Basic ethical principles in dentistry

Ethical principles in medical profession originate from ancient times when Hippocrates has established basic principles of doctor’s ethics. Those are universal ethical principles, being actual till nowadays, but supplemented with new requirements. In this paper underlined were basic ethical principles for all dentists mandatory to follow

PROFESIONALNA TAJNA ZDRAVSTVENIH RADNIKA I RAZLOZI ZA NJENO OTKRIVANJE

The prevalent objective of the present article is to analyze reasons for disclosure of professional secret in health care, particularly that of physicians, and to evaluate whether such disclosure amounts to grave unconscionable conduct; what would the exceptions be from the duty to keep a secret and whether they are justified, from the point of view of our national and foreign legal theory, domestic and foreign law, Directive 95/24 EC on the protection of personal data, Directive R/97/5 on the protection of medical data, case law and professional rules in the medical profession. After the general legal issues about professional secret of health care workers are presented, reasons for its disclosure are observed in detail, with a special reference to case law of the British judiciary.Pretežan cilj ovog članka je da razmotri razloge za otkrivanje profesionalne tajne zdravstvenih radnika, pre svega, lekara, i da odmeri da li se ova otkrivanja svode na ozbiljno profesionalno nesaveno ponašanje; koji su izuzeci od dužnosti čuvanja profesionalne tajne i jesu li oni opravdani, i to kako sa stanovišta naše i strane pravne teorije, tako i sa gledišta našeg i stranog zakonodavstva, Direktive 95/24 EC o zaštiti ličnih podataka, Direktive R/97/5 o zaštiti medicinskih informacija, sudske prakse i staleških pravila medicinske profesije. Pošto se, najpre, izlože opšta pravna pitanja profesionalne tajne zdravstvenih radnika i prateća pravna regulativa, u daljem izlaganju opširno se razmatraju razlozi za njeno otkrivanje, sa posebnim ukazivanjem na odluke britanskih sudova

A bimanual manipulation technique for establishing the CR position

In this work, we demonstrate a modern concept of the cr position. We analyze main characteristics of the central relation position from mechanical and physiological aspects. Furthermore, we discuss the bimanual manipulation technique on the lower jaw, required for balancinh procedures or investigation of premature contacts. Since an effective manipulation technique requires a combination of gentle yet firm digital pressure in a cranial direction., with a good sense of timing, clinician needs to have ! a mental picture of what is happening in TMJs and how are muscles affected by different movements and pressure. We have specifically presented instructions on firm-digital-pressure test. With this test it is possible to effectively verify the consistency of a certain cr position as well as to exclude the intra-articulating problems. Most of the time when the patient is tense and uncooperative, it is because the pressure is applied on the mandibule before the lower jaw is gently positioned into its most cranial position with separate dental arches. It seems, at least for now, that there are no procedures which can provide so much practical benefit for both the clinican and the patient at the same time, as can routine registration of the cr position and verification of its accuracy

Testing the effectiveness of work in the Balint group in developing empathy and preventing the burnout syndrome of doctors

Ciljevi ovog istraživanja su bili ispitavanje da li je učestvovanje u Balint grupama povezano sa većim stepenom empatije i smanjenjem sindroma sagorevanja lekara, kao i ispitivanje psihometrijskih karakteristika upitnika za empatiju, Interpersonal Reactivity Index (IRI), uključujući lingvističku validaciju i kulturološku adaptaciju srpske verzije upitnika. Metod: Ovo istraživanje je obuhvatilo 210 lekara iz primarne zdravstvene zaštite. Od 210 lekara, 70 je završilo Balint edukaciju u trajanju od minimum godinu dana, dok 140 lekara nije pohađalo pomenutu edukaciju. Za svakog doktora sa završenom Balint edukacijom metodom slučajnog izbora izabrana su po dva lekara koja nisu završila ovu edukaciju, a koja rade u istom domu zdravlja i imaju istu poziciju (lekar opšte medicine ili specijalista). Kriterijumi za isključivanje iz studije za obe grupe lekara su bili sledeći: lekari koji su bili na bolovanju ili odmoru najmanje mesec dana pre prikupljanja podataka, koji su imali prekid u radu duže od jedne godine (usavršavanje u inostranstvu, dugotrajna bolest ili česte promene posla u poslednjih pet godina) i koji su bili izloženi većoj fizičkoj ili psihičkoj traumi van posla (bolest ili smrt u porodici, razvod, itd.). Za potrebe ovog istraživanja, konstruisan je opšti upitnik za ispitanike i korišćena su još dva dodatna upitnika, za ispitivanje empatije-Davisov „indeks interpersonalne reaktivnosti“ (IRI) i Maslach upitnik za procenu sindroma sagorevaja na poslu (MBI). U statističkoj obradi podataka su korišćene metode deskriptivne statistike, Studentov t-test, Pearson-ov hi-kvadrat test, Spearman-ov koeficijent korelacije, metode logističke i ordinalne regresije, Cronbach-ov koeficijent alfa, intraklasni koeficijent korelacije, kao i faktorska analiza. Rezultati: Preko tri četvrtine (82,9%) lekara u našem uzorku je bilo ženskog pola, dok je 17,1% ispitanika pripadao muškom polu. Srednja vrednost godina starosti ispitanika je iznosila 48,3±9,6 i kretala se od 30 do 65 godina. Lekari koji su završili Balint edukaciju su imali značajno veće skorove na subskalama Zauzimanje tuđeg stanovišta, Fantazija i Empatijska brižnost u odnosu na lekare koji je nisu završili, p<0,001. Što se tiče subskale Lična nelagodnost, nije bilo statistički značajne razlike između lekara ove dve grupe, p=0,530...The aim of our study was to examine whether the participation in Balint group is associated with a higher degree of empathy and reduced burnout syndrome amongst primary health care doctors, as well as testing the psychometric characteristics of empathy questionnaire, Interpersonal Reactivity Index (IRI), including the linguistic validation and cultural adaptation of the Serbian version of the questionnaire. Methods: This investigation was conducted on a population of 210 doctors employed in primary health centers in Belgrade. Of 210 doctors, 70 have completed Balint training for a period of at least one year, whereas 140 doctors have never attended this training (Non-Balint group). Each doctor who completed Balint education, was grouped with two other randomly chosen Non-Balint doctors, who worked at the same health center and had the same level of education (general practitioner or specialist). Exclusion criteria for both groups related to doctors on sick leave or holiday absence at least 1 month prior to the data collection period, who have not worked for more than 1 year (prolonged studies abroad, prolonged illness, or various and frequent changes in the workplace over the past 5 years), and with exposure to increased mental or physical trauma outside of work (death or disease in the family, divorce, etc.). For the purposes of this research, a general questionnaire was drafted and two additional questionnaires used, one to test the empathy-Davis' IRI and the other to measure the burnout-Maslach Burnout Inventory (MBI). The statistical analysis used descriptive statistics, Student’s t-test, Pearson's hi-square test, Spearman's correlation coefficient, logistic and ordinal regression methods, Cronbach alpha, intraclass correlation coefficient, and factor analysis. Results: Over three quarters (82.9%) of doctors in our sample were females, while 17.1% thereof were male doctors. The mean age of the respondents was 48.3 ± 9.6 and ranged from 30 to 65 years. Doctors who completed Balint education had significantly higher scores on subscales Perspective Taking, Fantasy and Empathic Concern compared to doctors who did not complete it, p<0.001..

Dužnosti pacijenta – evropski i anglosaksonski pravni sistem

Person requiring treatment measures from physician is also obliged to do everything possible to enable successful treatment. European legal theory considers patients’ duties to compliance as patients’ subsidiary contractual obligations, comparing to the obligation to pay the physicians’ fee. Patients’ compliance can’t be treated as a real legal obligation, but as the duty in his own interest. This obligation is owed, but it’s not actionable, nor can it be forced in other way. Duties in patients’ own interest are, in European legal theory, divided into two basic groups. Frist encompasses all duties which serve to the successful treatment and are “patients’ duties to comply”. Other group encompasses duties of the patient to reduce or remove damage that has already occurred. Anglo-Saxon theory considers the duties of the patient, very often, as the duties towards other patients, medical personnel and society, which provides free health care. By using the public funds (of health insurance, budget or other public resources), legally capable patients have the obligation towards society to act in an appropriate manner. Patients’ duties towards others, society and himself are, very often, in these systems, observed through the prism of the profitability of the patients’ treatment

Učešće pacijenata u donošenju odluka iz oblasti zdravstvene zaštite i zdravstvenog osiguranja

Participation of the patient in decision making does not arise from the principle of autonomy only as the right or duty, but is also the need of the patient to influence the decisions related to him. The participation in decision making is, therefore, necessary not only when relevant for patients own health, but also when relevant for the patients issues in general or for specific group of patients. In the last few decades, and specifically in the last decade, the effort has been made to introduce patient into decision making process on different health issues on macro and mezzo level, through different institutional forms. Results of these efforts are visible in developed European countries. However, initiations of democratisation in decision making process is also visible in the European countries which do not have very developed tradition of the patients’ rights protection

AKTUELNOSTI VEŠTAČENJA LEKARSKIH GREŠAKA U MEDICINI RADA

Sporovi vezani za postupanje lekara medicine rada izdvojili su se u pravnoj literaturi i postali su predmet jednog dela sudske prakse i njenih komentara. Sve slučajeve karakteriše određena medicinska pozadina i pravno poimanje odnosa lekara i zaposlenog koji se ispituje i koji nema uobičajeni položaj pacijenta. Naime, većinom se razmatraju situacije lekarskih pregleda kod zapošljavanja, periodičnih pregleda i ciljanih pregleda. Često su to pregledi po nalogu poslodavaca ili osiguravajućeg društva. Na primer, lekari medicine rada mogu obavljati fizičke preglede pre zapošljavanja ili se od njih može tražiti da procene stepen invaliditeta koji je pretrpeo oštećeni zaposleni u svrhu određenja naknade za rad. Sudovi su odlučivali o prirodi odnosa povodom takvih pregleda u okviru prakse medicine rada, gde opšte dužnosti proizilaze iz odnosa lekar-pacijent koji je sporazumni, odnosno i lekar i pacijent treba da imaju nameru da uspostave odnos. Neke od najčešće analizi - ranih presuda činjenično mogu biti drugačije, ali svakako pretpostavljaju lekarevo stručno i pažljivo postupanje. Cilj bližeg razmatranja preduzetih lekarskih postupaka, u smislu dužnog postupanja i zakonite prakse, jeste da se rasvetle sporne situacije u smislu odgovarajuće pravne zaštite, kako onog ko medicinski odgovorno postupa, tako i onog prema kome se postupa

Pacijentova prava kroz zakonodavne reforme - primer Nemačke

Despite advanced legal system and developed case law concerning institutions and mechanism for protection of patients’ rights in Germany, and after a fruitful debate regarding the need for the codification, the standpoint that it was necessary to adopt a special law on patients’ rights has prevailed. Germany promulgated a Law on Improvement of Patients’ Rights (2013), by inserting detailed new provisions into the German Civil Code (BGB). This Law is a part of wider legislative reform package introduced in German healthcare system over the previous years. Although the law is primarily aimed at physicians, its scope encompasses also other health care professionals involved in provision of healthcare services. The Act creates the medical treatment contract, governing every relationship between a person administering medical treatment and the patient. The adopted law also puts patients’ rights within a wider context, substantially covering somewhat differentiated legal spectrum. Patients’ rights’ were prior to the adoption of the law scattered across the range of legal instruments, causing a challenge for patients without medical and legal knowledge to use guaranteed rights and instruments for protection effectively. The previous regulation by the general rules of civil law has thus become in practice insufficiently clear and uncertain. In such a state of fragmented regulation of guaranteed individual rights there is a considerable degree of discrepancy between normative and practical realms. Regulation of medical malpractice and responsibility for damage to the human body and health also is partially covered by this law. In regulating the area, it is of utmost importance for a law to include governing legal principles, address human dignity, quality and safety of health care, information and autonomy, documentation, and rational and safe organization as well as the right to participate in decisions about treatment and healthcare system. From the perspective of comparative law, the German law now stands among the number of legal acts on patients’ rights of that have been adopted in numerous jurisdictions over the previous period. It can also serve as a model for other legislators, especially taking into account that it rep¬resents the latest examples reflecting general efforts at international and European level to improve protection of rights relating to human health through high standards of medical care and legal protection. It can also be of importance for the Serbian legislators, given the fact that codification of these rights also resulted in adoption of the Law on Patients’ Rights, but with a high level of dissatisfaction among stakeholders

Autonomija pacijenta – pravo na samoodređenje

Patient autonomy is at the core of all medical decision-making. It means that patients have the right and ability to make their own choices and decisions about medical care and treatment they receive, as long as those decisions are within the boundaries of law. There is a legal presumption that they are fit and competent to make those decisions until a court determines otherwise. Right to self-determination is considered as one of the most important and fundamental of all is patients’ right to direct the medical treatment they choose to receive or reject. It is provided to make patients better informed about many of their rights regarding treatment decisions. It underscores the role and importance of patient participation in healthcare decisions by clearly identifying the parameters of their decision-making authority. The result of the patient self-determination can be a focused interest on patient’s taking responsibility for the course of their healthcare decisions. The hope is that enlightened and prudent patients, guided by sound assistance in reflecting on their conditions, alternatives, and possibilities will make realistic decisions, within the context of their personal values. These decisions will then take the form of approaches to treatment which will truly benefit them and allow them to achieve their goals. The right of patients to consent to or refuse treatments is the basis of everything to be found in this law. This is an application of the basic liberty which all enjoy in a democratic society