Despite remarkable advances in medical technology, the increasing number of high-risk elderly patients and rising patient expectations have led to an increase in medical disputes in Korea. Internal medicine faces particularly high litigation risks owing to disease complexity and unpredictable outcomes, contributing to a decline in its attractiveness as a specialty. This study analyzed internal medicine disputes using the data from the Korea Medical Dispute Mediation and Arbitration Agency from 2020 to 2024. In 5 years, 1,468 internal medicine disputes were filed, representing 13.8% of the total disputes and ranking second after orthopedic surgery. Common causes included symptom deterioration (32.5%), delayed diagnosis (8.2%), and nerve injury (7.6%), with the highest frequency observed in patients aged 70-79 years. The average claimed amount was KRW 117 million, while the actual settlement averaged only KRW 11 million. The mean interval from incident to filing was 336.6 days. Korea's medical dispute system has evolved from requiring patients to prove negligence to imposing stronger explanatory duties on physicians based on reasonable probability. However, international comparisons reveal Korea's exceptionally high criminalization of medical practice, with prosecution rates approximately 15 times higher than those of Japan and 580 times higher than those of the United Kingdom. Current challenges, such as committee composition dominated by non-medical professionals, insufficient no-fault compensation, and low national health insurance reimbursement rates, are paradoxically driving litigation. Moreover, reforms are essential for sustaining essential medical services; hence, institutional improvements should include establishing objective advisory systems through medical societies, expanding no-fault compensation programs, and restricting criminal prosecution to gross negligence or intentional harm.a
Kim et al. (Mon,) studied this question.