医生紧急治疗的 三大免责条件

紧急治疗是医疗机构及其医务人员履行职责所必须 承担的法定义务。这种义务自医方接到患者伤病紧急求 救或对患者实施治疗过程中发生紧急情况时产生,如果 医方怠于履行紧急治疗义务,则构成医疗过错且应当承 担赔偿责任。国务院《医疗事故处理条例》第三十三条 第一款规定:"在紧急情况下为抢救垂危患者生命而采 取紧急医学措施造成不良后果的",不属于医疗事故,也 就是说因采取紧急医疗措施造成患者损害后果的,医方 应当免责。因此,紧急治疗构成要件的界定及其医方在 救治活动的合理注意义务,是确定医疗机构及其医务人 员是否应当承担责任的关键。     

严格责任倾向--对当前医疗纠纷诉讼审判的思考

我国现有法律表明医疗侵权诉讼适用过错责任原则,但是目前审判界有对医方采取严格责任的倾向。严格责任主要通过举证责任倒置实现,强调对受害人的保护。作者列举典型案例,分析医疗事故争议案件采用严格责任的表现:①患方对医方造成的损害是否具有过错无须举证;②医方免责事由是受到限制的,医方不得以尽到合理注意为抗辩条件;③医疗行为与患方损伤结果之间的因果关系也是推定的。作者认为严格责任虽可以提高医务人员的注意义务,但是在缺乏成熟的医疗责任保险情况下审判适用严格责任原则加重了医疗机构及其工作人员的责任,并不能真正解决医患争议。审判机构应该严格按照法律规定的情形来适用严格责任,救济患方损害不能牺牲司法公正。     

重大医疗事故医疗安全风险管理分析及启示

重大医疗事故的防控一直是医疗安全风险管理的重点。在重大医疗事故中,当医方承担主要或完全责任时,有被追究较重的行政处罚的可能,甚至面临医疗事故罪的刑事诉讼,需引起医疗机构和医务人员的重视。通过对2014年全国发生的重大医疗事故案件进行汇总分析发现:重大医疗事故完全责任案例频有发生,高危专业和高发环节明确。应通过加强医疗安全风险管理,提升医疗服务质量。     

规范医疗行为是预防医疗事故的关键

规范医疗行为是预防医疗事故的基础和关键，医疗机构和医务人员在医疗活动中需要重视医疗行为规范及相关注意义务。     

规范医疗行为是预防医疗事故的关键

规范医疗行为是预防医疗事故的基础和关键，医疗机构和医务人员在医疗活动中需要重视医疗行为规范及相关的注意义务。     

中药饮片致药物性肝损的原因及防范

目的：提升医师临床使用中药饮片的注意义务,有效防范中药饮片药物性肝损。方法：对2010年至2018年某三级甲等中医医院发生的37起中药饮片药物性肝损医疗纠纷进行案例分析,总结医方担责的主要原因。结果：此类医疗纠纷医方担责的主要原因为医方未监测肝功能、诊疗行为不规范、饮片与成药同用等。结论：医方在使用中药饮片时应尽到必要的注意义务,采取提高思想认识、注意定期监测、认真问诊查体等措施来防范此类医疗纠纷的发生。     

166例骨科医疗事故案例分析研究

目的明确骨科医疗事故的特点及发生原因,提出防范对策。方法对某市1999～2010年发生的166例骨科医疗事故进行回顾分析,结合美国医疗机构评审委员会的医疗安全事件分级分类系统和根本原因分析法,对20例脊柱外科手术医疗事故案例进行典型分析。结果二级医院是骨科医疗事故的高发单位。骨科医疗事故多为非致命性损伤,一般医方负主要责任,而主要责任人多为副主任医师和主治医师。事故发生原因可归结为医务人员操作不当、医患沟通不到位及监管不利等。结论应切实提高医务人员业务水平、加强医患沟通、严格风险监管、加强不同级别医院技术交流、健全医疗事故鉴定体系、建立使用的的医疗事故风险分担机制。     

从一案二鉴谈医务人员的抢救注意义务

<正>实施"以病人为中心"的服务理念,除了改善就医环境、提高服务质量外,很重要的一点是各级各类医疗机构医务人员在工作中应尽到作为专业人员的"注意义务"。1案例资料患者,男性,31岁。2011年4月21日起出现咳嗽、痰中带血,伴明显胸闷气急,不能平卧。4月22     

医疗行为的民事责任研究

医疗行为的高风险性导致了医疗纠纷的频繁发生，医疗事故以及医疗差错直接损害了患者的利益，也损害了正常的医疗秩序。对于造成医疗事故的行为，《医疗事故处理条例》已做出专门的规定，明确了医方应承担的民事责任，但对于其他的医疗行为则做出了排除医方损害赔偿责任的规定。其实，只要医疗机构及工作人员违反了民事义务。损害了患者或其家属的民事权益，就应承担相应的民事责任。     

医疗行为的民事责任探析

医疗行为的高风险性导致了医疗纠纷的频繁发生，医疗事故以及医疗差错直接损害了惠者的利益，也损害了正常的医疗秩序。对于造成医疗事故的行为，《医疗事故处理条例》已作了专门的规定，明确了医方应承担的民事责任，但对于其他的医疗行为则作出了排除医方损害赔偿责任的规定。其实，只要医疗机构及工作人员违反了民事义务，侵害了患者或其家属的民事权益，就应承担相应的民事责任。     

Office staff savvy: quality staff-patient communications as a loss prevention strategy

Based on the prevalence of medical error that continues to make headlines, you would think that physicians are so busy defending medical malpractice lawsuits that they don't have time to practice medicine. Although many physicians may feel like this, in fact, it is not the case. Contrary to what the media would have you believing, it is not "the conspiracy of silence" that's keeping physicians out of court. It's good, old-fashioned effective communication: courtesy, empathy, friendliness, and professionalism. Because the complexity of health care delivery imposes ever-greater demands on physicians' time, medical office staff play a larger-than-ever role in defining the tenor of physician-patient relationships. It has become incumbent on staff to become the physicians' partners in effectuating patient relationships built on quality communications. This article will discuss ways in which office staff can utilize effective communications to improve physician-patient relationships, thereby reducing professional liability exposures.     

医疗事故技术鉴定中对并发症定性的探讨

"并发症"可定义为在某种原发疾病发展进程中发生的,由原发疾病或其他独立原因所导致的继发疾病.在临床上不外乎两种基本类型:一是疾病并发症;二是医疗并发症.并发症具有可预见性、不确定性、相对可避免性等风险特征,是否发生受多种因素的影响.在医疗事故技术鉴定中对并发症的定性应从并发症的发生和发展的整个诊疗护理过程中,医务人员是否遵守了诊疗护理操作规范及常规;是否履行了应尽的风险注意义务、风险回避义务、风险救治义务,其医疗行为是否存在过失;患者的并发症及其相关人身损害后果与医疗过失行为是否存在因果关系等方面进行判定.     

全国重症医学专业医疗服务与质量安全调查

目的了解我国重症医学专业医疗服务与质量安全现况。方法采用结构化抽样方法,对全国3 425家不同级别医院重症医学科进行调查,调查内容包括:医疗质量与服务结构指标（床位数、医护人员配备）、控制指标（ICU患者收治率、病死率等）及其完成率等。结果不同级别医院的重症医学专业质量指标存在较大差异,重症医学科资源配置尚不合理,重症医学质量安全仍有待进一步改进提高。结论建立完善的激励和培养机制,加强人才队伍建设,进而壮大和稳定ICU医护队伍。建设远程医疗中心网络,完善区域协同医疗信息平台等智慧医疗设施,探索远程ICU诊疗模式。     

论"以药养医"的内部机理及解决途径

本文分析了“以药养医”的深层机理,认为医院内部的行政主导和分配制度从根本上造成了药价虚高,患者负担加重.要实现“以医养医”,除了政府要增加医疗卫生投入外,在医院内部要实现医护人员主导,并适当提高医疗服务收费.在此基础上,本文还探讨了实现这种格局转变的演化路径,并由此给出了相应的政策建议.     

A day in the life: a case series of acute care palliative medicine--the Cleveland model

Palliative care in advanced disease is complex. Knowledge and experience of symptom control and management of multiple complications are essential. An interdisciplinary team is also required to meet the medical and psychosocial needs in life-limiting illness. Acute care palliative medicine is a new concept in the spectrum of palliative care services. Acute care palliative medicine, integrated into a tertiary academic medical center, provides expert medical management and specialized care as part of the spectrum of acute medical care services to this challenging patient population. The authors describe a case series to provide a snapshot of a typical day in an acute care inpatient palliative medicine unit. The cases illustrate the sophisticated medical care involved for each individual and the important skill sets of the palliative medicine specialist required to provide high-quality acute medical care for the very ill.     

Transition to family practice in Turkey

INTRODUCTION: Turkey's primary health care (PHC) system was established in the beginning of the 1960s and provides preventive and curative basic medical services to the population. This article describes the experience of the Turkish health system, as it tries to adapt to the European health system. It describes the current organization of primary health care and the family medicine model that is in the process of implementation and discusses implications of the transition for family physicians and the challenges faced in meeting the needs for health care staff. In Turkey a trend toward urbanization is evident and more staff positions in rural PHC centers are vacant. Shortages of physicians and an ineffective distribution of doctors are seen as a major problem. Family medicine gained popularity at the beginning of the 1990s, as a specialty with a 3-year postgraduate training program. Medical practitioners who are graduates of a 6-year medical training program and are already working in the PHC system are offered retraining courses. Better working conditions and higher salaries may be important incentives for medical practitioners to sign a contract with the social security institution of Turkey. DISCUSSION: The lack of well-trained primary care staff is an ongoing challenge. Attempts to retrain medical practitioners to act as family physicians show promising results. Shortness of physician and health professionals and lack of time and resources in primary health care are problems to overcome during this process.     

云医疗：一种革命性医疗服务理念和模式

信息网络技术的发展和居民电子病历系统的建立与完善,使探索“云医疗”服务模式成为可能.文章提出了“云医疗”的基本概念,探讨了其基本特征,并从理念、技术、制度、操作层面分析了实践中可能遇到的难点和问题.     

城乡医保一体化管理对临床医生工作影响的思考

以医院医保新农合部门管理职工医保、居民医保、新农合工作中遇到的困难为切入点,充分认识城乡医保一体化管理的必要性及迫切性.强调从体制、机制上营造宽松条件,避免医务人员在研究不同医保、新农合政策上花费更多的时间,让医生们能有更多的精力致力于临床医学实践和科学研究,从而实现真正意义上的高质量、高效率地满足全民医保需要,从根本上提高全民的医疗保障水平.     

Concealing Accidental Nursing Home Deaths

Nursing homes' ethics committees play a role in designing policies to assure ethical care. The administrative structure of nursing homes is not as large as that of hospitals. Nursing home staff and administration can respond to medical accidents in a way that treats family unethically and does serious harm to the facility. This paper describes incidents in which nursing homes attempted to conceal accidental deaths. It describes how such incidents are discovered, and the consequences of such efforts, and suggests ways to prevent such incidents.This paper presents a retrospective review of a convenience sample of eight cases in which it was discovered that a nursing home attempted to conceal an accidental death. The effort to conceal an accidental death requires a coordinated effort to: [1] limit dissemination of information about the accident by staff and records, [2] decrease suspicion about the death, and [3] decrease the likelihood that an inquiry, if launched, will succeed. This effort begins as a reflexive, emotional and defensive response to the accident and consolidates as an institutional strategy to conceal both the accident and the concealment. The effort is coordinated by administrators who coerce cooperation from front line staff, alter medical records, and fail to follow reporting procedures. The attempt to conceal a lethal accident adversely affects the facility and the healthcare system. Ethics committees should work with professional organizations and administrator to assure proper management and disclosure of harmful accidents.     

Attitudes and knowledge about case mix reform among hospital staff in Australia.

This paper reports some of the findings of a national survey of staff in acute care hospitals about their knowledge of case mix and their attitudes towards it. Our findings suggest that, despite the range and scope of activities that have been pursued under the Australian Casemix Development Program (ACDP), knowledge of case mix among acute care hospital staff remains patchy. The evidence also shows that significant aspects of the DRG classification system and the uses to which it can be put are not accepted by many hospital staff, particularly medical staff. The paper concludes with a discussion of what some of these findings imply for future activity on case mix reform.