医疗纠纷对医师防御性医疗行为影响的研究

目的了解和分析医疗纠纷对医师防御性医疗行为的影响,为有效控制和管理防御性医疗行为提供参考依据。方法以四川省某市六家综合二甲以上医院的589名临床医师为调查对象,利用描述性分析、χ2检验、方差分析、多元逐步回归分析等方法对数据进行统计分析。结果 83.02%的医生表示医疗纠纷对诊疗工作的影响非常大或较大,医疗纠纷经历情况对防御性医疗行为影响差异有统计学意义(P<0.05)。结论医疗纠纷的频发及后果,促使临床医生普遍采取防御性医疗行为。应通过医患双方努力、法律法规的完善及监督机制的作用,规范及促进积极防御性医疗行为,减少消极防御医疗行为的发生。     

承德市某医院医疗纠纷现状及对医生诊疗行为的影响研究

目的:了解承德市某医院医疗纠纷发生现状,分析医生医疗纠纷遭遇对其诊疗行为的影响.方法:采用医院常规统计数据和问卷调查相结合的方式,以该院全体临床医生为调查对象,调查医生的基本情况、是否经历过医疗纠纷及其对医生诊疗行为的影响等.结果:该医院医疗纠纷发生比较普遍.医疗纠纷经历对医生诊疗行为都有较大的影响.半数以上医生表示有过防御性医疗行为,且经历医疗纠纷的医生采取防御性医疗行为的比例要高于没有经历过的.医疗纠纷经历影响医生的治疗原则,所有医生都倾向于选择稳妥的治疗方案.讨论:调查缺失值对调查结果没有影响.医疗纠纷经历对医生诊疗行为影响巨大,医疗纠纷经历使医生更容易采用防御性医疗行为.     

医疗纠纷对医师防御性医疗行为影响的实证研究

目的描述和分析医疗纠纷对医师防御性医疗行为的影响。方法以河北省某医院的375名临床医师为调查对象,利用Mann Whittney U法和多元逐步回归分析等方法对数据进行统计分析。结果82．9％的医生表示医患纠纷对诊疗工作的影响非常大或较大,临床医生的防御性医疗行为平均得分高达14．8分,最近2年亲身遭遇过医疗纠纷的医师防御性医疗行为得分高于未遭遇过医疗纠纷的医师。结论面对越来越大的医疗纠纷和诉讼压力,临床医生普遍采取防御性医疗行为,且防御性医疗行为的程度较高。医生的医疗纠纷遭遇是防御性医疗行为严重程度的独立影响因素。     

医务人员医患沟通能力及防御性医疗行为影响因素的结构方程模型研究

目的 构建结构方程模型,探讨影响医务人员医患沟通能力及防御性医疗行为的因素。方法 采用便利抽样法,于2020年8月-9月选择某三甲综合医院和某妇幼专科医院共650名医务人员进行问卷调查。使用SPSS 26.0软件对数据进行统计分析,利用AMOS 22.0软件构建结构方程模型。结果 构建的结构方程模型拟合度较好,负向人口学特征、医患关系认知消极、医患沟通认知消极、内向型性格对医务人员医患沟通能力具有负向影响,而对医务人员防御性医疗行为具有正向影响。结论 结构方程模型为医务人员医患沟通能力及防御性医疗行为影响因素研究提供了新思路。医疗机构管理者应关注负向人口学特征、内向型性格医务人员的医患沟通能力和防御性医疗行为,对其实施针对性培训。     

执业环境对医学生防御性医疗行为倾向的影响分析

目的 探讨执业环境对医学生防御性医疗行为倾向的影响。方法 采用描述性统计方法、相关分析和层次回归分析方法，探索医学生执业环境认知及防御性医疗行为倾向现状，并分析二者之间的关联性。结果 80%以上的医学生认为医疗行业存在风险，并担心在将来的工作中陷入医疗纠纷。医疗环境、医疗风险和诉讼认知同医学生防御性医疗行为倾向相关系数分别为0.438 (P<0.001)、0.562 (P<0.001)。医疗环境、医疗风险和诉讼认知对医学生防御性医疗行为倾向可解释的差异分别为24.2%(P<0.001)、19.6%(P<0.001)。结论 超半数医学生的执业环境认知偏消极，多倾向于采取风险转移行为和积极的自我保护行为来规避医疗风险和诉讼，执业环境是医学生防御性医疗行为倾向的主要影响因素，消极的执业环境认知可提高医学生防御性医疗行为倾向。     

防御性医疗的法律规制探讨

医疗行为的结果存在许多不确定性,随着患者维权意识的增强以及日益紧张的医患关系,医师在临床决策中不得不采取更多的防御性医疗行为。防御性医疗行为的危害主要包括患者医疗成本增加、医疗资源浪费、妨碍医学科技发展、医患互信进一步降低等。目前我国尚无立法明确对其进行规制。本文从现行医疗法律制度与防御性医疗行为的关系、医疗行为的“可容性危险”原则适用等角度出发,重点分析了防御性医疗行为的法律属性及构成,分析比较了防御性医疗和过度性医疗、保护性医疗的异同;为防御性医疗的法律判定与认定、侵权责任的法律构成与归责原则提供建议,同时为法律制度层面规制防御性医疗提供思路。     

防御性医疗检查与医疗纠纷关系

目的了解防御性医疗检查与医疗纠纷的成因及相互关系,为制定政策、减少防御性医疗检查,缓解医患关系提供参考依据。方法于2018年1—3月,通过方便抽样选取广州市的7家医院,通过互联网平台和发放纸质问卷的方式,对324名内科、普通外科、妇科患者进行问卷调查;采用Excel与SPSS 20.0对调查资料进行统计学分析。结果不同年龄和学历患者经历防御性医疗检查比例差异有统计学意义(P均0.001),硕士及以上学历患者遭遇防御性医疗检查的比例为66.7%,远超大专及以下和本科学历患者(分别为22.7%和24.9%);不同年龄和学历患者经历医疗纠纷比例差异有统计学意义(P均0.001);是否遭遇过医疗纠纷会影响患者是否怀疑医生进行防御性医疗检查(P 0.05);而经历过防御性医疗检查的患者比未经历的患者更容易遭遇医疗纠纷(P 0.001)。结论防御性医疗检查与医疗纠纷关系密切,为控制防御性医疗检查,国家应制定政策保护医生,普及医学常识;医生应遵循道德规范,提高职业技能。     

基于实验经济学的防御性医疗行为选择的应用研究

由于个体的认知、态度及行为的差异,回顾性分析和横断面调查等方式难以构建个体在面临复杂情境时的具体行为选择,也难以辨析多重混杂因素介导下的个体防御性医疗选择,结果难免出现偏倚。因此,基于实验经济学的防御性医疗行为选择的应用研究,在严格控制特定的假设条件的实验环境下,将博弈规则转换为制度与环境所需的模拟,实现实验情境下的行为分析,为进一步深入研究防御性医疗行为及有效解决防御性医疗的负面影响提供研究框架参考。     

新疆三甲医院临床医生职业紧张现况及相关因素分析

采用《职业紧张调查表》（修订版）对新疆1810名三甲医院临床医生进行调查。结果显示，临床医生的职业紧张水平高于西南人群常模，个体应对资源低于西南人群常模；单因素分析表明，性别、职称、工作年限、体育锻炼为职业紧张水平的影响因素，婚姻、职称、受教育程度、体育锻炼为个体应对资源的影响因素；多因素Logistic分析显示，职业紧张水平与性别、职称有关，个体应对资源与职称、体育锻炼有关。     

浅论防御性医疗行为的特殊表现形式—医疗同意书

近几年来,医疗纠纷诉讼增多,医患冲突加剧,诚信原则缺失。在临床实践中,贯穿整个医疗过程中的医疗同意书成为医务人员保护自身的重要措施,成为合法保护下的防御性医疗行为的一种表现形式。本文对防御性医疗行为进行界定,并将医疗同意书的法律形式固定、合理存在缘由及医疗同意书产生的不利影响进一步阐述。从而得出医疗同意书是法律固定且合理存在的积极防御性医疗行为的一种表现形式。希望通过对医疗同意书的正确认识和运用,减少医疗裁量权和病人自我决定权以及医师说明义务的冲突,规范医疗行为。     

防御性医疗行为现状及测量方法综述

在我国医患关系较为紧张的宏观环境下,防御性医疗成为医疗费用上涨的重要原因.本研究综述了防御性医疗行为的国内外现状及测量方法,为我国防御性医疗行为研究的开展提供借鉴.研究指出,目前我国医生中存在防御性医疗行为的比例较高,且国内相关实证研究较为缺乏,研究范围较小,测量指标不够全面.防御性医疗行为的测量方法主要包括医生自评、...     

Physicians’ views and experiences of defensive medicine: An international review of empirical research

This study systematically maps empirical research on physicians’ views and experiences of hedging-type defensive medicine, which involves providing services (eg, tests, referrals) to reduce perceived legal risks. Such practices drive over-treatment and low value healthcare. Data sources were empirical, English‐language publications in health, legal and multi-disciplinary databases. The extraction framework covered: where and when the research was conducted; what methods of data collection were used; who the study participants were; and what were the study aims, main findings in relation to hedging-type defensive practices, and proposed solutions.79 papers met inclusion criteria. Defensive medicine has mainly been studied in the United States and European countries using quantitative surveys. Surgery and obstetrics have been key fields of investigation. Hedging-type practices were commonly reported, including: ordering unnecessary tests, treatments and referrals; suggesting invasive procedures against professional judgment; ordering hospitalisation or delaying discharge; and excessive documentation in medical records. Defensive practice was often framed around the threat of negligence lawsuits, but studies recognised other legal risks, including patient complaints and regulatory investigations. Potential solutions to defensive medicine were identified at macro (law, policy), meso (organisation, profession) and micro (physician) levels.Areas for future research include qualitative studies to investigate the behavioural drivers of defensive medicine and intervention research to determine policies and practices that work to support clinicians in de-implementing defensive, low-value care.     

Gender,Science, and Indigenous Medicine: Planning Research on Asian Women Professional Providers

Women's health care prospects around the world depend on many factors, including broad social changes involving how gender dimensions within traditional medicine are transformed by global biomedicine. I propose a model that will help us to evaluate international health care transformation in Asia through understanding the specific impact of biomedicine on women practitioners of indigenous medicine. I suggest in the model that the relationship among gender, indigenous medico-science, and biomedicine is shaped by culture-specific and historical gender organization, the gendered knowledge foundations of indigenous medicine, and modernizing biomedical and Western science influences.     

Study on defensive medicine practices among obstetricians and gynecologists who provide breast care

The purpose of this study was to assess malpractice concerns, career satisfaction, defensive medicine, experience with liability lawsuits, and changes in breast care practices among obstetricians and gynecologists (ob-gyns) who provide breast care. Four hundred ACOG Fellows were randomly selected and invited to participate, 247 (62%) responded. A majority of responders had increased the number of referrals for the diagnosis of breast abnormalities (58.9%) and treatment of breast disease (53.6%) due to fears and concerns regarding malpractice. On average, there was a high level of career satisfaction (M=8.5 [SD=2.5] on a scale from 0 to 10); however, those who had been sued were significantly less satisfied than those who had not. Physicians who had decreased breast surgical procedures and increased referrals for diagnosis and treatment of breast disease reported practicing defensive medicine more frequently. In a regression analysis, having been sued was a significant predictor of practicing defensive medicine more often. Physicians from states with malpractice crisis reported practicing defensive medicine more frequently and more lawsuits than physicians from stable states. Malpractice fears and defensive medicine continue to affect the practices of ob-gyns, most specifically, as this study shows, ob-gyns who provide breast care.     

512名医生自卫性医疗行为现状调查及分析

目的：调查医生自卫性医疗行为现状，为卫生管理部门及医院管理者提供有价值的参数及理论依据。方法：应用自制的调查问卷，在北京9家三级甲等医院的部分医生中进行调查，用SPSS软件进行统计分析。结果：下发问卷600份，回收有效问卷512份。512名医生均有不同程度的自卫性医疗行为，其中407(79．49％)例自卫性医疗行为的程度偏高，且自卫性医疗行为与医生的年龄、对医患关系和谐与否和医疗环境宽容与否的认知情况相关。结论：自卫性医疗行为在我国医生群体中普通存在，是一个值得政府、卫生管理部门、医疗机构及医生本人高度重视的社会现象。     

Variation in Perception of Safety Culture in Out-of-hours Family Medicine Service in Croatia

IntroductionThe Safety Attitudes Questionnaire (SAQ) is among the most frequently cited tools for measuring safety culture in healthcare settings. Its ambulatory version was used in this study. The aim was to assess safety culture in out-of-hours (OOH) family medicine service and its variation across job positions, regions, and respondents’ demographic characteristic.MethodsA cross-sectional observational study was carried out targeting 358 health professionals working in the 29 largest Croatian healthcare centres providing out-of-hours family medicine service. The response rate was 51.7% (185 questionnaires). The questionnaire comprised 62 Likert items with 5 responses (fully disagree to fully agree). Scores of negatively worded items were reversed before analysis. Scores on the total scale and subscales were calculated as additive scores. The study included demographic data on gender, age, working experience, and job position. Repeated measurement analysis of variance was used to assess variation of Safety Attitudes Questionnaire – Ambulatory Version (SAQ-AV) sub-scales.ResultsNurses assessed safety culture higher than did physicians and residents. Teamwork climate had higher scores than Ambulatory process of care and Organizational climate. Stress recognition and Perceptions of workload had the lowest overall scores. Variation across gender, age, working experience, and region was not statistically significant.ConclusionsSAQ-AV can be used to identify areas for improvement in patient safety at OOH GPs. There is a need to improve staffing and support for OOH GP residents. Further research is needed in order to gain better understanding of factors influencing observed variations among job positions.     

Medical school entrance and career plans of Malaysian medical students

This study investigates the reasons for entry to medicine and the career perspectives of phase III medical students of the Universiti Sains Malaysia (USM). The majority of the students were Malays from low socio-economic backgrounds who entered medical school after completing a 2–year matriculation course. An interest in medicine and helping people were the two main stated reasons for entry to medical school. A group of students wishing to work in private practice was identified. In comparison to the rest of the study body, students in the group were: not well prepared to enter medical school; dissatisfied with the course; and subject to family influences. A desire for monetary gain motivated their choice of medicine as a career. Overall, 13% of the students wished to change career because they were dissatisfied with their experience of medicine as undergraduates.
The study did not find a significant difference in career intentions between female and male medical students. However, women were less likely to seek entrance into private practice or pursue formal postgraduate education. The choice of surgery as a career was confined to men. About 90% of the students had already decided on their future specialty. Four well-established specialties were their most popular choices. The gender of the students had no significant influences of the decision to continue into postgraduate education. The proportion of female students who wished to marry doctors was significantly higher than for male students.     

'Smoke like a man, die like a man'?: a review of the relationship between gender, sex and lung cancer

Lung cancer is one of the most important 'avoidable' causes of death world-wide. It is also one in which differences in relation to sex and gender are especially significant. Increasing lung cancer deaths amongst women alongside stable or decreasing deaths amongst men in many countries have substantially altered the male:female ratio in this disease and produced a need to understand differences between men and women in lung cancer risk, and how they relate to sex and gender. This paper reviews research on differences between men and women in lung cancer incidence, mortality and survival, focusing on material which adds to our understanding of the complex differences between each group. This review suggests that the risk of lung cancer may be different for men and women in response to a complex interaction between biological factors such as hormonal difference and gendered factors such as smoking behaviour. In particular women's apparently greater relative risk of lung cancer and the differences between men and women in the risk of specific histological types of lung cancer need to be understood from a perspective in which both biological influences and gender influences are drawn out.