Management of future infectious diseases: eight recommendations for national quarantine

Republic of Korea (ROK) has coped well with coronavirus disease 2019 (COVID-19) without requiring an extreme containment policy. However, it is necessary to evaluate issues revealed during the COVID-19 quarantine process.Current Concepts: In the quarantine policy, the legal and scientific basis for quarantine, role of ministries in charge, government-wide support, fairness of quarantine measures, protection of vulnerable people, compensation for vaccination damage, and quarantine budget are important. Discussion and Conclusion: As a result of reviewing the COVID-19 quarantine process, the following issues were found. First, COVID-19 was not properly designated as a first-class infectious disease under the InfectiousDisease Control and Prevention Act. Second, the major direction of the quarantine policy did not reflect ROK’s objective scientific capabilities. Third, quarantine measures did not reflect the relative risk of infection. Fourth, the professional and objective judgments of the Korea Disease Control and Prevention Agency were not respected by other Government officers. Fifth, the fairness of the quarantine policy was greatly undermined. Sixth, the vulnerable and those caring for them were marginalized. Seventh, the purpose of the vaccination damage compensation system of the Infectious Disease Control and Prevention Act was not well reflected. Eighth, the quarantine policy was ignored in allocation of the national budget. To properly respond to future infectious diseases, ROK must address issues that emerged during the COVID-19 quarantine process.

Prioritizing ICU Care and Legal Liability During the COVID-19 Crisis in Korea

no abstract available.

Preventing workplace violence against healthcare workers

Healthcare workers face significant risks of workplace violence, which includes verbal, physical, and sexual assaults and harassment. Most violent acts are committed by patient and their family members, although in some cases, medical staff may perpetrate various types of violence against other medical staff. In the course of training, professors or senior residents sometimes criticize junior residents who make mistakes. However, beyond a certain point, the purpose of protecting the patient from harm is lost and only the violence remains. Various efforts should be made to prevent workplace violence against healthcare workers. First, it is necessary to investigate the actual incidence of workplace violence in healthcare settings. Second, each hospital should have a process in place to expedite the response when a violent act is reported. Third, the Korean Hospital Association should ask individual hospitals to take appropriate measures when victims file complaints with the Korean Hospital Association. Fourth, medical societies and the Korean Academy of Medical Sciences should strive to create a healthy training environment in which residents are respected and educated. Fifth, violence prevention education is needed as part of medical school coursework. Sixth, the Korean Medical Association should organize a consultative body including the Korean Academy of Medical Sciences, the Korean Hospital Association, and the Korean Association of Medical Colleges, to encourage the entire medical community to spread safety culture in health care settings. Through these efforts, a new safety culture should be created by integrating patient safety and worker safety in health care settings.

Preventing workplace violence against healthcare workers

Healthcare workers face significant risks of workplace violence, which includes verbal, physical, and sexual assaults and harassment. Most violent acts are committed by patient and their family members, although in some cases, medical staff may perpetrate various types of violence against other medical staff. In the course of training, professors or senior residents sometimes criticize junior residents who make mistakes. However, beyond a certain point, the purpose of protecting the patient from harm is lost and only the violence remains. Various efforts should be made to prevent workplace violence against healthcare workers. First, it is necessary to investigate the actual incidence of workplace violence in healthcare settings. Second, each hospital should have a process in place to expedite the response when a violent act is reported. Third, the Korean Hospital Association should ask individual hospitals to take appropriate measures when victims file complaints with the Korean Hospital Association. Fourth, medical societies and the Korean Academy of Medical Sciences should strive to create a healthy training environment in which residents are respected and educated. Fifth, violence prevention education is needed as part of medical school coursework. Sixth, the Korean Medical Association should organize a consultative body including the Korean Academy of Medical Sciences, the Korean Hospital Association, and the Korean Association of Medical Colleges, to encourage the entire medical community to spread safety culture in health care settings. Through these efforts, a new safety culture should be created by integrating patient safety and worker safety in health care settings.

Medical ethics guidelines and related laws

Professional ethics can often encompass areas regulated by law. This is true of the Korean Medical Association (KMA) code of ethics. Therefore, doctors should consider their legal obligations when complying with medical ethics guidelines. A revision prepared by the KMA committee on medical ethics guidelines contains 5 types of amendments. First, some guidelines deal with areas that are not governed by current legislation. A second set of guidelines clarify the obligation to comply with current legislation by specifying “to the extent permitted by the law”. A third set of guidelines repeat the contents of current legislation almost verbatim. A fourth set of guidelines explain the content of the current legislation in lay language when a chance of misunderstanding is present. Fifth, some guidelines can be interpreted as being in conflict with current legislation. The statement that physicians must consider the content of relevant laws does not mean that they must accept those laws uncritically. At a minimum, doctors should avoid falling into legal difficulties because of legal ignorance. Furthermore, doctors must make efforts to revise relevant laws that are not acceptable from the point of view of medical ethics. If doctors continue this effort, they can maintain their professional dignity. The revision of the medical ethics guidelines is the beginning of this effort. If doctors understand the relationship between medical ethics guidelines and current legislation, it will be easier for doctors to comply with medical ethics guidelines in the clinical setting.

Medical ethics guidelines and related laws

Professional ethics can often encompass areas regulated by law. This is true of the Korean Medical Association (KMA) code of ethics. Therefore, doctors should consider their legal obligations when complying with medical ethics guidelines. A revision prepared by the KMA committee on medical ethics guidelines contains 5 types of amendments. First, some guidelines deal with areas that are not governed by current legislation. A second set of guidelines clarify the obligation to comply with current legislation by specifying “to the extent permitted by the law”. A third set of guidelines repeat the contents of current legislation almost verbatim. A fourth set of guidelines explain the content of the current legislation in lay language when a chance of misunderstanding is present. Fifth, some guidelines can be interpreted as being in conflict with current legislation. The statement that physicians must consider the content of relevant laws does not mean that they must accept those laws uncritically. At a minimum, doctors should avoid falling into legal difficulties because of legal ignorance. Furthermore, doctors must make efforts to revise relevant laws that are not acceptable from the point of view of medical ethics. If doctors continue this effort, they can maintain their professional dignity. The revision of the medical ethics guidelines is the beginning of this effort. If doctors understand the relationship between medical ethics guidelines and current legislation, it will be easier for doctors to comply with medical ethics guidelines in the clinical setting.

The Korean Medical Association and self-regulation

According to the World Medical Association Declaration of Madrid on Professionally-led Regulation, physicians have been granted a high degree of professional autonomy, which is an essential component of high quality medical care. As a result, physicians have a continuing responsibility to be self-regulating. Historically, credible self-regulation has required maintaining professional competence, identifying problem physicians and conflicts of interest, and taking appropriate action. Recently, our society had two incidents that gave patients strong doubts about the professional expertise of physicians. The Korean Medical Association should consider the following in promoting its self-regulatory policies. First, if the structure of the self-regulation of lawyers is instructive, self-regulation completely independent from the government is unlikely to be realized. KMA or independent bodies should exercise primary authority and responsibility for self-regulation, and if this is not implemented well, it is reasonable that the Department of Health and Human Services should intervene. Second, the Ethics Committee of KMA should avoid political disputes between members and devote itself solely to establishing the core ethics of the medical profession. Third, KMA should inform its members that the ultimate beneficiaries of self-regulation are physicians and patients. KMA must determine the objectives it has in common with the Department of Health and Human Services and create a model of self-regulation.

The Korean Medical Association and self-regulation

According to the World Medical Association Declaration of Madrid on Professionally-led Regulation, physicians have been granted a high degree of professional autonomy, which is an essential component of high quality medical care. As a result, physicians have a continuing responsibility to be self-regulating. Historically, credible self-regulation has required maintaining professional competence, identifying problem physicians and conflicts of interest, and taking appropriate action. Recently, our society had two incidents that gave patients strong doubts about the professional expertise of physicians. The Korean Medical Association should consider the following in promoting its self-regulatory policies. First, if the structure of the self-regulation of lawyers is instructive, self-regulation completely independent from the government is unlikely to be realized. KMA or independent bodies should exercise primary authority and responsibility for self-regulation, and if this is not implemented well, it is reasonable that the Department of Health and Human Services should intervene. Second, the Ethics Committee of KMA should avoid political disputes between members and devote itself solely to establishing the core ethics of the medical profession. Third, KMA should inform its members that the ultimate beneficiaries of self-regulation are physicians and patients. KMA must determine the objectives it has in common with the Department of Health and Human Services and create a model of self-regulation.

Future directions for the Korea Medical Dispute Mediation and Arbitration Agency

Three years have passed since the Korea Medical Dispute Mediation and Arbitration Agency (KMDMAA) was established. In this time, its performance has fallen far short of expectations. Currently, both the KMDMAA and the Korea Consumer Agency (KCA) are responsible for alternative medical dispute resolution in Korea. In the most recent National Assembly administration inspection, Rep. Kim Jae Won of the Saenuri Party made the criticism that in 2013 the KMDMAA spent more than 13 times the budget of the KCA, but did not achieve significantly improved results. An analysis of the relevant law reveals that the KMDMAA has a much more advantageous legal and financial position than the KCA. Mediation takes the form of alternative dispute resolution in place of court adjudication. Mediation is a voluntary process and generally only succeeds when both parties agree. The mediator must be impartial and should aid parties in arriving at a mutually agreed-upon outcome. However, the KMDMAA has failed to build a trusting relationship with medical professionals, and has instead sought power to rule over them. The agency should be aware that power over medical personnel might deter mediation processes, which are based on the spontaneity and trust of both parties. The Department of Health and Human Services and the National Assembly also need to understand the essence of this problem and seek to remedy it.

What Does the Korean Medical Association Need to Talk About?

No abstract available.

Policy and law of big data use in health care

According to Article 17 of the Korean Constitution, the privacy of no citizen shall be infringed. There have been considerable advances in the fields of computers and communications technology in the late 20th century. However, processing large amounts of personal information has caused many problems. In Korea, incidents of personal information leakage have been occurring frequently. To solve these problems, the Personal Information Protection Act was enacted in 2011. The most significant feature of this Act is that it applies not only to public institutions, but also to corporate bodies, organizations, and individuals who manage personal information. However, the Act does not allow the management of personal information for public purposes such as public health. Recently, the European Parliament has adopted a legislative resolution on the proposed European Union General Protection Regulation. This regulation allows the management of personal information for public health, reflecting the opinions of European public health experts. According to Article 81 of the proposed regulation, processing of personal data concerning health is permitted for the purposes of preventive or occupational medicine, medical diagnosis, the provision of care or treatment, or the management of health-care services. It is also permitted for reasons of public interest in the area of public health, such as protecting against serious cross-border threats to health or ensuring high standards of quality and safety for medicinal products or medical devices and reasons of public interest in areas such as social protection, in order to ensure the quality and cost-effectiveness of the health insurance system and the provision of health services. The proposed regulation is an example of the balance of privacy and public interest in the management of personal information. Although the management of personal information is allowed in the public interest without the consent of the subject of the information, all measures should be taken for privacy protection. It is time for Korea to take legislative steps for the management of personal health information for public health under conditions of strict privacy protection measures.

Medical law for physicians

No abstract available.

Effect of Bioethics and Safety Act in medical research

The ethics of medical research is an important area of physician ethics. Physicians are called to respect the life, health, and personality of human subjects. In contrast to other ethical fields, physician ethics, including the ethics of medical research, does not rely on the good faith of physicians alone; ethics and the law are intermingled. While respecting international norms related to medical ethics, individual countries have expanded legal interventions into medical research. The United States has regulated the research of human subjects receiving federal funding through the Common Rule. In Korea, legal interventions for human subjects protection have been applied to a limited extent in clinical trials under the Pharmaceutical Affairs Act and the Medical Devices Act in Korea. On January 29, 2004, the Bioethics and Safety Act was enacted, requiring embryo research institutes, gene banks, and gene therapy institutions to establish Institutional Review Boards. On February 1, 2012, the Bioethics and Safety act was completely revised, which was a significant turning point in medical ethics in Korea. Structural differences between the Common Rule of the United States and the Bioethics and Safety Act of Korea are as follows. First, the Bioethics and Safety Act shall be applied regardless of the presence or absence of government funding. Thus the Bioethics and safety act has a more comprehensive and compulsory effect than the Common Rule. Second, under the Bioethics and Safety Act, the Ministry of Health and Welfare has direct supervision over institutional review boards, rather than supervision of the research organization itself. This differs from the Common Rule, which regards the research organization as the counterpart to the government. Third, the Bioethics and Safety Act regulates the study of derivatives of human bodies, in addition to research on human subjects. The Bioethics and Safety Act has the following problems. First, it mandates that researchers, instead of IRBs, record and store data concerning medical research. Second, the Act does not provide a specific definition of "minimal risk". Third, as the Act does not allow the exemption of informed consent of children under the age of 18 even if specific prerequisites are met as in the case of adults, research involving children will atrophy significantly in Korea.

Training residents in the prevention of legal disputes

Unlike medical students, doctors-in-training (residents) are physicians who can legally provide medical treatment with a medical doctor's license obtained from Korea the Ministry of Health and Welfare, and thus they are liable for the care they provide. Therefore, residents need to be aware of the legal and risks they facing in medical practice and ensure that they have the ability to deal with such risks. Legal responsibilities of residents can be examined from three perspectives: the relationships between patients and doctors, the relationships between doctors and medical officials, and the Korean health and welfare system. With regard to the relationships between patients and doctors, the legal responsibilities of doctors-in-training span a diverse range of liability for explanation (informed consent), malpractice, medical records, prohibition on revealing medical secrets, emergency medical treatment, treatment for the opposite sex, and other basic responsibilities. They will be liable for any damage caused under Article 268 of the Criminal Code, which addresses the crime of professional negligence resulting in injury or in death, and Article 750 of the Civil Code, which addresses torts liability, and above and beyond them of legal liability in general. With regard to the relationships between doctors and medical officials, the legal responsibilities can be classified into two types of relationships. One is between a doctor and a senior doctor, and the other is between a doctor and a doctor from a different medical specialization. it there is miscommunication between two or more doctors, it could lead to poor outcomes for patients. Regarding the health and welfare system, the issuance of medical licenses and the duty of notification are the most important legal responsibilities. The system's treatment of residents require special caution as issuance of falsified medical licenses has caused serious social problems. Laws that state the various notification duties allow no exceptions even for the residents. Residints should therefore understand the basic notification duties involved in cases of accidental death, child abuse, and etc. and prepare for contingencies.

The relationship between depressive symptoms among female workers and job stress and sleep quality

OBJECTIVE: Recently, workers' mental health has become important focus in the field of occupational health management. Depression is a psychiatric illness with a high prevalence. The association between job stress and depressive symptoms has been demonstrated in many studies. Recently, studies about the association between sleep quality and depressive symptoms have been reported, but there has been no large-scaled study in Korean female workers. Therefore, this study was designed to investigate the relationship between job stress and sleep quality, and depressive symptoms in female workers. METHODS: From Mar 2011 to Aug 2011, 4,833 female workers in the manufacturing, finance, and service fields at 16 workplaces in Yeungnam province participated in this study, conducted in combination with a worksite-based health checkup initiated by the National Health Insurance Service (NHIS). In this study, a questionnaire survey was carried out using the Korean Occupational Stress Scale-Short Form(KOSS-SF), Pittsburgh Sleep Quality Index(PSQI) and Center for Epidemiological Studies-Depression Scale(CES-D). The collected data was entered in the system and analyzed using the PASW (version 18.0) program. A correlation analysis, cross analysis, multivariate logistic regression analysis, and hierarchical multiple regression analysis were conducted. RESULTS: Among the 4,883 subjects, 978 subjects (20.0%) were in the depression group. Job stress(OR=3.58, 95% CI=3.06-4.21) and sleep quality(OR=3.81, 95% CI=3.18-4.56) were strongly associated with depressive symptoms. Hierarchical multiple regression analysis revealed that job stress displayed explanatory powers of 15.6% on depression while sleep quality displayed explanatory powers of 16.2%, showing that job stress and sleep quality had a closer relationship with depressive symptoms, compared to the other factors. The multivariate logistic regression analysis yielded odds ratios between the 7 subscales of job stress and depressive symptoms in the range of 1.30-2.72 and the odds ratio for the lack of reward was the highest(OR=2.72, 95% CI=2.32-3.19). In the partial correlation analysis between each of the 7 subscales of sleep quality (PSQI) and depressive symptoms, the correlation coefficient of subjective sleep quality and daytime dysfunction were 0.352 and 0.362, respectively. CONCLUSION: This study showed that the depressive symptoms of female workers are closely related to their job stress and sleep quality. In particular, the lack of reward and subjective sleep factors are the greatest contributors to depression. In the future, a large-scale study should be performed to augment the current study and to reflect all age groups in a balanced manner. The findings on job stress, sleep, and depression can be utilized as source data to establish standards for mental health management of the ever increasing numbers of female members of the workplace.

Improving quality of healthcare in Korea

Korea has achieved a remarkable expansion in health coverage at modest costs relative to other Organization for Economic Cooperation and Development (OECD) countries. Hospitals are more accessible and equipped with more advanced medical technologies than in most other OECD countries. OECD Reviews of Health Care Quality seek to support the development of better policies to improve the quality of healthcare. In 2012, a report on Korea presented best practices and offered recommendations for improvement in the Korean health system. Korea's health care system needs to shift its focus from simply supporting an ever-continuing expansion of acute care services to quality of healthcare. First, Korea needs to strengthen the focus of governance to the quality of healthcare by establishing HIRA as an institutional champion for quality. Second, Korea must strengthen primary healthcare because in Korea it is woefully underdeveloped today. Third, Korea must use financing to drive improvements in quality of care. In reality, HIRA has used its power over healthcare providers to force them to accept financial constraints; it has not supported quality of all healthcare sectors. Without structural changes allowing for independent judgment on the quality at HIRA, NECA is more suitable for ensuring quality for all healthcare sectors. As suggested by the OECD report, Korea must strengthen primary healthcare by restoring patients' trust in health professionals. In using financing to drive improvements in quality of healthcare, Pay for Performance may be helpful, but that must be driven on a voluntary basis and with a great financial incentive.

Reform of OTC distribution in Korea

In the US, over-the-counter (OTC) drugs have long been available in non-pharmacy outlets, and in the UK, general sale list medicines can be supplied without the need for the supervision of a pharmacist. Recently, the Japanese government allowed medications for colds or fever and painkillers, which account for 95% of general pharmaceuticals, to be sold at retail stores through the amendment to the Pharmaceutical Affairs Act. Among the key trends of the global OTC market are major changes in product distribution. However, in Korea, the independent pharmacy model traditionally has been the method of OTC distribution for many years. 19 years have passed since the first civil petition for non-pharmacy distribution of selected OTC drugs. At last in 2012, Korea revised the Pharmaceutical Affairs Act, allowing selected non-prescription drugs to be distributed by non-pharmacy outlets. The revised Pharmaceutical Affairs Act restricted the number of selected OTC drugs to under 20. The new Act included the registrations of nonpharmacy outlets and the mandatory education of the sellers. We must discuss the criteria for placement of medicines on the GSL, the reclassification system based on the safety profile of the medicines, and the expansion of non-pharmacy outlets. In preparation for the aged society, we should implement health policies to lower the price of pharmaceuticals by adopting the market principle thus giving consumers a broader choice.

Charactersitics and issues of guideline to withdrawal of a life-sustaining therapy

Agenerally accepted consensus of end-of-life (EOL) care decision-making did not appear in Korean medical society until the year 2009. To enhance physician's ethical perception of EOL care, consensus guidelines to withdrawing life-sustaining therapies endorsed by Korean Medical Association, Korean Academy of Medical Science, and Korean Hospital Association, were published on October 13, 2009. In this article, the characteristics and issues with the guidelines are presented to improve understanding by physicians who interact with EOL patients. According to the guidelines, physicians should identify, document, respect, and act on hospitals inpatients' needs, priorities, and preferences for EOL care. The guidelines advocate that competent patients express their right of self-determination in EOL care decisions through advance directives. However, there are barriers to adopting advance directives as a legitimate tool of EOL decision-making in our current society. The guidelines stressed the importance of open communication between care-givers and patients or their surrogates. Through communication, physicians can create a plan regarding how to manage EOL until the patients' last day of life. Concerted actions among the general public, professionals, other stake-holders for EOL care, and governmental organizations to improve EOL care in our society are also stipulated. Physicians, who know the clinical meaning of the treatments available to EOL patients, should play a central role based on the consensus guidelines to help patients and their families make informed decisions about EOL care.

Urodynamic Findings and Voiding Symptoms according to LesionSites in Stroke

OBJECTIVE: To investigate urodynamic findings and voiding symptoms according to the location of brain lesion after stroke. METHOD: Twenty-six patients with stroke (19 infarction, 7 hemorrhage) who had complained of voiding dysfunction were studied. Brain MRI was performed to identify the suprapontine lesion or pontine lesion. Intravesical pressure and voiding control function of the external urethral sphincters were evaluated by urodynamic study with electromyographic study of the external urethral sphincter. Also voiding symptoms were evaluated. We classified voiding dysfunction into three subgroups by urodynamic findings as follows: detrusor hyperactivity, detrusor hypoactivity, and normal. Functions of the external urethral sphincters were divided into normal, impairment of external urethral sphincter volitional control (IEUS), and detrusor-sphincter dyssynergia (DSD). The symptoms of voiding dysfunction were categorized into three types as a irritative, obstructive or mixed type. RESULTS: In patients with suprapontine lesion (n=22), 11 (50%) showed hyperactive detrusor and 6 (27.3%) showed hypoactive detrusor. However, in the pontine lesion (n=4), one patient (25%) was normal and the others were hypoactive detrusor. Fourteen cases (64%) of the suprapontine lesion and 1 case (25%) of pontine lesion demonstrated normal external urethral volitional control. Seven of 11 patients with irritative symptoms showed detrusor overactivity. Five of 9 patients with obstructive symptoms showed hypoactive detrusor. CONCLUSION: We concluded that hyperactive detrusor in suprapontine lesion and hypoactive detrusor in pontine lesion were dominant. However, voiding symptoms in stroke patients were various according to the external urethral sphincter function as well as the detrusor activity.

The Implications and Significance of the Case at Severance Hospital

This year on May 21st, the full panel of the Supreme Court in Korea had first made a judgment on 'withdrawal of life-sustaining management'. In this case, where a 76 -year-old patient was represented by her children, while being in a persistent vegetative status, the Supreme Court ruled that if a patient is in an irreversible condition with imminent death and the discontinuation of treatment can be approved as the patient's self -determination, while such action will not be allowed in any other special circumstances. This judgement presented the general criteria and process of withdrawal of life -sustaining management in Korea for the first time. The Supreme Court also brought about the specific requirements of advance directives and decided that in case where legal proceedings are not taken, the hospital ethic committee constiting of medical specialists should decide whether the patient is in an irreversible condition. However, the judgment vaguely defined the concept of 'irreversible death-imminent condition' and did not clearly examine the relations between the patient's right on self-determination and the duty of the national government to protect the life of the people, and the discretionary power of the doctor.