LEGAL NORMS AND MEDICAL AUDIT OF ENDOSCOPIC TREATMENT

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  • 内視鏡治療における法的規範と医療評価

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Abstract

A physician has an obligation to appropriately carry out diagnosis and treatment by effectively utilizing his medical knowledge and skills, and to have the awareness that medical codes of ethics as well as related laws and regulations constitute the code of conduct to which physicians must adhere to in the daily performance of diagnosis and treatment. Endoscopic treatment is invasive, and, as such, there is a legal requirement for medical services to apply greater attention than it is required for general diagnosis and treatment. Informed consent is particularly important. At the root, there is legal accountability, which requires specific explanations on the suitability of treatment, selection of the method of treatment, effectiveness of treatment, complications, among others. A healthcare provider who does not provide sufficient explanation will be held legally liable, and, if a complication or an accident occurs, even when sufficient explanations were given, a healthcare provider's legal liability would be judged based on whether or not the response was sufficient to meet a standard of medical service.<BR>Medical audit in Japan is based on the methods used in the more advanced U.S. At present, however, the audit is performed mainly on the structure and process of medical services, and there is a need for audits on the more essential aspects of medical care, by using EBM-based clinical indicators in each field of specialization. For improvement in the quality of specialized medical services and for medical audit, clinical indicators on appropriate endoscopic examination and treatment need to be prepared. This should be considered through objective randomized controlled study. For preparation of clinical indicators for endoscopic treatment, it should be most appropriate for Japan Gastrointestinal Endoscopy Society (JGES) to fill the leadership role in conducting research and development.

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