전공의관련 법적 분쟁의 최근 유형들과 제도적 시사점 : 전공의관련 판례의 유형과 제도적 개선방안

박경기 ( Park Kyung Kgi ),김기영 ( Kim Ki-young ),허정식 ( Huh Jung-sik ) 한국의료법학회 2019 한국의료법학회지 Vol.27 No.1

전공의는 피교육자이자 의과대학의 학생의 임상실습에서 중요한 역할을 하는 교육자이다. 전공의는 지도전문의의 지도하에 전문과목에 대한 수련을 받아야 하며 이는 학교와 같은 교육기관이 아니라 환자의 치료를 담당하는 병원에서 이루어지고 있다. 수련 과정은 인턴과정과 전공의 과정으로 나누어져 있으며 전문과목마다 수련기간이 다르다. 전공의의 수련환경은 각 병원마다 차이가 있으나 도제식교육과 피교육자라는 것으로 인해 장기간의 근무로 인해 만성피로와 주의력부족 등으로 인해 의료사고에 노출이 될 수 있으나 최근 전공의 특별법이 제정되어 전공의의 근무시간을 제한하게 되어 있다. 전공의의 경우 전문과목별 술기에만 교육과정이 초점을 맞추는 경향이 많다. 각 전문학회에서 전공의 교육을 위한 목표와 목적을 정하고 수련과정을 정하고 있으나 인성과 최근 변화되는 의료환경과 의료법 등에 대한 교육은 미흡하고 특히 의료사고 발생과 관련된 조치에 대한 교육은 미흡한 상태이다. 최근 의료사고와 관련되어 전공의를 포함한 의료진이 구속되는 등의 사건이 발생하였다. 전공의와 둘러싼 법적 문제들 중에서 의료법 위반 및 징계 및 행정처분 사건, 의료사고에 대한 민형사상책임문제, 전공의의 강제추행 등 사건 및 전공의의 과로 등 보호의무위반으로 인한 병원의 사용자책임 사건 등을 분석하면 다른 의료사고와 마찬가지로 전공의 능력을 초과한 부분에 대한 지도전문의의 감독지도가 부족하고 이를 인지 못하는 경우가 있다. 이로 인해 전공의가 수련과정이지만 민형사상의 책임을 지는 경우가 있으며 직접 의료사고의 인과관계가 없다는 것을 설명할 수 있어야 한다. 의료사고가 발생시 적극적으로 대처하는 능력을 키워나가야 하며 이를 위한 병원과 전문학회의 교육과 보호방안이 필요할 것이다. A resident is a trainee and also a teacher who plays an an important role in the clinical practice of the students of the medical school. The residents must be trained in specialized courses under the guidance of a specialist. They work at the hospital and they are in charge of the patient's treatment, not the educational institution such as the school. The training process is divided into internship courses and resident courses. The training environment of the residents is different in each hospital, but it is exposed to medical accidents due to chronic fatigue and lack of attention, because of long-term work as the apprenticeship education and the trainee, but recent special law has been enacted, therefore working time at the hospital is limited. The resident training course tends to be focused only on the technique of each speciality. Although each special association of speciality has set goals and objectives for the education of its resident and set the course of training, the education on humanity and the recently changed medical environment and medical law is insufficient and there is no education about measures related to the occurrence of medical accidents. Recently, there have been incidents such as the arrest of the medical staff including the residents related to the medical accident. Analysis of the legal issues surrounding the medical law, cases of discipline and administrative disposition, problems of civil liability for medical accidents, cases of forced enforced of residents, and cases of hospital occupational accidents caused by violation of the protection obligations like other medical accidents, there is a lack of supervisory guidance by the specialist in areas beyond the competence of the major. This should explain the fact that the residents are in the process of training but have civil liability and there is no causal relationship between direct medical accidents. It is necessary to develop the ability to deal actively when a medical accident occurs, and education and protection measures at the hospital and association of speciality will be needed.

제주지역 비뇨기계암발생율 추이(1999-2012)

박경기(Kyung Kgi Park),김성대(Sung Dae Kim),김영주(Young-Joo Kim),김현주(Hyeon Ju Kim),허정식(Jung-Sik Huh) 대한비뇨기종양학회 2016 대한비뇨기종양학회지 Vol.14 No.1

Purpose: Incidence of cancer has been increasing each years. The incidence of genitourinary cancer are also being increased. We aim to describe the time trends in genitourinary cancer incidence in Jeju province. Materials and Methods: Age-standardized rates for incidence of genitourinary tract cancer in Korea and world standard population were calculated using the databases from the Jeju Cancer Rigistry from 1999 to 2012. Results: Cancer incidence in Jeju was increased approximately 2-fold from 1217 cases 1999 to 2376 cases in 1999. Prostate cancer occurred most frequently followed by bladder tumor, and kidney cancer in 2012. In the prostate cancer, incidence was increasing every year from 18 cases in 1999 to 110 cases in 2012. Age-standardized incidence rate (ASR) was approximately four time increased, from 3.0 cases in 1999 and 11.2 cases in 2012. Incidence of bladder cancer were 43 cases in 1999 and 27 cases in 2012, ASR of bladder cancer was increased from 5.0 cases in 1999 to 7.5 cases in 2012. Kidney cancer showed constantly reducing the incidence. Peak is 60 cases in 2009 and recent incidence was 37 cases in 2012. There was no significant change in the incidence of testicular cancer, ureter cancer, renal pelvis cancer from 1999 to 2012. Conclusions: Incidence of cancer has been increasing in Jeju, similar to other area In Korea. Prostate cancer is the most common urological cancer in Jeju province, and kidney cancer incidence is recently decreasing. We should try to prevent genitourinary tract cancer caused obesity and smoking.

방광종물에 대한 방광초음파검사의 진단적 유용성

허정식,김성대,박경기,김영주,유현욱,Huh, Jung-Sik,Kim, Sung Dae,Park, Kyung Kgi,Kim, Young Joo,You, Hyun Wook 제주대학교 의과학연구소 2020 The Journal of Medicine and Life Science Vol.17 No.3

Ultrasonography is used to examine gross or microscopic hematuria without side effects. It is one of the methods of diagnosing bladder lesions, but in some cases, the lesions are not found. We attempted to identify the problems during the ultrasonic examination by analyzing the symptoms, location of lesion, and medical history of urothelial cancer for cases of undetected bladder lesions. Thirty-three patients who underwent transurethral resection of a bladder tumor from January 1 to May 4, 2018 in one hospital were enrolled in this study. Patients who underwent preoperative ultrasonography and cystoscopy were treated. Ultrasonography did not detect bladder lesions in five patients. The size of the lesion was 0.5~2.5 cm in various locations, such as the side, front, and so on. Ultrasonic examination requires more attention if there is gross hematuria or a history of urothelial cancer, and it is necessary to detect recurrence by conducting cystoscopy at the same time, especially when there are lesions on the anterior wall of the bladder.

코비드-19(COVID-19) 위기와 의료의 우선순위에 대한 비교법적 고찰

김기영 ( Kim Ki-young ),박경기 ( Park Kyung Kgi ),허정식 ( Huh Jung-sik ) 한국의료법학회 2021 한국의료법학회지 Vol.29 No.1

인체감염병은 병원체 즉 바이러스, 세균, 기생충 등과 같은 미생물이 감염경로로 상관없이 인간의 몸안으로 침투가 되어 증식되는 것으로 우리나라에서 코비드-19(Corona Virus Disease: COVID-19)위기상황 속에서 의료의 우선순위를 정해야 하는 상황이 발생할 가능성은 얼마나 되는지는 모른다. 하지만 최근에도 기존의 암환자나 심혈관 등 중환자들을 치료할 전담 병상으로 확보되어 있는데 이외에 코로나 환자를 수용할 중환자실 부족이 대유행의 상황에 따라 계속 심화될 수도 있을 것으로 보인다. 무엇보다 이러한 의료적 조치와 관련하여 비교법적인 측면에서 COVID-19 전염병에서 발생하는 소위 우선순위의 판단상황을 예방하기 위해 지금까지 어떤 입법적, 행정적, 기타 조치가 어떻게 조치가 취해졌는지를 살펴보아야 하며 일상적인 임상실무에서 수용부족상황이 어떻게 처리되었는지 살펴보고 그러한 결정을 내리는 사람은 누구이며 주로 어떤 권한을 사용할 수 있는지를 비교검토하고 있다. 뿐만 아니라 이러한 결정의 기준은 어떠한 것이 있는지 그리고 절차에 대한 특별한 요구사항이 있는지 그러한 결정에 대해 어떤 법적 요건이 실제로 구속력이 있는가를 도출하고 있다. 본 논문에서 갑작스러운 감염병의 발생, 의료자원의 한계와 의료의 우선순위에서 임상적 치료성공가능성은 구체적으로 얼마나 중요하게 보는지를 각국의 규율상황들을 비교하고, 다른 국가에서 우선 순위설정시 의료시스템에 적용되는 규정이 있는지 혹은 법적으로 규율하고 있는지 등을 살펴보고 있다. 그 외에도 의학적으로 이러한 결정에서 기존의 장애와 만성적인 질환은 어떤 중요성을 가지는지를 검토하고 성공가능성의 기준을 다른 기준으로 대체하거나 치료를 필요로 하는 모든 사람들의 요구를 충족할 수 있도록 하는 보다 더 정확하게 정의하는 것이 필요하다는 결론을 도출하고자 한다. In fact, it is not known how likely there is COVID-19 pandemic situation in which the priority of medical care will occur in Korea in the corona crisis. However, in recent years, it has been secured as a dedicated bed to treat critically ill patients such as existing cancer patients and cardiovascular disease. In addition, the lack of intensive care units to accommodate corona patients may continue to intensify depending on the situation of the pandemic. In relation to these medical measures, we are especially looking at what legislative, administrative, and other measures have been taken so far to prevent the so-called priority decision situation arising from the COVID-19 epidemic in terms of comparative law. In addition, it examines how the deprivation situation was handled in routine clinical practice, who makes such a decision, and what authority can be used primarily. In addition, the criteria for these decisions are deriving what are the specific requirements for the procedure and which legal requirements are actually binding on those decisions. In this paper, we compare the regulatory situations of each country to see how important the possibility of clinical treatment success is specifically regarded in the priority of medical care, and whether there are triage that apply to the medical system in other countries or whether they are legally regulated. In conclusion, we draw the conclusion that it is necessary to review or define medically the importance of pre-existing disabilities and chronic diseases in these decisions, to replace the criterion of success with other criteria, or to make it more accurate to meet the needs of all those in need of treatment.

요로감염과 관련된 중증 패혈증 및 패혈성 쇼크의 치료

황규빈,허정식,김영주,박경기,김성대,유현욱,Hwang, Kyu Bin,Huh, Jung-Sik,Kim, Young-Joo,Park, Kyung Kgi,Kim, Sung Dae,You, Hyun Wook 제주대학교 의과학연구소 2020 The Journal of Medicine and Life Science Vol.17 No.3

Urinary tract infections are among the most common infectious diseases and are the major causes of mortality and morbidity. These diseases result in many severe hospitalizations each year. Severe sepsis and septic shock are common and life-threatening medical conditions, and large cases are associated with urinary tract infection. The medical term "severe sepsis" is defined as sepsis complicated by hypotension, organ dysfunction, and tissue hypoperfusion, whereas "septic shock" is defined as sepsis complicated either by hypotension that is refractory to fluid resuscitation or by hyperlacteremia. A recent multicenter-study in Korea reported that the rate of in-hospital mortality associated with severe sepsis and septic shock was > 34%. Among the causative diseases, urogenital tract infection showed a high correlation. Moreover, it is very important that clinicians detect severe sepsis and septic shock early and treat them properly. The principles of initial treatment include provision of sufficient hemodynamic resuscitation and early administration of appropriate antibiotic therapy to mitigate uncontrolled infection. Initial resuscitation includes the use of vasopressors and intravenous fluids, and it is a key to achieve the target of initial resuscitation. Supportive care in the intensive care unit, such as glucose control, stress ulcer prophylaxis, blood transfusion, deep vein thrombosis prophylaxis, and renal replacement therapy, is also significant. We have summarized the key components in the treatment of severe sepsis and septic shock in patients with urinary tract infection. Urologists should be aware that appropriate early treatment is necessary to prevent fatal outcomes in these patients.

Relationship Between Prostate Volume and Lower Urinary Tract Symptom in Health Checkup Subjects

Hyeon Ju Kim(김현주),Ji Hyun Moon(문지현),Yun Hwan Oh(오윤환),Mi Hee Kong(공미희),Kyung Kgi Park(박경기),Jung Sik Huh(허정식) 대한비뇨기종양학회 2020 대한비뇨기종양학회지 Vol.18 No.1

Purpose: This study aimed to evaluate the relationship between prostate volume and lower urinary symptom (LUTS) in subjects undergoing health checkup and to know the usefulness of TRUS in health screening. Materials and Methods: The study was conducted in 883 men aged ≥20 years who underwent TRUS for health screening. All participants had filled in the international prostate symptom score (IPSS) and were tested for prostate-specific antigen; prostate volume, central gland volume, and transitional zone index were measured using TRUS. We analyzed the differences in the IPSS by prostate volume and differences in prostate volume by severity of LUTS and correlation between prostate volume and each component of IPSS. Results: There were differences in the total IPSS, storage score, and voiding score between the subjects with prostate volumes of ≥30 mL or not (p=0.027, p=0.037, and p=0.029, respectively). However, the differences were found only for urgency and weak stream. The volume of the severe symptom group was bigger than those of the mild and moderate symptom groups (p=0.002 and p=0.014). The correlation between prostate volume and IPSS was significant only for the between the central volume and nocturia (r=0.112, p<0.01). Conclusions: The relationship between prostate volume and urinary symptoms showed significant but low correlation and found only in some components. For the accurate diagnosis, it would be more useful to accompany various voiding-related surveys in addition to TRUS during health screening.