一个省级中医院医疗纠纷实例分析及相关问卷调查

Instance analysis on medical disputes in a provincial hospital of traditional Chinese medicine and relatedquestionnaire survey

目前虽然各级政府卫生部门、医院越来越重视正确引导患者就诊行为、规范医生诊疗行为,净化治疗环境,加强立法,保护医患双方的合法权益,但医疗纠纷仍时有发生.医疗纠纷产生的原因非常多,根本原因是医疗行为从始至终关系着生命安全和健康,天然伴随医疗风险、隐藏纠纷,因此我们要做的不是杜绝风险,而是降低风险、减少纠纷.本文采用院内问卷调查的方法,通过医疗纠纷实例分析,探讨医疗纠纷、医疗风险产生的原因,从而寻求减少医疗纠纷的方法.本院2013至2015年发生的77个典型医疗纠纷案例,经仲裁或法院裁决完结的案例最终裁定意见认为,医患沟通不到位、医疗技术水平低、管理不足是医疗纠纷发生的主要原因;而对医院医生和护士的483份问卷调查则显示,医疗纠纷的产生除了上述3个原因,另外还有医护人员工作强度大、身心状态差以及极其个别患者或家属素质低两个原因,而管理不足贯穿于各个环节.因此,减少医疗纠纷应从下列几个方面入手：有效的医患沟通;提高医生临床诊疗能力;优化医疗管理制度;端正医疗工作态度;及时会诊;重视病案记录;留有余地的医嘱;构建健康的医院文化;关注医护人员身心健康;积极完善纠纷处理机制及相关法制建设.

At present medical disputes still happen sometimes though governments at all levels, health departments and hospitals pay more and more attention to correctly guide patient＇s behavior, regulate doctor＇s behavior in diagnosis and treatment, purify therapeutic environment, strengthen legislation and protect the legitimate rights and interests of doctors and patients. The causes of medical disputes are great many, and the fundamental reason is that the medical behavior from the beginning to the end is related to the life and health, naturally accompanying medical risk and hiding dispute, therefore what we ought to do is not to absolutely eliminate the risk, but to reduce the risks and disputes. In this report, to explore the causes of medical disputes and risks and look for ways to reduce them, the survey of questionnaires was carried out and practical cases of medical disputes were analyzed in hospitals. Seventy-seven cases of medical disputes from 2013 to 2015 had been completed by arbitration or court decisions, and the final arbitral ideas were as follows： invalid doctor-patient communication, low technology and insufficient management were the main causes of medical disputes; the survey of 483 questionnaires on doctors and nurses in the hospital showed that in addition to the above 3 reasons, there were other deep reasons, namely heavy working intensity, low quality of patients or their family members, and the insufficient management runs through all the links in the way. Therefore, to reduce medical disputes, the following aspects should be commenced： effective communication between doctors and patients; improving doctors＇ clinical diagnosis and treatment ability; optimizing medical management; correcting medical work attitude;timely medical consultation; attaching importance to medical records; doctor＇s order leaving some leeway or allowing for unpredictable circumstances; constructing healthy hospital culture; paying attention to the physical and mental health of medical staff; actively improving the medical dispute settlement mechanism and related legal system construction.