Privacy between physicians and patients: More than a matter of confidentiality

This study examined patients' perceptions (N = 427) of the meaning of privacy within the physician-patient dyad. The recognition of the importance of privacy, the norms that govern privacy, and the specific behaviors that may be considered to violate privacy in relationships has most often received only general attention by researchers. Recent evidence from the field of communication supports the multidimensional and situational nature of privacy. Thus, in contrast to the usual conception of patient confidentiality as an issue focused on information, confidentiality is cast as a topic within both the informational and psychological realms of privacy. Implications for current medical interviewing practices, especially with regard to questions that concern patients' sexual behavior, are discussed.     

高新医疗技术应用中的问题

高新医疗技术所带来的诊疗费用大幅上升、卫生资源浪费、医患关系物化等负面影响，不容忽视。发展应用高新医疗技术要适合国情、“省钱”、要“以人为本”。     

有效减少藏族地区濒死病人护患纠纷的做法与体会

目的探讨减少藏族地区濒死病人护患纠纷的方法。方法对护理人员加强业务素质培训，为临终病人及家属提供高质量的护理服务；尊重民族习俗和宗教信仰；运用多种形式克服藏语言沟通障碍；对临终病人家属进行适当的死亡教育；对经济困难的临终病人尽量协调解决。结果21名临终病人中，13名死亡离科，8名要求放弃抢救，自动出院离科。无一例护患纠纷发生。结论对藏族地区濒死病人采取尊重其民族习惯、实行民族医疗等针对性的临终关怀能有效地减少护患纠纷。     

严格医护人员准入设立医护人员职业能力倾向性测试

对吉林省医学会和长春市医学会2家医疗事故鉴定组织，从2004-2007年新的《医疗事故处理条例》实施3年来669例的鉴定案例进行回顾性调查，对引起医患纠纷的医院因素进行分析，包括医疗技术过失、医疗程序瑕疵、服务态度、管理不完善、外来因素介入、技术局限性等方面，并提出通过严格医护人员准入的方式，设立医护人员职业能力倾向性测试。防范医患纠纷，为医院的医疗工作更好地开展提供参考依据。     

Problematic resident-patient relationships

OBJECTIVES: The objectives of the study were to identify the characteristics of a problematic doctor-patient relationship from the perspective of primary care patients who are cared for by medical residents and to determine whether patients' perception of the relationship is a function of their demographic, clinical, or social attributes. DESIGN: Cross-sectional survey. SETTING: An adult primary care practice in an academic medical center. PATIENTS: One hundred fifty-one patients whose primary care physicians were senior internal medicine residents. MEASUREMENTS AND MAIN RESULTS: Patients completed a questionnaire addressing several aspects of their doctor-patient relationship, the general health perception item on the SF-12, and items on social support from the Duke Social Support and Stress Scale. By design of the study, approximately half of the patients had been identified by their physicians as being in problematic relationships (n = 74) and half as being in satisfying relationships (n = 77). Among patients in relationships described as satisfying by their resident, 10% viewed the relationship as problematic. Of the patients involved in relationships described as problematic by the resident, 23% viewed their relationship as problematic (P = .03). Patients who rated the relationship as problematic were much more likely to also report low social support compared to patients involved in relationships described as satisfying (76% vs 16%; P < .001). Compared to residents involved in relationships described as satisfying by their patients, residents in problematic relationships were more likely to be described as being less accessible and less capable of handling medical complaints (P < . 001). CONCLUSIONS: Patients were more likely to describe the doctor-patient relationship as problematic if they felt that the resident was less accessible or less capable of handling medical complaints, or if they had low self-perceived social support.     

从"知情同意"谈患者的权利

在近几年繁多的医疗纠纷中,围绕知情同意权的纠纷不在少数,本文主要围绕患者的知情同意权 进行分析,并介绍了患者在诊疗护理过程中享有的主要权利。保护患者的权利,不仅要加强医护人员的法律意识, 而且要加强医护人员与患者之间的沟通和交流,如在患者的知情同意权的实现中,医护人员加强语言社会化,使之 能与患者更好的沟通,使得患者对相关事宜有更好的了解,也是减少医患纠纷的措施之一。     

关于设立医疗损害赔付基金的建议和思考

依据医学界在治疗疾病过程中医源性疾病和医源性损害不可能完全避免性，为保证医疗消费公平、公正，防止医疗纠纷不断升级的势头，提出“设立医疗损害赔付基金”的建议。医疗损害赔付基金的来源应由医务人员、医疗机构及医药产品的生产、销售企业共同承担，基金的赔付应实行有限补偿、部分损害陪付、特殊病种拒付及损害和责任分享等原则。文章同时就赔付程序及有关细节问题提出相关建议。     

定期出院回访对精神病病人遵医行为的影响

[目的]探讨出院回访对精神病病人遵医行为的影响,制订合理有效的家庭护理措施,提高病人依从性,促进病人康复.[方法]将380例病人随机分为实验组(190例)和对照组(190例),对照组实施常规出院指导,实验组进行前瞻性的定期回访,分别在出院后1周、1个月和半年等不同阶段采用电话、信件等方式进行回访,1年后进行遵医行为和满意度调查.[结果]实验组病人遵医行为、满意度明显高于对照组,差异具有统计学意义(P＜0.01).[结论]定期出院回访可提高病人遵医行为和满意度,制订合理有效的家庭护理措施,对促进医患关系和谐、提高病人生活质量具有积极意义.     

53例护理纠纷原因分析及对策

目的总结2 a来处理护理纠纷的经验,提出减少护理纠纷的策略及如何处理护理纠纷。方法回顾分析我院2003-2005年53例护理纠纷的处理过程。结果53例护理纠纷中,50例经过积极的调查、解释、书面回复等处理后院内解决;1例上诉法院(院方胜诉);因护理过失行为与患方协商经济补偿2例。结论减少护理纠纷有赖于对纠纷原因的查找,及时堵塞漏洞;及时化解护理纠纷有赖于对护理纠纷的处理技巧和相关科室知情者的大力协助及密切配合。     

58例医疗纠纷尸体解剖病理学分析

目的:探讨涉及医疗纠纷病人死亡的原因,分析死亡所发生的病理学特点。方法:对58例不明死因的尸体进行系统解剖与组织病理学检验,部分做法医学毒物分析。结果:在58例尸检中,病理性死亡52例,心血管系统疾病最多,其次为呼吸系统疾病;机械性外力导致死亡4例。猝死42例。结论:科学的尸体解剖,准确的死因分析,不但为医疗事故的鉴别、判定及医疗事故的处理提供医学依据,而且丰富和发展了相关临床学科的内容。