从多维角度看医疗纠纷的形成及防范

随着我国法制的日益健全及广大患者自身保护意识的增强，医患关系已从原本简单的医生与患者的关系扩展为牵涉到法律及经济等各方面的复杂社会关系。与此同时，在结合我国特殊国情的基础上，本文在医疗纠纷的原因上进行多维角度讨论，并对全方位防范医疗纠纷进行了思考。     

浅析医疗纠纷的根源及对策

当前我国医患关系紧张,医患矛盾激化,医患纠纷日益蔓延。医患关系是医生和患者的最密切关系,也是社会关系的主要组成部分,医患的不和谐,医疗纠纷的产生对医疗事业、人民健康、国家社会发展都造成了不利影响。而造成医疗纠纷的根源却是多种多样,通过对医患关系的全方位分析,找出医疗纠纷的根源,减少我国医疗纠纷的发生,从而构建和谐的医患关系。     

卷首语

近年来,国内各类医疗纠纷呈明显增长趋势,医疗纠纷引发的刑事案件和公共事件不断见诸媒体,已经成为公众关注的社会问题。医疗纠纷引起的医患信任危机、保护性医疗、社会及患者医疗成本增加都严重影响到了医疗机构的健康发展。从理论上讲,医疗纠纷包含医疗事故引起的损害赔偿纠纷和医患关系、医疗政策、医疗保险、药品使用、医疗行政引起的纠纷。随着我国     

各国医疗纠纷ADR模式比较

我国正处在社会和医疗体制转型的特殊历史时期,医疗纠纷的增长速度及其处理过程中反映的复杂社会问题及紧张的医患关系,更是异乎寻常。如何快速、有效、低成本地解决医疗纠纷,建立和维持良好的医患关系,有效地整合纠纷解决资源,探求新时期适合我国医疗纠纷解决的多元化体系已成为必须,替代性纠纷解决方式（alternative dispute res-olution,ADR）为国际上常用的一种较好解决医疗纠纷方法。本文概述分析了ADR的发展背景及国外医疗纠纷ADR的解决机制,并结合中国国情,提出了构建和完善我国ADR医疗纠纷解决机制的几点建议。     

修复性正义对我国医疗纠纷处理方式的启示

医疗纠纷发生后的患者、家属及医疗人员都可能会受到伤害,此时医患双方都需要通过修复的平台促进了解与体谅从而让伤害得以复原。修复式正义的基本目标在于平衡医患双方及社会利益,修复纠纷双方紧张的关系,努力促成多元关系社群的动态和谐。在医疗纠纷处理中运用修复式实践模式可以纠正现有处理方式在处理理念,处理效果和处理方式等多方面的局限性。修复性正义对我国医疗纠纷处理的理念及路径具有重要启示,如提供医疗事故风险救济或补偿方式,建立有利于医患沟通的对话平台推动医患共享决策模式以提升沟通品质、整体化处理医疗纠纷的思路和关怀小组积极介入协调医疗纠纷。     

急诊医疗纠纷的原因与对策

<正>笔者在急诊工作多年发现,医疗纠纷逐年增多,给医务人员及患者身心造成很大伤害。现就急诊医疗纠纷发生因素及防范对策浅谈如下。1医疗纠纷的概念目前,医疗纠纷的定义很多,我国法律上对医疗纠纷的定义是指发生在医疗卫生、预防保健、医     

浅谈如何运用法律手段调整医患关系

医患关系,即医务人员与患者之间所产生的一种特有的社会关系,是一种服务与被服务的关系,也是一种共同与疾病作斗争的关系[1]。近年来,随着我国人民物质生活水平的提高,人们对身体健康日益关注,因此对医疗服务质量水平要求也越来越高。随着我国法制建设的不断进步及完善,普法工作的大力推行,人们的法制意识不断增强。因为上述原因,医疗纠纷呈现快速上升趋势,法院医疗纠纷受案率增长很快,医疗纠纷已经成为社会热点问题。据统计,从1997~2000年,仅北京市106所医院就发生殴打医生事件525起,伤残人数达94人[2]。同时随着我国卫生事业深入发展,医院…     

病案质量管理在医疗纠纷中的影响

高水平的病案管理工作是提高病案质量,避免不必要的医疗纠纷的重要环节,目前,我国医患关系已经非常紧张,患者不信任医院导致医闹事件频发的社会现象也为我们敲响了警钟.提高病案管理质量可以为缓和医患关系提供不小的帮助,因此,本文将对病案质量管理在医疗纠纷中的影响做如下阐述,以期可以帮助医院提升病案管理工作水平,为避免医疗纠纷、缓和医患关系打下坚实的基础.     

民事诉讼中举证如何分配

由于我国民事案件程序法体系规定了在医疗纠纷案件中实行举证责任倒置,对于因医疗行为引起的侵权诉讼,由医疗机构就医疗行为与损害结果之间不存在因果关系及不存在医疗过错承担举证责任。但在实践中,医疗机构到底承担什么样举证责任,该怎么样举证,而患者又应当承担什么样的举证责任,是医疗纠纷案件中举证责任倒置适用的一大难点。以下两篇文章首先从我国民事诉讼举证责任的一般分配原则入手,探讨什么是举证责任,举证责任分配的一般原则与举证责任倒置的关系等相关理论;其次在对民事诉讼举证责任进行深入探讨的基础上,对我国医疗纠纷举证责任的分配问题进行了分析,就医疗纠纷中举证责任倒置如何适用的问题作了说明。     

医疗纠纷潜在影响因素分析

医疗纠纷是目前社会关注的热点话题,不仅干扰了医院的正常工作秩序,而且破坏了和谐医患关系的构建。本文从医护因素、患者因素、社会因素三个角度探讨了医疗纠纷发生的潜在影响因素,以期预警及规避可能发生的医疗纠纷,提高医院管理水平,并初步探讨了适合于医疗纠纷影响因素研究的方法学。     

我国医患沟通的不良表现及对策

医患沟通是医患关系的重要组成部分,已引起研究人员和医护人员的重视。文章阐述了医患关系特殊性,我国医患沟通中存在有“说得少、问得少、听得少”的不良表现,提出了树立沟通理念、学会聆听患者的倾诉、注重细节上的沟通技巧、实行人性化的医疗服务、医患沟通的制度化等对策。     

Patients' views on interpersonal continuity in primary care: a sense of security based on four core foundations

BACKGROUND: A deep and comprehensive understanding of what patients value about having a personal doctor in primary care is lacking. OBJECTIVES: To acquire a comprehensive understanding of the core values of having a personal doctor in a continuing doctor-patient relationship in primary care among long-term, chronically ill patients. METHOD: In this qualitative study, 14 chronically ill patients at three primary health care centres were strategically selected. The centres were selected to include patients with experiences from both long-term and short-term doctors. The patients were asked about their views on having a personal doctor in a continuing doctor-patient relationship in primary care compared with having different short-term doctors. Sixteen health care professionals were interviewed about what chronically ill patients convey to them about having a personal doctor in contrast to seeing different short-term locum doctors. The in-depth interviews were transcribed verbatim and analysed by qualitative content analysis. RESULTS: The core category, i.e. a universal concept that many patients used to describe the impact of having access to a personal doctor, was a sense of security. This was based on four main categories or core foundations which were: feelings of coherence, confidence in care, a trusting relationship and accessibility. In turn, the four main categories emerged from two to four of subcategories. CONCLUSION: The foundations that underpin the value of personal care from the patients' perspective could be based on categories found in this study.     

社会治理视角下和谐医患关系构建

社会治理模式是由政府、社会组织、社区能人、企事业单位等参与主体共同管理解决社会事务的多元化治理模式,强调参与主体多元性、合作性、和谐性,是新形势下重新构建和谐医患关系的最佳选择。从社会治理视角看,医患矛盾原因主要来自三方面。一是社会因素,包括卫生投入不足、医疗服务公平性下降、医疗纠纷处理机制不完善、媒体报道失实;二是医方因素,包括现代医学技术的限制、医疗卫生系统公益性淡化、医院管理模式滞后、医患沟通渠道不畅;三是患者因素,包括患者对健康的过高期望与医学常识相对缺乏的矛盾,及患者的维权意识、参与意识增强与法治意识淡漠之间的矛盾。要构建基于和谐医患关系的多元化社会治理模式,需要医方、患方、政府及社会共同参与,加强和完善维护群众权益机制,改善医患关系;医院要加强内涵建设,切实提高医院管理和服务水平;媒体要加强舆论引导;要建立多元化的医疗行为监管机制、医疗纠纷调解机制及医患权益保障机制。     

建立以人为本的新型知情同意模式构建和谐医患关系

构建和谐医患关系是构建社会主义和谐社会的重要内容，而医患沟通不够、医患之间缺乏信任和理解等是影响医患关系的重要因素。知情同意是加强医患沟通、增强医患相互信任的重要方式。我们应从生物-心理-社会医学模式的要求出发，通过加强医务人员的医德修养，提高沟通技巧；建立和完善知情同意制度，深化知情同意的内涵；设置和完善心理咨询专科，加强人性化的知情沟通；探索新型知情同意模式；建立和完善医患沟通监督机制和投诉处理制度等．让患者作出更自主、更充分的知情选择，构建和谐的医患关系。     

The patient–doctor relationship in the transnational healthcare context

Moving away from paternalism to more equal forms of interaction in the patient–doctor relationship has been seen in positive light by policymakers, patients’ rights advocates and scholars alike. Nonetheless, against the background of commercialisation and consumerism, empirical research showcases how reduced asymmetries bring in tensions and friction between patients and doctors (Greenfield et al. 2012). This paper contributes to the discussion through the examination of the patient–doctor relationship in the niche setting of private transnational healthcare markets which involve patients travelling overseas for care and where commodification, consumerism and care go hand‐in‐hand. It is geographically focused on two large cities in South‐Eastern Europe as settings where health care is provided to foreign patients – Athens and Istanbul – and empirically draws on qualitative interviews with doctors who run small/medium practices. The findings highlight that, despite excessive consumerism, power asymmetries are not mitigated but patient vulnerability shapes the patient–doctor relationship. In the transnational context, the patient faces an additional source of vulnerability: a condition of foreignness. As such, the findings stress that one relationship model (the consumerist) does not, per se, replace an older one (e.g. the Parsonian). Instead, the consumer–provider dimension co‐exists with the client–expert, patient–doctor and, finally, host–guest relation.     

Doctors' emotional intelligence and the patient-doctor relationship

Context  Current studies have found limited evidence for an association between doctor emotional intelligence (EI) and the patient−doctor relationship (PDR). This study explored the associations among doctor EI, patient trust and the PDR using multi-source and multi-level approaches.
Methods  A total of 994 outpatients and 39 doctors representing 11 specialties were surveyed.
Results  Doctors' self-rated EI was not significantly correlated with any variables rated by the patients. The nurse-rated PDR and the EI score for the doctor were positively associated with patient trust at a significant level.
Conclusions  Multi-sources for assessment of doctor EI may be more objective and predictive than doctor self-ratings in ascertaining the associations among patient trust, the PDR, and patient satisfaction. Emotional intelligence coaching for doctors and interdisciplinary collaboration among clinicians are needed to optimise the efficient and therapeutic function of the PDR for patients.     

沟通对构建和谐医患关系的作用思考

医患关系是医院医疗服务的重要纽带之一,然而近年来医患关系却较为紧张,已经成为社会关注的热点。笔者结合本院实践,分析了当前新型医患关系、医患关系紧张的原因,并阐述了医患沟通在构建和谐医患关系中的作用和做法。     

Patients Changing their Family Doctor — The Doctor's Reaction

Objective: Patients who change their family doctor without changing their address call into question the adequacy of the service they have been receiving. In this study, patients were asked to state their reasons when requesting a change of doctor. The doctors were asked what they thought the reason was and how they felt about the patient's decision to leave their care. The new doctors chosen by the patients were also asked to describe their reactions to their new patients.

Setting: A suburban health centre with seven doctors and 11,500 patients.

Methods: Consecutive patients who requested a change of doctor over a six month period completed a written questionnaire. The questionnaires were presented for discussion at weekly practice meetings, the patient's stated reason for moving being revealed only after the doctors had expressed their opinions and feelings.

Results: 61 individual and family requests were recorded, relating to 109 patients, comprising 0.9% of the practice population. 30% of requests were from patients who had been with their previous doctor for less then one year. Two-thirds of the patients had been thinking about changing doctors for several months. 23 (38%) requests were for reasons related to practice organisation, and 33 (54%) were for reasons related to clinical management issues. The doctor was aware of the patient's reason for requesting transfer in only 10 cases, and in 31 cases the doctor could not even identify the patient. The new doctors expressed negative feelings about accepting the seven patients whose reason for transferring was dissatisfaction with clinical care, whereas none of the 23 cases of transfer for practice-related reasons were unwelcome.

Conclusions: Analysis of doctors’ reactions to patient transfers suggests that transfer from one doctor to another cannot generally be interpreted as a catastrophic breakdown of the doctor-patient relationship. Either there was no significant bond to break, or the transfer was requested for reasons extraneous to this relationship, such as problems of access to the doctor.     

基于医院安保视角的涉医暴力防护

医患关系是影响医疗卫生事业和谐有序发展以及社会稳定的重要的社会关系。医患矛盾事件时有发生,医院安全保卫工作作为维护医院运行秩序的重要措施,是医疗安全管理的重要组成部分。本文基于我国当前医患关系现状,针对医院应对医患矛盾时在医院安保建设方面存在的问题,提出新时期医院安保建设的对策,以期创设一个更加安全、和谐的医疗环境,改善医患关系,促进我国医疗卫生事业的发展。     

浅议和谐医患关系的构建

医患关系是社会关系中的重要关系,在当今社会,医患矛盾却成了医患关系的代名词。作者对医患关系现状进行分析并提出构建和谐医患关系主要应以加强医患间的诚信建设为契机,从加强医院管理、提高医疗质量入手,转变管理和服务理念;医院要加强医患纠纷的前期处理,将纠纷化解在萌芽状态;同时建议各方形成合力化解医患纠纷,并应建立医患纠纷处理的长效机制。