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Hippocratic oath, written 4th or 5th century BC, is still the binding mantra for physicians, which swears to fulfill to the best of one's ability and judgement, and treat sick human beings not just illness. But with changing health trends in southeast Asia region, there is a dramatic shift in patients and patients' party expectations regarding treatment, recovery, complications, and death. Such expectations havelead to violence against physicians and shift towards alternative medical practice. This article explores the possible rise of defensive medicine and its broader implications in health care system in Nepal with regard to the new 'Muluki Aparadh Samhita Ain 2074/Criminal (Code) Act 2017'. Keywords: Changing health; criminal act; defensive medicine; muluki ain, Nepal.

INTRODUCTION: The term defensive medicine, referring to actions motivated primarily by litigious concerns, originates from the USA and has been used in medical research literature since the late 1960s. Differences in medical legal systems between the US and most European countries with no tort legislation raise the question whether the US definition of defensive medicine holds true in Europe. AIM: To present the protocol of a systematic review investigating variations in definitions and understandings of the term 'defensive medicine' in European research articles. METHODS AND ANALYSIS: In concordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a systematic review of all medical research literature that investigate defensive medicine will be performed by two independent reviewers. The databases PubMed, Embase and Cochrane will be systematically searched on the basis of predetermined criteria. Data from all included European studies will systematically be extracted including the studies' definitions and understandings of defensive medicine, especially the motives for doing medical actions that the study regards as 'defensive'. ETHICS AND DISSEMINATION: No ethics clearance is required as no primary data will be collected. The results of the systematic review will be published in a peer-reviewed, international journal. PROSPERO REGISTRATION NUMBER: This review has been submitted to International Prospective Register of Systematic Reviews (PROSPERO) and is awaiting registration.

Hippocratic oath, written 4th or 5th century BC, is still the binding mantra for physicians, which swears to fulfill to the best of one's ability and judgement, and treat sick human beings not just illness. But with changing health trends in southeast Asia region, there is a dramatic shift in patients and patients' party expectations regarding treatment, recovery, complications, and death. Such expectations havelead to violence against physicians and shift towards alternative medical practice. This article explores the possible rise of defensive medicine and its broader implications in health care system in Nepal with regard to the new "Muluki Aparadh Samhita Ain 2074/Criminal Code Act 2017".

El riesgo de judicialización de la medicina es inherente al desempeño de cualquier actividad que se realice en el ejercicio de la profesión médica, por lo cualquier médico se encuentra permanentemente expuesto a la realización de actos susceptibles de calificar por su resultado dañoso, de culposos y que por ello den lugar a una reclamación ante los entes de justicia. En las últimas décadas es habitual, también que, en nuestro país, que muchas decisiones médicas sean sometidas al escrutinio judicial por diversas causas, como lo son la falta de normas concretas en el derecho, o por equívocas interpretaciones de la normativa legal existente o por desconocimiento del progreso tecno-científico o de la realidad médica, o en muchas ocasiones también la desmesurada e injustificable actitud médica miedosa y desconfiada, conducen a la provocación de una medicina defensiva por omisión que resulta gravemente perjudicial para la sociedad. Esta conducta contribuye al desmantelamiento de la profesión médica que, ya se encuentra sometida a la gravosa situación del sistema de salud nacional que no cumple adecuadamente su finalidad de cuidar a la salud de sus congéneres. ; The risk of prosecution medicine is inherent in the performance of any activity performed in the exercise of the medical profession, so any doctor is permanently exposed to the realization of susceptible acts to qualify for their harmful result of culpable and thus giving rise to a complaint to the justice authorities. In recent decades usual, also in our country, many medical decisions are subject to judicial scrutiny for various reasons, such as lack of specific rules on the right, or misinterpretations of the existing legislation or lack of techno-scientific progress or medical fact, or in many cases also the disproportionate and unjustifiable fearful and distrustful medical attitude, leading to the provocation of defensive medicine default that is seriously damaging to society. This behavior contributes to the dismantling of the medical profession, and is subject to the difficult situation of the national health system not adequately fulfill its purpose of caring for the health of their peers. ; 1-20 ; jcaraujoc_65@hotmail.com; jcaraujoc95@gmail.com ; semestral

We describe an exemplary case of inadequate health legislation and defensive medicine, regarding umbilical cord tissue collection for personal "private" use.

La mediación en el cuidado de la salud es un proceso no contencioso para resolver una disputa entre pacientes y proveedores de servicios de salud durante la atención médica Objetivo: Caracterizar el proceso de mediación que tiene lugar en el sistema de salud pública en Chile, desde su inicio hasta 2017. Material y métodos: Cruz estudio descriptivo seccional. De conformidad con la Ley de Transparencia, se solicitó información sobre los procesos de mediación entre 2005 y 2017 al Consejo de Defensa del Estado (CDE). Estos datos se complementaron con la información disponible en el sitio web de esta agencia. Resultados: Noventa y cuatro por ciento de las denuncias presentadas en el CDE fueron consideradas elegibles para mediación. Solo el 19% de los casos concluidos condujeron a un acuerdo entre las partes contendientes. Los acuerdos alcanzados fueron principalmente compensación monetaria, asistencia médica, y disculpas / explicación de los hechos. El monto promedio de compensación alcanzó $ 14,862,088 (pesos chilenos). El daño más comúnmente reclamado como resultado de la atención médica fue la discapacidad parcial. Las especialidades médicas más frecuentemente reclamadas fueron Obstetricia y Ginecología, Cirugía general y Medicina interna. Conclusiones: El análisis de las mediaciones realizadas es una fuente de retroalimentación para el personal de salud y las instituciones de salud. Contribuiría en gran medida a prevenir posibles daños y conflictos médicos, especialmente dentro de las especialidades con más quejas. Se requieren mejoras en la legislación existente para garantizar el libre acceso a toda la población. Las especialidades médicas más frecuentemente reclamadas fueron Obstetricia y Ginecología, Cirugía general y Medicina interna. Conclusiones: El análisis de las mediaciones realizadas es una fuente de retroalimentación para el personal de salud y las instituciones de salud. Contribuiría en gran medida a prevenir posibles daños y conflictos médicos, especialmente dentro de las especialidades con más quejas. Se requieren mejoras en la legislación vigente para garantizar el libre acceso de toda la población. Las especialidades médicas más frecuentemente reclamadas fueron Obstetricia y Ginecología, Cirugía general y Medicina interna. Conclusiones: El análisis de las mediaciones realizadas es una fuente de retroalimentación para el personal de salud y las instituciones de salud. Contribuiría en gran medida a prevenir posibles daños y conflictos médicos, especialmente dentro de las especialidades con más quejas. Se requieren mejoras en la legislación vigente para garantizar el libre acceso de toda la población. ; Mediation in healthcare is a non-adversarial process to resolve a dispute risen between patients and health providers during medical attention Aim: To characterize the mediation process taking place in the public health system in Chile, from its start until 2017. Material and Methods: Cross-sectional descriptive study. Under the Transparency Law, information about mediation processes between 2005 and 2017 was requested to the State Defense Council (CDE in its Spanish acronym). This data was complemented with the information available on the website of this agency. Results: Ninety four percent of the complaints filed at the CDE were deemed eligible for mediation. Only 19% of the concluded cases led to an agreement between the disputing parties. The agreements reached were mostly monetary compensation, medical assistance, and apologies/explanation of the facts. The average amount of compensation reached $14,862,088 (Chilean pesos). The most commonly claimed damage resulting from medical care was partial disability. The medical specialties more often claimed were Obstetrics and Gynecology, General Surgery, and Internal Medicine. Conclusions: The analysis of conducted mediations is a source of feedback for healthcare staff and health institutions. It would greatly contribute to prevent possible damage and medical conflicts, specially within the specialties with the most complaints. Improvements to the existing legislation are required to ensure free access for all the population.