Tokat ili merkezinde çalışan hekimlerin tıbbi uygulama hataları ile ilgili bilgi, tutum ve davranışları

Ozet Amac. Hekimlerin mesleki uygulamalari sirasinda meydana gelen tibbi uygulama hatalari ile ilgili ozel bir duzenleme ulkemizde henuz yururlukte bulunmamaktadir. 5237 Sayili yeni Turk Ceza Kanunu hekimlerin tibbi uygulama hatalarindan dolayi sorumluluklarini tanimlayan ozel kavramlari icinde barindirmaktadir. Turk Ceza Kanunu'nda ki "Bilincli taksir" ve "olasi kast" gibi yeni kavramlar tip meslegi baglaminda belirsizliklere yol acmakta ve hekimlerin bu konuda kaygi hissetmelerine neden olmaktadir. Bu calismada hekimlerin tibbi uygulama hatalari ile ilgili bilgi ve tutumlarini, konu ile ilgili olarak ulkemizde yargi sisteminde yururlukte olan duzenlemeler hakkindaki bilgi duzeylerini ve mesleki mali sorumluluk sigortasi hakkindaki tutumlarini tespit etmeyi amacladik. Yontem. Tokat Il merkezinde hizmet veren Universite Uygulama ve Arastirma Hastanesi, Devlet Hastaneleri ve Saglik Ocaklarinda calisan 540 hekimden tabakali orneklemle 135 (% 25) hekim calismaya davet edilmistir. Orneklemin % 92,6'sina ulasilarak aktif gorevde bulunan ve gonullu olarak anketi cevaplamayi kabul eden 125 hekime tibbi uygulama hatalari ile ilgili yasal duzenlenmeler ve mesleki mali sorumluluk sigortasi hakkinda bilgi ve tutum degerlendirmeyi amaclayan 21 soruluk bir anket uygulanmistir. Bulgular. Calismaya katilan 125 hekimin %68,8'i erkek, %31,2'i kadin ve mesleki deneyim suresi 9,5±6,8 yil olarak tespit edilmistir. Katilimcilarin %49,6'si uzman hekim, %30,4'u asistan hekim ve %20'si pratisyen hekim olarak hizmet vermekteydi. Arastirmaya katilan hekimlerin %60'i tibbi uygulama hatalari ile ilgili mevcut yasal duzenlemeler hakkinda yeterli bilgilerinin olmadigini ifade etmislerdir. Tibbi uygulama hatalarinin en sik nedeni %26,9 ile "Tip egitiminde yetersizlik" olarak ifade edilmistir. Baskasinin tibbi uygulama hatalarini "hic kimseye soylemem" diyenlerin orani %5,2 iken, kendi yaptigi tibbi uygulama hatalarini "hic kimseye soylemem" diyenlerin orani %14 olarak bulunmustur. Tibbi uygulama hatalarina karsilik mesleki mali sorumluluk sigortasi olmayan hekim orani %98,3 oraninda bulunurken, katilimcilarin %43,7'si tibbi uygulama hatalarina yonelik mesleki mali sorumluluk sigortasinin hekimleri koruyacagina inanmaktadir. Sonuc. Tibbi uygulama hatalari konusunda tip egitimi surecinde ve mezuniyet sonrasi egitim programlari ile hekimlerin bilgilendirilmesi konu hakkindaki farkindaligin artmasini ve yasanacak muhtemel sorunlarin azalmasini saglayacaktir. Anahtar sozcukler: Tibbi uygulama hatasi, mesleki mali sorumluluk sigortasi, hekim, ceza kanunu. Abstract Aim. There are not any specific regulations on malpractice among physicians in Turkey. The new Turkish Criminal Code No. 5237 involves specific terms defining physicians' liabilities regarding malpractice. New terms in Turkish Criminal Code such as "probable negligence" and "deliberate negligence" bring about uncertainties in medical practice and cause physicians to feel anxious about it. The aim of this study was to investigate knowledge of malpractice and current regulations for malpractice in Turkey and attitudes towards malpractice and professional liability insurance among physicians in Tokat, Turkey. Methods. Using stratified sampling, we invited 135 out of 540 physicians (25%) working at the university hospital, government hospitals and primary health care centers in Tokat. 92.6% of the sample was contacted and informed consent was obtained from 125 physicians. Data were collected with a questionnaire composed of 21 questions about knowledge of and attitudes towards regulations for medical malpractice and professional liability insurance. Results. Out of 125 physicians, 68,8% were male and 31,2% were female and the mean duration of occupational experience was 9,5±6,8 years. Forty-nine point six percent of the participants were specialist, 30,4% were research assistant and 20% were general practitioner. Sixty percent of the physicians did not have sufficient knowledge of current regulations on malpractice. The most frequent cause of malpractice was low quality medical education (26,9%). Five point two percent of the physicians noted that they would keep other physicians' malpractice secret and 14% noted that they would keep their own malpractice secret. The rate of the participants who did not have professional liability insurance was 98,3%. However, 43,7% of the participants believed that professional liability insurance would protect physicians regarding medical malpractice. Conclusion. Medical curricula and in-service training programs should offer knowledge of malpractice and increase awareness of malpractice among physicians to avoid potential malpractice cases. Keywords: Medical malpractice, professional liability insurance, physician, criminal code