Article 1
How do clinicians avoid disputes between doctors and patients
In recent years, with the continuous advancement of medical reform, patients gradually have higher requirements for medical quality, and their legal awareness of medical rights and medical care is also increasing, and the requirements for doctors are also gradually improving. Doctor-patient dispute is a common doctor-patient relationship in clinical medical work. This paper will analyze the common disputes between doctors and patients in clinical medical work, and then analyze the causes and put forward corresponding countermeasures, so as to improve the quality of clinical medical work and establish a harmonious relationship between doctors and patients.
Key words: clinician; Medical disputes between doctors and patients
In clinical medical work, doctors are medical workers who have more contact with patients and are also direct participants in medical activities. Due to doctors' lack of legal awareness, poor skills and weak sense of responsibility, disputes between doctors and patients often occur. The occurrence of doctor-patient disputes may bring trouble to medical work, but it may also have a great impact on patients' health and even endanger their lives. Therefore, in clinical medical work, fully aware of the easily occurring disputes between doctors and patients and taking effective preventive measures can effectively reduce the occurrence of disputes between doctors and patients and improve the quality of clinical medical work.
1 Common disputes between doctors and patients in clinical medical work
Doctor-patient disputes caused by sloppy work and weak sense of responsibility;
Disputes arising from lack of communication between doctors and patients, or inattention to language and methods during communication;
The doctor's service attitude is blunt and cold, which leads to disputes between doctors and patients;
Disputes arising from the failure to record the medical work process in time;
Disputes caused by neglecting to protect patients' privacy in medical work;
Disputes arising from failure to discover and eliminate potential safety hazards in medical work in time;
The use of drugs and instruments is not safe enough, and patients can't get timely treatment when they have accidents, which will delay their illness and even cause disputes because of their death.
2 causes of disputes between doctors and patients in clinical medical work
Doctors are weak in legal awareness and lack of responsibility. With the continuous improvement of China's legal system, universal legal education has gradually enhanced people's legal concepts. However, there are still some doctors who lack legal awareness and self-protection awareness, do not pay attention to their words and deeds in their work, and do not know enough about the right to know of patients and their families; Lack of awareness of protecting patients' privacy; There are illegal operations at work; Due to the weak sense of responsibility, the course records are incomplete; In the process of rescuing patients, we don't pay attention to occasions and methods; Lack of appropriate protective measures for elderly patients who need special care and patients with mental symptoms leads to patients falling out of bed or other accidents and disputes between doctors and patients.
Lack of effective communication. Humanized management concept is gradually recognized and accepted by people in modern society. In medical services, people-oriented humanistic medical concept has also been widely introduced into medical work. When patients are admitted to the hospital, they want to see the smiling faces of medical staff, not the cold faces. Because of the heavy workload, doctors often ignore the communication with patients, have a cold attitude towards patients, lack patience, and speak in a blunt tone, which will cause dissatisfaction among patients and their families and lead to disputes between doctors and patients.
The management system is not perfect and the system implementation is not strict. Medical work is facing the safety of human life. In clinical medical work, some doctors only rely on experience to judge the patient's condition and do not follow the rules and regulations, which leads to disputes between doctors and patients. This mainly includes the following aspects: First, prescribing the wrong medicine is not serious enough; Second, the handover time is not clear, and the condition is not clearly conveyed during the handover; Third, poor observation, careless observation of the patient's condition changes, when the patient's condition worsens, can not be found in time, miss the best rescue opportunity; Fourth, inadequate preparation for the rescue of critically ill patients leads to serious deterioration or even death of patients, which is the most serious situation in the dispute between doctors and patients.
Medical technology is not too hard and the work is not meticulous enough. Some medical staff, especially doctors who have just joined the medical team, lack solid theoretical knowledge and practical experience in medical work, so they are often in a hurry in case of emergency, which affects the rescue of patients. In addition, the instrument operation was not carefully counted, which led to the phenomenon that the instrument was left in the patient's body.
The bad attitude of medical staff caused patients' dissatisfaction. Although China has strengthened the quality training of medical staff, there are still some medical staff with low quality. Some doctors are busy with all kinds of medical activities, ignoring the care and friendly service for patients, being unfriendly to patients and impatient with patients' inquiries, which leads to patients losing confidence in high-quality medical work and leading to disputes between doctors and patients.
Reasons from patients and their families. Because some patients and their families lack medical knowledge, they also don't understand the management system of the hospital. For example, in order to provide patients with a quiet and clean rest environment, the hospital has made regulations on the system of visiting and accompanying, and some patients' families have unreasonable quarrels with medical staff because of lack of understanding or bad motives, which leads to disputes between doctors and patients.
3 Measures to prevent and strengthen disputes between doctors and patients
Enhance doctors' awareness of law and self-protection. Clinical medical work has its unique characteristics, so it is very necessary and necessary to carry out some legal and safety management education. Combined with the actual situation of the hospital, from the perspective of managers, this paper analyzes the hidden dangers in the ward, guides doctors to eliminate possible problems in the medical process, protects themselves with legal weapons, and reduces or avoids disputes between doctors and patients.
Operate in strict accordance with the specifications. Medical operating rules and various normative systems are summarized through long-term clinical medical practice, which are systematic and scientific to some extent. If the doctor can't follow the operating rules, it will bring harm to the patient or the patient. Therefore, in medical work, we should strictly abide by the operating rules and strictly control every link in medical work to avoid disputes between doctors and patients.
Strengthen communication between doctors and patients and provide quality medical services. Doctors should always integrate humanized medical concept into medical work, treat patients warmly and sincerely, protect patients' privacy, and reduce disputes between doctors and patients caused by careless words and deeds. At the same time, doctors should constantly improve their professional quality, not only have a solid theoretical foundation, but also have superb practical experience, gain the trust of patients, improve the level of medical work and avoid disputes between doctors and patients.
Improve the management level of doctors. The main causes of doctor-patient disputes can be summarized as follows: first, doctors are not responsible enough, and second, they have insufficient work experience. Therefore, the hospital should strengthen the management of doctors, adopt a scheduling system in which new and old doctors cooperate with each other, and exchange work experience in time, so that new doctors can be competent for medical work as soon as possible. At the same time, it is necessary to study doctors' ideological and moral education regularly, enhance doctors' sense of responsibility, always take humanistic nursing concept as the guiding ideology in medical work, continuously improve the quality of medical work, enhance communication between doctors and patients, and establish a harmonious doctor-patient relationship.
refer to
[1] Wu Mingju, Zhu Minnan. Causes of nurse-patient disputes and preventive measures [J]. China Journal of Misdiagnosis, 2009, ***02***
the second
Talking about the Innovation of Clinicians
Medicine is a science that is still being explored, and people's understanding of themselves and diseases is still in the "childhood stage". Facing the unknown medical world, doctors can acquire or discover new knowledge only by continuous exploration. A medical history, full of exploration and discovery, has made today's medicine. The medicine that our clinicians are studying, understanding, mastering and applying now, whether it is western medicine or Chinese medicine, whether it is internal medicine or surgery, whether it is surgery or medicine, has been explored, discovered and revealed by countless pioneers of "Medical Columbus". The starting point of exploration and discovery is sometimes clear and sometimes vague, but it will never end.
There are many unknown problems in the case and diagnosis and treatment of clinicians. With questions, they ask for documents, consult teachers or colleagues, participate in consultation and discussion, post online for help, and try their best to find solutions through various channels. This is exploration. Found the root and mystery of the problem, found a new and good diagnosis and treatment technology, method or operation, and even a small innovative invention, that is, discovery. It seems ordinary, but it profoundly reflects the thinking and cognitive process of scientific activities, aiming at finding objective things or laws and helping doctors overcome diseases.
However, everything has two sides, and exploration means taking risks. In recent years, the relationship between doctors and patients in China is tense. Doctors wear helmets and tanks to practice medicine, and their awareness of self-protection is getting stronger and stronger. They shouldn't have surgery, they shouldn't take risks and they shouldn't innovate. Clinicians do not seek merit, but seek nothing, preferring to be "Dr. Taiping". In the era of harmonious doctor-patient relationship, doctors' mistakes can often be understood by patients, prompting doctors to spare no effort to treat patients, thus accelerating the progress of medicine. For the current tense doctor-patient relationship, most clinicians are full of contradictions and anguish. We hope to explore the medical restricted area, but we are also afraid that patients will make trouble unreasonably, so that the original simple medical problems will eventually rise to legal disputes. To this end, many doctors have to choose "inaction".
A generation of famous doctor Zhang described China's caution in medical practice as "walking on thin ice". The patients faced by doctors are very different, and there is always the possibility of making mistakes in the process of diagnosis and treatment. Therefore, some doctors lamented that if every medical process is analyzed in reverse, most of them can find some shortcomings in the treatment process. For this reason, the American Medical Association published the famous announcement "To err is human" in 1999, pointing out that the public must realize that doctors are human beings and make mistakes, and it is unfair to blame doctors for all medical defects. According to some data, even in western countries with developed medical technology, the incidence of medical defects is still as high as 10% ~ 15%, which is more than the number of deaths caused by some malignant diseases.
At present, we still lack a rational attitude towards medical defects, and doctors have a neurotic taboo about their own medical defects. At the same time, China lacks feasible ways to deal with medical defects. There is a set of compensation standard to appease family members in plane crash, but there is no clear compensation standard for medical defects, so disputes and sky-high compensation in medical disputes often appear in newspapers, which further intensifies the escape of medical personnel from medical defects.
In this way, when faced with patients' doubts, medical ethics and rules are left behind, and medical records are modified to "save lives". And the doctor's "inversion of burden of proof" stipulated by Chinese law also puts our doctor at a disadvantage. Moreover, the affiliation between doctors and hospitals at present makes the fault of doctors become the fault of hospitals. Once compensation occurs, hospitals generally need to bear the brunt. In this case, the hospital will spare no effort to create conditions for doctors to modify medical records, and even urge and guide doctors to modify medical records.
Comparatively speaking, the management mode of independent practice of foreign doctors is more reasonable. In many countries, although doctors have a working relationship with some hospitals, their interests are independent and directly linked to insurance companies. Patients go to the insurance company for reimbursement, including medical defects, and the insurance company may also pay the bill.
However, once the doctor is often complained by the patient and the compensation exceeds a certain amount, the insurance company may terminate the contract with the doctor. Once the doctor loses the support of the insurance company, it means that the patient will not be reimbursed by the insurance company, so few patients will look for him, and it is difficult for him to sign a work contract with the hospital. This mode of doctors taking responsibility by themselves can not only enhance doctors' sense of responsibility, but also prevent hospitals and doctors from playing tricks on patients because of their interests. In the face of medical defects, how to make doctors relatively independent should be a serious problem in current medical reform.
Failure is possible without mistakes, and failure does not mean success. Is no mistake equal to perfection? Of course, the answer is no, what's more, there is no doctor who never makes mistakes. This "inaction" of doctors not only hinders medical progress, but also harms the fundamental interests of patients. What should doctors do? What should medicine do?
The profession of doctor is very special. Because life is a matter of life, the requirements for this profession are higher. Taking undergraduate courses as an example, the academic system of regular medical universities is one year longer than that of ordinary universities. After graduation, you have to be a resident for a long time and practice for a long time before you can really become a doctor. However, being a doctor is a high-risk profession. In addition to people may die because of poor medical skills or negligence, misunderstandings from patients' families are also extremely serious. Because doctors are in contact with patients, and no patient doesn't want to get better as soon as possible, doctors can't guarantee that every patient will get better as soon as possible. In this way, there is bound to be friction between doctors and patients. It is often heard that doctors in a hospital are attacked by patients' families. Many doctors who were attacked should be innocent. It's not that they don't want to cure the patient, but that there is nothing they can do. It's not that the doctor is weak, but that the patient is terminally ill.
Medicine has great limitations, because the characteristic of medicine is to study human beings, and the unknowns of human beings are the most. The limitation of medicine lies in the limitation of cognition, which is relative, perhaps one-sided, and later wrong. So will medical principles. Science will not say "I know everything". Science only knows part of it. "A cure for all diseases" is definitely a lie. Doctors must leave room for their patients. Everything can be cured, that is, nothing can be cured; Without any side effects, it is ineffective. The limitations of medicine also lie in the limitations of methods. 100 years ago, there was no blood transfusion, no antibiotics and no real anesthesia. Diseases are beyond human conquest. They are always waiting for an opportunity to fight back, or "improve their level" and push mankind into a trap.
Doctors should pay attention to the patient's experience, not just the process of the disease itself. Treatment doesn't mean curing a disease, sometimes it means caring and relieving pain. In April 2004, the British Medical Journal published a passage: For some "diseases", there are at least 60 kinds of * * * *, and there is no need to take any measures to treat them, and there is no conclusive evidence to prove that any measures are effective. Maybe no treatment is better than treatment, and maybe the best way is no treatment.
Medical treatment is also risky, because the characteristic of medical treatment is to diagnose and treat the acquired human body. There are the following risks in medical treatment: diagnostic risks: misdiagnosis and accidental injury. Drug use risks: toxic and side effects, dose tolerance differences, allergies. Surgical risks: anesthesia, bleeding, injury, infection. The risk lies in the complexity of the disease, the limitation of knowledge, the obstruction of skills, and the lack of responsibility and experience. Medical treatment is a service industry, but it is also a special and risky service. Medicine is a broken car driving on the highway. Various media and radio stations push medicine to embarrassment, leaving doctors helpless. The doctor's hand trembled cautiously. Doctors can only use such expressions as "try their best" and "try their best" to understand.
As a clinician, we should have a scientific spirit and contribute to patients. If a doctor is unwilling to take risks, he can only become a mechanic who repairs machines, not a master of medicine. The doctor's adventurous spirit comes not only from the pursuit of truth, but also from his feelings for patients. People's hearts are all flesh. As long as the doctor is affectionate, the patient is reasonable. Of course, it is also conditional for patients to understand doctors. Clinically, although misdiagnosis is objective, doctors can't use it as an excuse to ignore the dignity of life and let patients make unnecessary sacrifices and suffer unnecessary pain at will. Patients can tolerate normal mistakes, but they can't tolerate mistakes caused by perfunctory and disregard for human life.
China's ancient politicians and philosophers said, "Be reasonable and conform to national laws". So is being a doctor. For doctors, the laws of nature are the laws of nature, the occurrence and development of diseases. Human feelings are people's thoughts, consciousness, emotions and wishes. National laws are the principles, norms, technical routes, methods, skills and policies of diagnosis and treatment. The essence of clinicians' exploration in daily diagnosis and treatment is to eliminate mistakes, make continuous progress and serve patients. "Patients worry first, patients are happy later" fully embodies the spirit of truth, goodness and beauty of medical kindness, which is deeply rooted in modern medical staff. No matter how the times and social environment change, it is still the mainstream of China medicine.
Science is not everything. Knowledge is infinite, but our cognitive level and exploration scope are always very limited. The diagnosis and treatment of diseases should follow two principles: scientific principle and humanistic principle. The scientific principle is aimed at the disease, and the principle of scientific caution should be adopted in the pathology, physiology, treatment method and technical route of the disease; Humanistic principle is aimed at people's feelings, and it is necessary to take humanistic care of patients' psychology, will, quality of life and personal and family requirements.
The current medical model is: biological-psychological-social. Doctors should integrate science and humanities: have a complete knowledge base, excellent and prosperous thinking quality, effective working methods, harmonious relationship and healthy physical and mental state. It is very important for doctors to communicate with patients and their families. Communication is the key link in diagnosis, treatment, medical development and prevention of medical disputes, and it is also the embodiment of medical ethics. Clinicians in the new era must be careful observers, patient listeners and keen communicators.
The road of exploration and discovery by clinicians is a road of clinical medical research, a road of integrating theory with practice, seeking truth from practice and achieving nature. The soil of clinical scientific research lies in the cases and medical records of clinical diagnosis and treatment. The key is to be good at finding problems, to have thinking and academic sensitivity, to study and explore while grasping problems, and to be creative in exploration. The exploration and discovery of clinicians in their work is a narrow path that goes deep into the clouds, which requires us clinicians to have a persistent dedication, a career, a keen thinking wisdom and an action habit, not for utilitarian purposes, but for the selected goals and missions. It is the patients who really improve the ability and wisdom of doctors.
The patient is the exhibitor of pathological phenomena. Only in this way can the doctor's eyes shine with wisdom in front of patients, not in books. The patient is the doctor's real teacher. Need to learn and improve their majors and skills. Humanistic cultivation and philosophical thought are fundamental and lifelong. Don't confine yourself to a narrow field, we need to learn more knowledge.
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