Most patients want to play an active role in their own health care. There is now a movement from medical paternalism to patient-centered care in the consultation process that is based on the therapeutic alliance and negotiation between the doctor and patient, aptly named “shared decision-making” (SDM). It is a process where doctors work together with patients, including their families and caregivers, to select tests, treatments, management, or support packages, based on clinical evidence and personal informed preferences, health beliefs, and values. Successful implementation of SDM is associated with improved quality of consultations, favorable patient-reported health outcomes, and increased patient and doctor satisfaction. Patients are empowered to make proactive health decisions resulting in decreased anxiety, faster recovery, increased treatment compliance, and reduced unnecessary health care expenditure. There are multiple existing models in facilitating SDM. Two simple and easyto-follow models are the “three-talk model” and “S.H.A.R.E. approach.” The three-talk model endorsed by the NICE divides the SDM consultation into three steps, namely: team talk (explaining the need to consider treatment options as a team), option talk (describing the alternatives in more detail, and making use of patient decision aids [PDA] whenever appropriate), and decision talk (helping patients explore and form their personal preferences). On the other hand, the S.H.A.R.E. approach promoted by the Agency for Healthcare Research and Quality (AHRQ) is a five-step SDM consultation process that includes exploring and comparing the benefits, harms, and risks of each treatment option through meaningful dialogue about what matters most to patients.
Decision Making, Shared

Background: Shared decision-making (SDM) is the active process of collaborative clinical decision making between patient and physician. Factors associated with use of shared decision making have been investigated previously, but few have explored this topic locally. Objective: To determine patient and physician characteristics associated with shared decision making of adult Filipino patients with type 2 diabetes mellitus. Methods: A cross sectional study was conducted from January to April 2020 among patients of the Family Medicine Clinic (FMC) of the Philippine General Hospital (PGH) with type 2 diabetes mellitus and all residents of the Department of Family and Community Medicine (DFCM). Sociodemographic characteristics and clinical characteristics were obtained using self-administered questionnaires, and shared decision making was measured using the SDM Q-9 Filipino Version. Responses were encoded using Microsoft Excel and analyzed using SPSS. Results: A total of 153 patients and 36 residents were recruited into the study. The patients had an average age of 59 (SD + 9.52) years, with the majority being female (68.6%), and a mean HbA1c level of 7.76% (SD + 2.53%). The physicians had an average age of 29.6 (SD + 4.59) years, and more than half were female (66.67%). The mean level of perceived shared decision making was 85.77% (SD + 14.12%). Patients who were not aware of the current HbA1c level were less likely to have high shared decision making, while having two or less comorbidities increased the likelihood of having a highly participative consultation. Conclusion The perceived mean shared decision making was 85.77%. Shared decision making was associated with lack of knowledge on HbA1c level and few comorbidities among adult Filipino patients with Type 2 diabetes mellitus at the Family Medicine Clinic of the Outpatient Department of the Philippine General Hospital. None of the physician characteristics were linked to patient participation.
Decision Making, Shared ; Patient Participation ; Diabetes Mellitus

China ; Decision Making ; Decision Making, Shared ; Humans ; Physician-Patient Relations

OBJECTIVE: From November 30, 2016, the Korean Government carried the revised Medical Dispute Mediation and Arbitration Act into effect. Mediation will start automatically without agreements of the defendant, when the outcome of the patient was death, coma more than a month or severe disability. Cerebral aneurysm has a definite risk of bad outcome, especially in the worst condition. Any surgical intervention to this lesion has its own high risk of complications. Recently, Seoul central district court decided 50% responsibility of the doctors who made a rupture of the aneurysm during coiling (2015Ga-Dan5243104). We reviewed judicial precedents related to cerebral aneurysms in lawsuit using a web search.METHODS: We searched judicial precedents at a web search of the Supreme Court, using the key words, "cerebral aneurysm".RESULTS: There were 15 precedents, six from the Supreme Court, seven from the High Court, and two from district courts. Seven precedents were related to the causation analysis, such as work-relationship. Five precedents were malpractice suits related bad results or complications. Remaining three precedents were related to the insurance payment. In five malpractice precedents, two precedents of the Supreme Court reversed former two precedents of the High Court.CONCLUSION: Judicial precedents on the cerebral aneurysm included not only malpractice suits, but also causation analysis or insurance payment. Attention to these subjects is needed. We also need education of the independent medical examination. To avoid medical disputes, shared decision making seems to be useful, especially in cases of high risk condition or procedures.
Aneurysm ; Coma ; Decision Making ; Dissent and Disputes ; Education ; Expert Testimony ; Humans ; Insurance ; Intracranial Aneurysm ; Malpractice ; Negotiating ; Rupture ; Seoul

As part of the medical dispute mediation act, no fault compensation legislation was enacted in 2011 and took effect from April 2013 in Korea. According to this law, obstetricians should share thirty percet of the compensation expenses with the government. Although the government argues that this law can contribute to the safe obstetric practice environment, most of obstetricians are concerning about the negative effects that can be exerted by the act, including decline in new OB/GYN residents' applications, dropping number of delivering clinics and hospitals, and ultimately, devastating the obstetric practice in this country. In this review, we summarize the process and issues in no fault compensation. We also introduce no fault compensation system in Japan and compare it with ours. Finally, we will give suggestions for the improvement of the law.
Compensation and Redress ; Dissent and Disputes ; Japan ; Jurisprudence ; Korea ; Negotiating ; Obstetrics

China ; Dissent and Disputes ; Humans ; Negotiating ; Physician-Patient Relations

So called 'national criminal DNA Database (Law about The Use and Protection of DNA Identification information)' has started from July 2010 in Korea after long days of dispute. The supreme prosecutor's office has already announced that it has arrested offenders in several unsolved cases with the help of DB. The DB is just on the entrance now, and is expected to evolve. The dispute concerning ethical issues has not been ended, and new techniques would be introduced. The concerns about DB may be alleviated as DB is operated without any formerly expected problem. So we have to keep eyes open for DB and be prepared to further development. Experience of countries which are operating same system in ahead would be of great help. The number of related crime type would change, and we have to be prepared for more negotiation. Abolishment policy after DNA test for samples would have to be reconsidered. New system for the administration committee is preferable for more national advancement in the field of forensic science as a whole. Ethical issues concerning new use of DB must be settled down. As a part of forensic science and supporting tool for human right of people, not as a tool for investigative purpose only, criminal DB need more concern for more evolvement.
Crime ; Criminals ; Databases, Nucleic Acid ; Dissent and Disputes ; DNA ; Eye ; Forensic Sciences ; Human Rights ; Humans ; Korea ; Negotiating

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.
Budgets ; Dissent and Disputes* ; Jurisprudence ; Korea ; Negotiating* ; United States Dept. of Health and Human Services

PURPOSE: To analyze the characteristics of medical disputes relating to ophthalmology for prevention in advance. METHODS: Retrospective analyses of ophthalmic cases applied for Korea Medical Dispute Mediation and Arbitration Agency between June 2013 and September 2016. RESULTS: A total of 41 cases were analyzed. The number of cases relating to cataract were 19 (46.3%), refractive surgery 4 (9.8%), anterior segment 4 (9.8%), retina 7 (17.1%), oculoplasty 3 (7.3%), glaucoma 2 (4.9%), and miscellaneous 2 (4.9%). The specialty with the lowest mean payment of mediation per case was cataract (￦3,591,700), which has the largest number of cases, and oculoplasty was the highest mean payment per case (￦21,933,000). There were 16 cases confirmed as negligence by authenticators. Among these 16 cases, 7 (44%) were related to accident during surgery or procedure, 5 cases (31%) were insufficient explanation, and 4 cases (25%) were lack of tests which should have be performed before or after surgery. The results of mediation were agreement in 25 cases (61%), decision made by mediation department in 6 cases (15%), 7 cases were not adequate to mediate (17%), and 3 cases were canceled (7%). CONCLUSIONS: The number of cases associated with cataract was the largest. Among negligence of doctors, cases during surgery were most common, suggesting the need to explain surgical factors such as complications or side effects and the need for complete surgical records. If a medical dispute occurs, the Korea Medical Dispute Mediation and Arbitration Agency can be used to achieve an agreement.
Cataract ; Dissent and Disputes ; Glaucoma ; Korea ; Malpractice ; Negotiating ; Ophthalmology ; Refractive Surgical Procedures ; Retina ; Retrospective Studies

Although medical damage risks really exist, an effective medical risk sharing system is still not available in China right now. By analyzing the status quo of Chinese medical damage risks sharing system, the authors put forward the following suggestions to improve the current system: Upgrading the preventive strategy for medical disputes, establishing multi-level and multi-channel comprehensive medical damage risks sharing system, promoting the effective cooperation between insurance relief systems and mediation system for medical disputes, and constructing highly effective pathways to resolve the medical disputes.
China ; Dissent and Disputes ; Humans ; Insurance, Liability ; Malpractice ; Negotiating ; Risk Sharing, Financial