009, analyzed by descriptive statistics. Results: The job description of rehabilitation nurse in Korea revealed 11 duties, and 61 tasks. On the all 11 duties, the highest duty in frequency and importance was direct nursing care ($2.47{\pm}.31$, $2.77{\pm}2.8$) and the highest duty in difficulty was self-development ($2.39{\pm}.48$). Among the tasks of duties 'direct nursing care' in 'manage medication' ($2.87{\pm}.35$) in frequency, the task 'prevent and manage bedsore' ($2.91{\pm}.31$) of duty 'direct nursing care' in importance, and 'cope emergency situations' ($2.72{\pm}.49$) of duty direct nursing care in difficulty showed the highest degree. Conclusion: The political efforts for the legislation of role and task of rehabilitation nurse were needed.