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1、What can be trust?The combined survey of medical accidents and medical errorsLi Benfu, Cong Yali, Sun Fuchuan, Chen Xiaoyang, Chen Pei, Zhu Kangmei, Fan Mingsheng & Zhou HongzhuOutlineThe current situation of medical accidents in China The survey of medical errors in 2008What can medical professiona
2、lism do for patient safety?Medical accidents medical errorsMedical accidents are 医疗事故是指在诊疗护理过成中，因医务人员诊疗护理过失，直接造成人员死亡、残废、组织器官损伤导致功能障碍的。Be classified into 4 gradesSubjective and objective reasonsErrors, disobey rules, cause harmMedical errors is dereliction of duty and technological negligence in the
3、process of 医疗差错是指在诊疗护理过成中，医务人员虽有失职行为或技术过失，但未给病员造成死亡、残废、组织器官损伤导致功能障碍的不良后果。The reasons of medical accidents26 cases of a hospital in 2003Itemcasespercentage（%）misdiagnosis、missed diagnosis & delayed treatment623.1Operative indication choice, operation method and mishandling the observation after opera
4、tion1661.5Improper use of drugs and adverse reaction27.7Carelessness, disobey the concerned rules27.7The current states of medical accidents47.8% happens on holiday and in the eveningMost statistics shows that accidents happen often in the orthopedics, obstetrics and gynecology .Mainly elders and yo
5、uth Some statistics shows that there less accidents in the first level hospital than the second level, less in the second than the third level. But some survey shows the contrary results. The history of medical accidents in ChinaPeriod of exploration1949-1956. over punishment, limited compensation f
6、or patients. administrative mediation. Period of improvement1956-1965. Treat the medical errors more reasonably, but the radical phenomena does exist. Period of anarchy1966-1976. Culture Revolution. Period of legalization1978 to now。1987, Measures ; 2002, StatuesThe reality that patients faceMedical
7、 accidents are very few; most are medical errors“The experience of foreign courtiers to deal with medical errors”，Management Magazine of Chinese PLA Hospital. No.6, 2002：In U.S.A medical errors rank 8th in the death reasons. In China, major factors for medical error are: skills, incompetence, faulti
8、ness of the basic regulations and imperfect supervision The attitude of physicians to medical errorsthe combined survey in Harbin, Beijing, Jinan, and ShanghaiSharing resultssample （396）beijing：140（眼科、产科等）shanghai：58（内科和外伤）jinan：100（妇儿、外科、内总、五官、，门诊各20）harbin：985.According to your observation, the ra
9、te of medical error around you?A. 05% B.510% C.1015% D.其他：如 %90%以上选择以上选择A. One special point, beijing baby delivery：38.8% select B，or C。Harbin pediatrics: 37.5%6.After medical error happened, you found how your colleagues to deal withA.dont let leader knowsB dont let colleague knows C.dont tell pati
10、ent first, but observe and check carefully D.Tell department, but keep secret to outside E.others： 选择C：33.3% 【132（396）】选择D： 36.4% 【144（396）】7.Do you once make medical error? if yes, who you once tell：A.colleague；B leader. C.lower colleague；D. family；E.patient；F.others选择A和B居多，其中B要多于A。 B A8.IF happene
11、d by yourself, how much percent you should take responsibility? %，other factors, please fill at least three itemsMost: 10-20%。One eldest，73 yrs, he answered 50-60%。Other factors：patient not cooperation, work pressure, too tired, complicated disease, not developed system of rule and regulation, and t
12、he work exchange time. eg. Some patients not polite, and rude, so physicians very worried, and usually esay to make something wrong9.If dont want to tell colleage and leader, what is the main reasonsA. afraid leader think uncompetent；B. afraid colleague think lower level; C. afraid affect the promot
13、e of position D. afraid punishment on bonus Eothers明显地，选择A C和D疑问：现实中的医生差错发生，与相继的医院、科室对其的经济处罚，到底是否进行了客观的区分和考虑10. If dont want to tell patient, the reasons：A.sue, court；B.tell the media C.not necessary to tell pt D.others：reason：pt will not understand physicians, dont trust physician, quarrel, hit doc
14、tor, sue doctors.（nothing is impossible）Special pointHard to answer, some not serious, or one take several questionnairesBut still there exist many true response. Something like communicate with themDifferent depts, and hospitals, sometimes can show the obvious differences. If sample large enough, c
15、an find some factors related to hospital education environment, and different hospital rules and its relationship with medical error医疗差错对待，医师职业精神的核心问题之一谁的利益至上？新型的利益冲突患者生命安全利益 Vs 医生的经济利益和名誉等其他利益目前不利的表现：观念上的扭曲都清楚这是客观存在的事实，但又认为不能“承认”；行政管理措施：报告则意味着处罚经济和名誉（如美国的高额赔付的风险赔偿机制也在一定程度上制约着医疗事故的自愿报告；我国的“面子”方面、“被歧
16、视”等心理；有空子可钻：不报告有可能对自己没有负面的影响。客观上，不信任的医患关系，更加阻碍了医疗差错的报告，也因此丧失了医生从差错中学习的机会。我国，仍然缺乏认错、反省、互相理解等机制和传统。患者对差错也缺乏客观的认识。Share experienceShouldnt inform the patients. Otherwise it will lead such results: misunderstanding by patients, mistrust by patients, quarreling with doctors, prosecution, battery, etc. （n
17、othing is impossible）Dont report to the hospital administrators. Otherwise you will be punished. Whose interests are first? New model of interests conflicts: patients safety vs. doctors interests Some adverse phenomena：Distortion of ideasit is objective, but some do not accept it.Administrative meas
18、ures: report means punishmentExploit an advantage. There are some bad effects with no report.Objectively, the mistrust between doctors and patients hinders the report of medical errors. So doctors lose the chance to learn from the errors. There is no tradition of misknow, reflection and mutual under
19、standing. Patients have no objective knowledge of medical errors. What can be trust for patient safety？Foreseeable：dealing with accidents, compensation, report of medical errors, building the safety system, the team work, etc. Unforeseeable ：the attitude to medical errors, the psychological stats af
20、ter errors, etc. The construction of Error report systemvisible任仲杰，the report system of medical error and medical accident in U.S ，中华医院管理杂志，2006年06期In U.S, there are more and more evidences that the report system of medical error and medical accident would promote the medical quality and security. I
21、t is adopted in mostly hospitals. Peter Singer etc，The ethical dilemma medical error and medical culture，An ethical dilemma-Medical errors and medical culture- 2002年03期 Commentary: Learning to love mistakesDoctors are obliged to be honest with their patients the atmosphere of trust, understanding in
22、visibleWhat can be done for medical professionalism on medical error Take more objective education on medical error to medical students Educated differently -for physicians, for hospitals, for patients, for doctor-patient understanding etc.Constitute for the long term doctor-patient relationship wit
23、h understanding and trust, so we can create medical humanity idea Changing the culture of blamewhether a culture, in which there is more trust and security between doctor and patients, can be constructed? Changing the culture of blaming doctors only (excluding the subjective factors like responsibility ) ?
