Medical dispute refers to the occurrence ofmedical service、medical diagnosis 、medical care、Medical cosmetology、medical recordWrite the disputes between legal persons or institutions of medical enterprises and institutions with legal qualifications and patients.Medical disputes in China are particularly difficult to deal with.
One party (or multiple parties) believes that the other party (or multiple parties) is providing medical services or performingStatutory obligationsandContractual obligationsWhen there is fault, causingActual damageThe consequences shall be borneLiability for breach of contractortort liabilityHowever, the two parties (or multiple parties) have different understandings of the disputed facts, dispute with each other, and hold different opinions.
Medical dispute refers to a medical dispute between the doctor (medical institution) and the patient (patient or patient)Close relatives）Between the treatment plan andTreatment resultsDisputes caused by different perceptions.
Cause
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Medical disputesIt is usually caused by medical fault and negligence.Medical negligenceIt is the fault of medical staff in the process of diagnosis and nursing.Medical fault refers to the fault of medical personnel in medical activities such as diagnosis, treatment and nursing.These faults often lead to patients' dissatisfaction or harm to patients, thus causing medical disputes.
In addition to medical disputes caused by medical faults and negligence, sometimes, the medical side has no negligence and mistakes in medical activities, and disputes can also be caused simply because of the patient's unilateral dissatisfaction.This kind of dispute can be caused by the lack of basic medical knowledge of the patientMedical treatment, SickNatural reversionAnd unavoidablecomplicationAs well as medical accidents caused by not understanding, it can also be caused by patients' unreasonable censure.Some people also call it medical treatmentInfringement disputes, i.emedical serviceProviders andrecipientThere are disputes over whether the medical behavior and its consequences are tort and tort liability.
On February 24, 2016, the medical administration of the National Health and Family Planning CommissionHealth AdministrationIntroduction: In 2015Person time of diagnosis and treatmentThe number of medical disputes has continued to decline with the increase of medical disputesMedical troubleThe overall trend of events is decreasing.According to preliminary statistics, in 2015people's mediationSeventy one thousand disputes were settled, and the success rate of mediation was more than 85%. In 2015, the number of medical disputes continued to decline with the increase of the total number of diagnosis and treatment.
When medical disputes occur between doctors and patients, they can choose tort liability or liability for breach of contract to require the other party to assume liability.
Medical fault,[2]It is a kind of fault.There is a distinction between the old and the new fault theories in the judgment of fault.The so-called old fault theory refers to the comparison of fault and intention, and believes that both fault and intention belong to the subjective malice of the actor who should be punished.Intention is positive malice, and negligence is negative malice.If there is a considerable causal relationship between the behavior and the result, and the actor has the possibility to foresee the result, and should have foreseen but did not foresee or should have paid attention but did not pay attention, that is to say, he should be liablefault liability。The new fault theory believes that fault not only refers to the fault that should be punishedmentalityWe should also consider and judge whether the objective state of the behavior is appropriate.That is, in addition to the causal relationship between the behavior and the result and the foreseeable possibility, it is also necessary to examine whether the behavior is objectively wrong.As far as the specific medical fault is concerned, the judgment of whether the doctor has made a mistake should be based on whether the doctor has made an objectiveDuty of careIt is the standard, that is, whether to take appropriate measures to avoid the consequences should be judged.Based on the new fault theoryrationality, this theory has been widely confirmed.This requires that when discussing the determination of medical fault, the special medical behaviorJudgment criteriaGive an accurate understanding.
Solutions
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medical carecivil disputeLike other civil disputesequal subjectsBetweenProperty relationsandPersonal relationship, which belongs to the adjustment scope of civil law.According to“Autonomy of private law”Under normal circumstances, the state does not intervene, so both parties can negotiate on medical disputes, or conduct civil mediation andadministrative mediationIn theory, medical contract disputes can also be settled by arbitration, but arbitration is still ignored.The state's intervention in medical civil disputes is shown ascivil action, which can only happen if the parties sue.You can also applyHealth administrative departmentsolve.
The CPC Central Committee and the State Council attach great importance to the prevention and handling of medical disputes.In order to fully bring the prevention and handling of medical disputes into the track of rule of law and protect both doctors and patientsLegal rights and interests, maintain medical order and guaranteeMedical safetyThe State Council formulated these Regulations to promote the legal prevention and proper handling of medical disputes from the institutional level, focus on building a harmonious doctor-patient relationship, and promote the sustainable and healthy development of China's medical and health services.
《regulations》It clearly pointed out that the diagnosis and treatment activities should focus on patients, strengthen humanistic care, strictly abide by relevant laws and norms, and strictly abide by professional ethics.By strengthening the daily management of medical quality and safety, strengthening the risk prevention and control of key links and fields of medical services, highlighting the importance of communication between doctors and patients in medical services, and preventing medical disputes from the source.
The Regulation clarifies the principles, ways and procedures for handling medical disputes, and emphasizes the role of people's mediation in resolving medical disputesAppraisal standard, procedures and expert database, etcIdentification of medical damageActivities.
One misunderstanding: medical disputes are equal to medical accidents
Medical accident refers to the death, disability and tissue and organ damage of patients directly caused by medical staff's fault in diagnosis, treatment and nursingdysfunctionOf.The medical dispute usually refers to the event that the doctors and patients have different opinions on the diagnosis, treatment and nursing results and their reasons, and the party concerned proposes to investigate the responsibility or economic compensation, which must be settled through administrative or legal mediation and adjudication.
Myth # 2: When a patient enters a hospital, he or she enters the hospital“Safe Deposit Box”
Medical disputes caused by new technologies, new equipment and new therapies are also gradually emerging. While people enjoy modern civilization, they also increase the risk of damage.The best doctor can't cure all diseases. A patient's admission to a hospital is not equal to a "safe deposit box".
Among the numerous medical disputes, some have constituted medical accidents, which shall be implemented in accordance with the Measures for Handling Medical Accidents issued by the State Council and formulated by various localitiesdetailed rules and regulationsIn accordance with the provisions of, one-time economic compensation will be given to those identified as medical accidents.
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① The number increases year by year:Many medical complaints, requiring medical treatmentTechnical appraisalMore, requiredDisability appraisalMore, simultaneouslynews mediaParticipation also increased;
③ The amount of compensation increases:The final result of medical disputes is often to ask the hospital for economic compensation. As long as there are adverse circumstances for the hospital, especially when the evidence cannot be provided, patients and their families will make a lot of noise and ask for compensation. The more the amount, the better;
④ Increased difficulty in handling:Most medical accidents and medical disputes have complex causes and are relatedlaws and regulationsIt is not perfect, and people from all walks of life generally believe that patients aredisadvantagedIt should be specially protected, so it is very difficult to deal with;
⑤ Increased social impact:In particular, some medical accidents and medical disputes are repeatedly reported toHealth administrative department、judicial departmentsThe hospital's reputation was greatly damaged by complaints from relevant media, as well as some media's lack of medical knowledge, ignorance of the truth and blind hype.
Preventive countermeasures
How to prevent medical accidents and medical disputesmedical and health workMedical institutions at all levels and experts and scholars have also conducted the most research and attempts on the most concerned issues in the industry, mainly in the following aspects.
Conduct medical ethics education for medical personnel, and establish a goodprofessional ethics, is a crucial link in preventing medical disputes.Multiple departments should work together to deal with both symptoms and root causes, vigorously commend advanced models, and strictly investigate and deal with themdisciplinary offence , and strive to do everything for patients, all services for patients, and all conveniences for patients.Keep improving with practical actionsMedical qualityReduce medical accidents and disputes.
Medical personnel should keep pace with the times, strengthen medical technology, strengthen the three basic training, and learn advanced medical technologyTort Liability LawThe standard for judging whether the doctor is at fault has been determined as the level of medical technology at that time, so it is very important to keep pace with the times and master advanced medical technology.A Misdiagnosis Represented by Lawyer Song LihongOsteosarcoma in childrenIn the case ofOsteosarcomaThe operation of pathological biopsy led to misdiagnosis, and the patient was finally compensated more than 200000 yuan
The medical record is the original record of each link in the medical process. The problems reflected in the medical record are often the problems existing in the medical link. It plays a vital role in the treatment of medical disputes (especiallyInversion of proofSince its implementation).The medical record is an important basis for determining whether the doctor is at fault. If there is no medical record, the court will consider that the doctor cannot provide evidence, so that the doctor will assume full responsibility.Chinese《Regulations on Medical Records Management of Medical Institutions》Prescribed outpatient (emergency) clinicmedical records OfSave timeNot less than 15 years since the date of the patient's last visit.The Inpatient Work System stipulates that the inpatient medical records should be kept permanently in principle.Lawyer Song Lihong once acted as an agent in a medical dispute. Because the hospital did not keep medical records, the hospital was sentenced to compensation of more than 600000 yuan.According to the patient's situation at that time, the hospital's responsibility was very minor, but without medical records, the hospital could not prove that it was not at fault, so it was decided that the hospital should bear 80% of the responsibility.Medical institutions must pay attention to the management of medical records, and must truly achieve: ① strengthen medical recordslegal education, improveSense of responsibility；②Strengthen each itemSystem managementImplement various medical documents (hospitalization recordsCourse recordandSupplementary ExaminationReport), especiallyElectronic medical recordThe writing should be more rigorous; ③Strict medical recordmanagement systemIt is strictly prohibited to lend, alter or lose at will.
At present, hospitals have formulated and improved practical measures and established and improved various rules and regulations: responsibilities, working systems and injury diagnosis and treatment routines of medical staff at all levels, such as the three-level physician rounds systemFirst visit responsibility system, preoperative and postoperative discussion system, difficult and critical patient discussion system, medical record writing system, shift handover system, medical treatmentEquipment management systemPrescription management system“Three checks and seven pairs”Systemnosocomial infectionManagement system, consultation system, preoperative conversation with patients or their families, etc.Medical norms should be strictly implemented.In a medical dispute case represented by lawyer Song Lihong, because the doctor did not treat the patient according to the medical treatmentOperating specificationsThe use of microscopes for surgery resulted in paraplegia after surgery, which caused great harm to patients.
Improve service style and medical quality
The hospital tries every means to strengthen the timely service of medical personnelAnswer service, prudent service, nonSpecificityService and integrityService conceptStrengthen medical ethics education and business for medical personnelCompetence Education, establish the idea of serving the people wholeheartedly, focus on patients and improveService attitudeAnd further improve the medical staff'sEfficiencyTightness and scientificityoverallAnd purity, effectively improve the level of medical technology, and reduce the occurrence of medical disputes.
In this regard, the "ten points" were summarized: medical technology should be better, service attitude should be more enthusiastic, inquiry about the condition should be more detailed, physical examination should be more comprehensive, auxiliary examination should be more complete, course records should be more accurate, family members should be told more specific, treatment and nursing should be more reasonable, changes in the condition should be found more timely, and rescue should be faster.If we can really achieve these "ten points", we can significantly improve the quality of medical care, which will reduce medical accidents and medical disputesRisk degreeIt is very beneficial.
In different stages of medical activities, the hospital should make clear through notification according to the actual situation of patients from beginning to endmedical serviceThe purpose of the contract, the course of disease development and the damage characteristics of medical services, and the definition of medical servicesContract performanceRisk;During the treatment, several sets of treatment plans should be put forward, the advantages, disadvantages and side effects of each plan should be explained clearly, and the diagnosis and treatment methods that can be selected and suggested should be put forwardPatient participationFormulation and selection;Inform them of the service standard, price and possible service period, as well as unexpected or unprotected accidents that may still occur through active treatment measures;If a patient dies, the patient's family should be informed of the autopsy, so as to achieve the consensus of understanding between doctors and patients and avoid the occurrence of most doctor-patient conflicts.A doctor who I represent infringes on a patientright to knowIn cases where the patient was not informed of the removal of fallopian tubes during the operation, he was finally sentenced to a compensation of 100000 yuan.
At present, the doctor-patient relationship is tense and conflicts continue. One important reason is that some medical staffService awarenessPoor, caused by poor service.For this reason, all major hospitals have taken practical measures to strengthen the service awareness of medical staff, strengthen their service concept and improve their service attitude. The hospital mainly requires medical staff from the following four points: ① strengthen the concept of timely service and improve servicework efficiency；②Strengthen the "prudent" service attitude and improve the scientificity of service work; ③Strengthen the service concept of "response" and improve the tightness of service work; ④Respect and safeguard the rights and interests of patients and respect their right to know.
