Hekimlerde defansif (çekinik) tıp uygulamalarının araştırılması
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2008
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Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Dünyada, insan haklarının gelişmesine paralel olarak hasta haklarının da gelişmesi ile hasta hekim arasındaki ilişki de değişmek zorunda kalmıştır. Hasta haklarının gelişmesi tıbbi malpraktis ve tıp hukukunun gelişmesine neden olmuştur. Bu süreçte hekimler de kendilerini korumak için defansif tıp (defensive medicine) uygulamaya başlamışlardır.Defansif tıp kısaca; ?hekimin ceza veya hukuk davalarıyla karşılaşmamak, tazminat ödememek, sigorta poliçe primlerini artırmamak amacıyla aşırı korumacı veya çekingen davranarak, tanı ve tedaviye yönelik tıbbi uygulamaları gereksiz kullanması ve malpraktis davası ile sonuçlanma riski yüksek olan uygulamalardan kaçınması? şeklinde tanımlanabilir.Çalışmada, Konya İl Merkezindeki tüm hastanelerde hasta hekim ilişkisi yaşayan 762 hekimle anket çalışması yapılarak, hastane hekimlerinin defansif tıbbı belirgin olarak uyguladıkları tespit edildi. Sağlık Bakanlığı bünyesindeki kamu hastanesi hekimlerinin, cerrahi branş hekimlerinin, acil servislerde çalışan pratisyen hekimlerin, haklarında malpraktis davası açılanların, malpraktis sigorta poliçesi yaptıranların, yeni Türk Ceza Kanunu'nun yürürlüğe girmesinden sonra hekimlik uygulamalarında tedirginlik hissedenlerin ve her an bir malpraktis davası ile karşılaşma riskini yüksek görenlerin istatistiksel olarak anlamlı olacak şekilde pozitif ve negatif defansif tıp uygulamalarını daha fazla uyguladıkları tespit edildi. Defansif tıp uygulamalarının, hekim için risk oluşturan konulardaki endişeleri ile bağlantısı olduğu belirlendi.Hekimlerin, ülkemizdeki tıbbi malpraktis dava sayılarının artmakta olduğu gerçeğinin farkında oldukları ama bu farkında olmanın gereklerini tıp hukuku konularına gereken önemi vermeyerek yerine getirmedikleri tespit edildi. Hekimlerin, komplikasyon-malpraktis ayrımının net olarak yapılamadığını düşündükleri ve tıbbi malpraktis sigortası hakkındaki fikirlerin dağınık olduğunu belirlendi.Hekime, hastaya, sağlık sistemine ve ekonomiye zararı olan defansif tıbbın kendisi tek başına temel bir problem olarak görülmeyebilir ama tıbbi malpraktis temel probleminin iyi yönetilemediğini gösteren çok önemli bir belirtecidir. Bu nedenle birçok araştırmacının da belirttiği gibi defansif tıbbın direk kendisinin önlenmesi için yapılacak mevzuat ve hukuki yaptırımlarla ilgili çalışmaların hiçbirisinin problemi çözmeyeceği gibi durumu daha da kötüleştirmesi olasılığı yüksektir.Tıbbi malpraktisleri önleme sisteminin işleyebilir ve iyi düzenlenmesi kapsamında yapılacak tüm yasal düzenlemelerin temel kuralı, sağlık çalışanının tedirginliğini ve risk algılamasını ?dengede tutabilmek? olmalıdır.Anahtar Kelimeler: Defansif tıp, tıbbi malpraktis, adli tıp, tıp hukuku
The relation between the patient and doctor had to be changed as a result of the improvement of patient rights in parallel with the development of human rights in the world. The advancement in the patient rights led to development of the medical malpractice and medical law. Meanwhile, physicians started to practice defensive medicine to defend themselves.Defensive medicine can shortly be described as the avoidance from high risked practices that may end with malpractice prosecutions because of using unjustifiable medical practices of diagnosis and treatments acting reluctantly or extremely conservative in order not to face with penalty or civil lawsuit, pay compensation and not to increase the insurance premium.In this study, a survey was applied to 762 physicians of all hospitals in the city centre of Konya who had patient-doctor relations and it was established that the physicians used defensive medicine significantly. It was determined that the physicians at the government hospitals, surgeons, practitioners at emergency services, the doctors who were sued for malpractices, those who had malpractice insurances, those who had concerns about the practices after the new Turkish penal code had been put into effect, and those who thought that they had high risk to encounter with a malpractice trial at any moment applied positive and negative defensive medicine more, which is statistically significant. It has been determined that practicing defensive medicine is related with the concerns of the subjects which risk the physicians.It has been established that physicians are aware of the fact that the number of malpractice cases have been increasing more and more but they do not fulfill their duty not paying necessary attention to medical law. It has also been determined that physicians think that the complication and malpractice has not been clearly distinguished and they are confused about malpractice insurance.Defensive medicine which is harmful for the physicians, patients, sanitary system and economy can not be considered itself as a fundamental problem; however, it is an outstanding indicator revealing that basic malpractice problem has not been well administrated. Therefore, as many researchers stated, none of the attempts to change the regulations and legal sanctions to prevent defensive medicine itself directly can not solve the problem and, what is more, may deteriorate the problem.The basic rule in all legislation and regulations for better application of medical malpractice should be to keep the balance the concerns and risk perception of the health staff.Keywords: Defensive medicine, medical malpractice, forensic medicine, medical law.
The relation between the patient and doctor had to be changed as a result of the improvement of patient rights in parallel with the development of human rights in the world. The advancement in the patient rights led to development of the medical malpractice and medical law. Meanwhile, physicians started to practice defensive medicine to defend themselves.Defensive medicine can shortly be described as the avoidance from high risked practices that may end with malpractice prosecutions because of using unjustifiable medical practices of diagnosis and treatments acting reluctantly or extremely conservative in order not to face with penalty or civil lawsuit, pay compensation and not to increase the insurance premium.In this study, a survey was applied to 762 physicians of all hospitals in the city centre of Konya who had patient-doctor relations and it was established that the physicians used defensive medicine significantly. It was determined that the physicians at the government hospitals, surgeons, practitioners at emergency services, the doctors who were sued for malpractices, those who had malpractice insurances, those who had concerns about the practices after the new Turkish penal code had been put into effect, and those who thought that they had high risk to encounter with a malpractice trial at any moment applied positive and negative defensive medicine more, which is statistically significant. It has been determined that practicing defensive medicine is related with the concerns of the subjects which risk the physicians.It has been established that physicians are aware of the fact that the number of malpractice cases have been increasing more and more but they do not fulfill their duty not paying necessary attention to medical law. It has also been determined that physicians think that the complication and malpractice has not been clearly distinguished and they are confused about malpractice insurance.Defensive medicine which is harmful for the physicians, patients, sanitary system and economy can not be considered itself as a fundamental problem; however, it is an outstanding indicator revealing that basic malpractice problem has not been well administrated. Therefore, as many researchers stated, none of the attempts to change the regulations and legal sanctions to prevent defensive medicine itself directly can not solve the problem and, what is more, may deteriorate the problem.The basic rule in all legislation and regulations for better application of medical malpractice should be to keep the balance the concerns and risk perception of the health staff.Keywords: Defensive medicine, medical malpractice, forensic medicine, medical law.
Açıklama
Anahtar Kelimeler
Adli tıp, Forensic medicine
Kaynak
WoS Q Değeri
Scopus Q Değeri
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Künye
Aynacı, Y. (2008). Hekimlerde defansif (çekinik) tıp uygulamalarının araştırılması. (Yayınlanmamış tıpta uzmanlık tezi) Necmettin Erbakan Üniversitesi, Meram Tıp Fakültesi Dahili Tıp Bilimleri Adli Tıp Anabilim Dalı, Konya.
