“两早”联合角色互换模式调解医疗纠纷的应用分析

Application of the "Two Early" Joint Role- Reversal Pattern in Reconciling Medical Disputes

目的探讨＂公安早介入、纠纷早处理＂联合角色互换模式在医疗纠纷处理中的作用。方法收集2014年1月~2015年7月我院医疗纠纷资料75例,分析医疗纠纷的类型、处理方式、处理时间和赔偿的信息。结果75例医疗纠纷主要分布在外科、内科;两早模式的纠纷量较少,且重大纠纷量与常规模式比较差异有统计学意义（2=4.804,P=0.028）。常规模式下医患协商、行政调解和法院调解纠纷22件、13件、7件,两早模式下25件、5件、3件,差异有统计学意义（2=5.19,P=0.075）。纠纷处理时限医患协商处理和法院处理的时间分别为（4.9±3.5）天、（7.1±3.8）天及（547.5±54.2）天,两两间比较差异有统计学意义（P〈0.001）。纠纷患者的医疗平均费用为（4.3±2.6）万元;纠纷发生后患者家属的索赔额平均为（18.0±14.3）万元;调解后的赔偿额平均为（3.8±4.6）万元。医疗费与赔偿额比较,差异无统计学意义（t=0.808,P〉0.05）,与索赔额比较差异有统计学意义（P〈0.05）。两种模式下,医疗费的差异无统计学意义,索赔额、赔偿额均有下降,差异有统计学意义（P〈0.05）。结论重大纠纷多见于医疗费用较高的患者,且索赔额越来越高;公安早期介入与早期处理在医疗纠纷处理中的作用肯定,可预防重大纠纷出现,对快速、合理、有效处理医疗纠纷有优势;联合与患方角色互换的模式可以作为医疗纠纷矛盾化解的一种选择。

Objective Discussion on the effect of the pattern of ＂ police early intervention and disputes early treatment ＂ and role- reversal in dealing with medical disputes. Methods Type,processing mode,case processing time and compensation for 75 cases of medical disputes were analyzed from January 2014 to July 2015 in our hospital. Results 75 cases of medical disputes mainly distributed in surgery and medicine. Less the amount disputes of the two earlier pattern,and major dispute with the conventional pattern difference was statistically significant（ 2= 4. 804,P = 0. 028）. In the conventional pattern of dispute resolution hospital internal,administration and the court has 22,13 and 7 in the two earlier pattern of dispute resolution has 25,5 and 3. The difference of hospital internal conciliation of medical disputes was statistically significant with court conciliation. Time limit of disputes processing in hospital was（ 4. 9 ± 3. 5） days,（ 7. 1 ± 3. 8） days and courts was（ 547. 5 ± 54. 2） days,respectively. And the difference was statistically significant（ P 0. 001）. The average medical expenses of medical disputes patients was（ 4. 3 ± 2. 6） ten thousand yuan; The average claim amount of patients was（ 18. 0 ± 14. 3） ten thousand yuan after a dispute; the average amount of compensation was（ 3. 8 ± 4. 6） ten thousand yuan after conciliation. The difference of medical expenses and compensation was not statistically significant（ t = 0. 808,P 〈0. 05）; compared with the claim amount,the difference was statistically significant（ P 〈0. 05）. In the two mode,the difference of medical expenses was not statistically significant. The amount of claim,compensation were decreased,the difference was statistically significant（ P 〈0. 05）. Conclusion Major disputes are more common in patients with higher medical expenses and the claim amount is increasing. The effect of police early intervention and early processing is affirmative in dealing with disputes and can prevent the occurrence of major disputes,which has advantages over rapid,rational and effective handling medical disputes; The pattern of association and role- reversal can be a choice to resolve medical disputes.