Go homepage(回首页) Upload pictures (上传图片) Write articles (发文字帖)
The author:(作者)hpmailerpublished in(发表于) 2013/11/17 8:55:31 Doctor-patient dispute inventory： doctors to discourage jumping skull was hit by the bursting of
If the disputes between doctors and patients, is just one manifestation of the doctor-patient contradiction and conflict between doctors and patients, did not dispute, but reflected attitudes of apathy, distrust between patients and doctors, and hospitals feel the pressure even more. Making hospitals more "grievance" is that hospitals now more as a psychological catharsis of places, there is no way to reason with patients. With all the more reason: "I pay a doctor, why do not have access to good health services? "And where are your patient grievances? Some experts believe, it is doctors and patients, on the economic factors caused by the opposition. Intern Gu Jinjuan modern Express Reporter Liu Jun
Why in the hospital would fight
Doctors often have
Last week, a level-III hospital in Nanjing there is a "little thing", but ask a nurse with 26 years experience, feeling very aggrieved, call modern Express, Express has something to say. Modern express trail library, is seen in patients with complaints against hospitals, doctors complaints in patients with very rare indeed.
It's simple, a patient would like to doctor's Office Chair onto the ward. The nurse thinks is disallowed by rules and regulations, go and stop, and drag the Chair back to the Office. Think nursing in patients with poor attitude. The nurse said, it's hospital policy. Both sides ended a bit unpleasant, pushing and shoving.
Last month, the doctors of Tongren hospital in Nanjing, was a drunk patients injured. 3 in 4 incisors serious loosening and right faces obvious traces have ever kicked by shoe prints left. Diagnostic report is a head concussion of brain surgery, and there are multiple signs of bruises were. Only 1 year of work extremely wronged. In fact, Nanjing tertiary hospital emergency-room doctors, most of them have been hit or abuse experiences. Department Director was beaten.
Earlier this year, neurosurgical wards of hospitals of traditional Chinese and Western medicine in Jiangsu Province, patients with a doctor who was struck with a cane, has been in a coma, skull and ejected the head up to 13 cm, surgery where 12 stitches. Reason is because patients have to "jump" to see a doctor.
A three-level specialist hospital wards in Nanjing, the ward a few nurses, they have a common habit is not to have long hair. The first half of 2011, family linen, slow enough nurses, nursing a slap in the face. Nurses were scared silly, so to call her family, family apology from the patients ' family members, the family nurse is considered attitude problem, also called the five or six people to both sides a lot of disputes. Excited family members rushed to rip hair off a lot of nurses, wounded in her family. Though calm down after the patients ' relatives saw the police coming, also gives nurses an apology and pay his medical bill, but leaving nurses psychological shadow did not eliminate, which nurses and several colleagues dare not long hair.
A University Hospital office worker told reporters that they each year, a dozen doctors and nurses have been incidents, some really is because of the little things.
Economic rivalry, dead lump?
Recent killing case in Wenzhou, once again shaken society, also make the tense relationship between doctor and patient become a focus topic again: in the eyes of patients, doctors why become "White Wolf"?
Hu Xiaoxiang, Vice President of Jiangsu provincial health law Institute believes that the formation of negative image and don't get all parties "do not understand reason." First, the functioning of basic medical security is far from in place, making doctors and patients in the service process of forming an undeniable economic rivalry, there can be no harmony. Existence and development of public hospital funding, over 90% from services, that is, in fact, from the economic factors between patients and doctors, this shift is a rivalry.
"Everything about money, hyped-up, angry stare are inevitable. "Hu Xiaoxiang said.
Modern Express Reporter, and the hospital continues to be a "drug to medical care" model, this model, I always have doubts about the nature of hospital patients. Even if it is a three-tier public hospitals must also "make money" in order to maintain the operation of hospitals.
For economic reasons, but also caused landslide in professionalism
Zhang zannin Southeast University Health Law Institute says, "which I was consistently recognized. Medical ethics than the last century now the 670. "At that time, national medical is almost full funding, hospitals need to find their own food. Medical care after being pushed into the market, funding has not increased, but diminished, hospitals have to find something to eat. "I think the medical is not on the market. Medical market, resulting in a landslide in medical ethics. "Right now, medical technology is worthless, do surgical charge a one thousand or two thousand Yuan is already pay very high, but a device is moving thousands of tens of thousands of dollars. Doctor's work does not reflect their values, also caused landslide in medical ethics.
Lack of green channel, the patient felt unsupported
Medical dispute, will lead to more intense conflicts and even "small big".
Director, Office of medical malpractice in Jiangsu province said Jiang Shihao, an objective fact is the current social contradictions of medical disputes, medical disputes in medical service, key government departments to deal with the aspirations of the people, to creation of an initiative for the community involved in disposal of medical dispute a "green channel", and made the whole society open. Disputes between doctors and patients don't get resolved quickly, that is causing the major cause of disputes lead to conflicts between doctors and patients. He said that, although currently there are doctor-patient consultations, administrative departments of public health, the people's mediation, litigation and other means, but they are passive. Involved disputes cannot be done the first time, consultation, and certainly not solve medical disputes between doctors and patients in particular ways, people's mediation system is "consensual" principle. When medical events cause damage, psychologically anxious, excited, there is not a first time "active intervention" and authoritative institutions and staff to help them, will undoubtedly spark patients ' dissatisfaction.
Jiang Shihao said treatment of the traffic accident is obviously different, sometimes despite the casualties, but police first arrived at the scene, identify and provide support. Medical dispute would lack the "green channel". Patients in the hospital when you are alone, just used the hard way to be resolved.
Ningbo mode can learn from
It is learnt that, as early as several years ago, Ningbo has established the mediation of medical dispute of "green channel", "green passage" exactly who is responsible for what? Jiang Shihao said Government departments would give "disposal of medical dispute settlement Center" certain powers, is responsible for handling medical disputes solely by the disposal of claims processing center. Disposal of claims processing centre will be recruited a number of clinical medicine, health law, insurance and other professional qualified full-time staff, also hired medical experts and legal experts, investigation, assessment and consultation for medical dispute provision of technical advisory services, truly orderly justice in dealing with medical disputes.
Jiang Shihao said disposing of claims centers turning passive into active processing, the first time the intervention, on duty 24 hours, reach a conclusion within a certain time, and how to deal with a set of procedures and provisions, which to a large extent, not only improves the efficiency of medical disputes, is also recognized by the society and the parties concerned.
Jiang Shihao says medical disputes in medical assessment is a clear right and wrong ways of scientific objectivity, fairness and impartiality of the truth, is the important basis for dealing with medical disputes and medical identification cases in recent years in increasing year by year. He expressed the hope that Government departments will be able to establish an initiative to intervene in disposal of medical dispute in the green channel, appealing platform of medical disputes, medical disputes followed by hope can learn from medical examiner to judge of right and wrong after taking normal protection methods.
Hospitals in high risk Department
Because there are many uncontrollable or difficult to control risks and accidents, doctors almost became a "high risk". In many of the hospital's departments, some sections "risk index" may be much higher. One expert told reporters: "hospitals are orthopedics, Gynecology and obstetrics medical tangle-sensitive sections. ”
Journalist had published an information display, in 2012, in Nanjing, Jiangsu Province, accepted a total of 104 cases of medical malpractice identification, identification issued report of 98 cases, more than half of which involved third-level medical institutions. More than 98 cases involving discipline of more than 20 mainly: orthopedics, 20; 7 cases in neurology; 6 cases in neurosurgery; all 5 patients of general surgery, urology, obstetric, cardio-thoracic surgery in 4 patients each.
One expert said: "the above sensitive sections for medical disputes Department. Also, in addition to emergency department often doctors and nurses have been called, although it may claim to medical disputes, but prone to doctors and patients shied away. ”
Nanjing, a specialist in communication between doctors and patients say, compared with the average Department, orthopedics more intuitive, patients can see and feel the effects and conditions of orthopaedic medicine ' necessary ' and patients ' understanding of differences. "In the hands of patients also have so-called ' evidence ' is the film, some patients can understand, do not think the bones are good, healing is not good. “
Gulou district, Nanjing full-time mediator Li Fenghua said disputes between doctors and patients, and some doctors say too full that "commitments will be able to walk after surgery, they lay down not for several months. Doctor movies one day, bones and everything is right, but some patients stand up. ”
It is another high risk departments of obstetrics and Gynecology, experts say, and sick patients presenting different maternal is healthy, and if deviations occur in the breeding, production processes, and psychologically difficult to accept.
如果说医患纠纷，只是医患矛盾的一个表现，那么有的医患冲突，真的称不上纠纷，但是反映出来医患之间冷漠、互不信任的态度，则更让医院感到压力大。让医院更“委屈”的是，医院现在更多成为一种心理宣泄的场所，没有办法和患者讲道理。患者则更有理由：“我花钱看病，为啥得不到好的医疗服务？”患者的怨气又是从哪里来呢？有专家认为，这是医生和患者，在经济要素上的对立造成的。实习生 顾金娟 现代快报记者 刘峻
进了医院为何会吵架
打医生经常有
上周，南京一家三级医院发生了一件“小事情”，却让一位有着26年经验的护士，感觉非常委屈，主动打电话给现代快报，表示有话要说。在现代快报的线索库中，多见的是患者投诉医院，医生投诉患者的确实非常少见。
事情很简单，一位病人想把医生办公室的椅子拖到病房。这位护士认为是规章制度不允许的，上前制止，并将椅子又拖回到办公室。患者认为护士态度差。护士说，这是医院里的规定啊。双方最后还发生了一点不愉快，推推搡搡。
上个月，南京同仁医院的医生，被一名醉酒患者打伤。4颗门牙中3颗严重松动，右脸部还明显留有被鞋子踢过的鞋印痕迹。脑外科诊断报告是头部有脑震荡，身上也有多处被打淤青的痕迹。工作才1年的医生非常委屈。实际上，南京三级医院急诊室的医生，大部分都有被打或者辱骂的经历。有的科室主任被打得鼻青脸肿。
今年初，江苏省中西医结合医院的神经外科病房，一名医生被患者用拐杖击打，已经处于昏迷状态，头部颅骨迸裂达13厘米，手术缝了12针。被打的原因，是因为患者要“插队”看病。
南京一家三级专科医院某病区，该病区有几名护士，她们有个共同的习惯就是不留长头发。原来2011年上半年，家属要求更换床单，嫌护士速度慢，就打了护士一耳光。护士当时吓傻了，于是打电话给她家人，家人来了要求患者家属道歉，家属则认为护士态度有问题，也叫了五六个人来，双方发生了较大的争执。激动的患者家属冲上去把护士的头发给揪掉不少，把她家人也打伤了。虽然最后患者家属看到警察来后冷静下来，也给护士赔礼道歉并赔了医药费，但给护士留下的心理阴影却没有消除，此后该护士和几个同事就不怎么敢留长发了。
一名大医院办公室人员告诉记者，他们每年都有十几起医护人员被打事件，有的真的就是因为小事情。
经济上的对立，成死疙瘩？
最近发生的温州杀医案，又一次震动社会，也使本就紧张的医患关系再度成为焦点话题：在患者的眼里，医生为何变成了“白衣狼”？
江苏省卫生法学会副会长胡晓翔认为，这个负面形象的形成不能全怪患方“不懂道理”。 首先，基本医疗保障职能履行远不到位，使得医患在服务过程中形成不可否认的经济上的对立关系，这就不可能和谐。公立医院生存与发展的资金，九成以上来自于服务创收，也就是说，事实上，医患之间于经济这个要素上，就是个此消彼长的对立关系。
“凡事一谈钱，吹胡子瞪眼、睚眦必较就在所难免。”胡晓翔说。
现代快报记者了解到，目前医院仍然是一种“以药养医”的模式，这种模式免不了让患者对医院的性质有所怀疑。即使是三级公立医院，也必须靠“挣钱”才能维持医院的运转。
经济上的原因，还会造成医德医风滑坡
东南大学卫生法学研究所所长张赞宁说：“这一点我是一贯承认的。现在的医德医风不如上世纪六七十年代。”那个时候，国家对医疗几乎是全额拨款的，医院不需要自己找饭吃。而医疗被推向市场后，拨款不是增加了，而是减少了，医院要自己找饭吃。“我认为，医疗是不能推向市场的。医疗推向市场，造成了医德医风滑坡。”现在，医疗技术不值钱，做个手术收个一两千元已经是收得很高了，但是一个器械却动不动几千上万元。医生的劳动没有体现自己的价值，也会造成医德医风的滑坡。
缺乏绿色通道，患者感到孤立无援
医疗纠纷，会酿成更激烈的冲突，甚至“小事成大事”。
江苏省医学会医疗事故鉴定办公室主任蒋士浩说，医疗纠纷是当前社会矛盾一个客观存在的事实，有医疗服务就会有医疗纠纷，关键是政府部门要正确对待人民群众的诉求，要为社会建立一个能主动介入医疗纠纷处置的“绿色通道”，并让全社会能够接受。其实医患纠纷得不到快速解决，就是导致医患纠纷容易酿成冲突的重要原因。他说，目前虽然有医患协商、卫生行政部门处理、人民调解、诉讼等途径，但都是被动接受。不能做到第一时间介入纠纷，尤其医患协商更不是解决医疗纠纷的办法，人民调解机制也是“双方自愿”原则。当患方面对医疗事件造成的损伤，心理上肯定是着急、激动，此时没有一个第一时间“主动介入”并具有权威性的机构和人员去帮助他们，必然会引发患方的不满。
蒋士浩说，交通事故的处理就显然不一样，有时虽然发生的伤亡重大，但是交警部门会第一时间赶到现场，进行鉴定并提供各种支持。医疗纠纷就缺乏这样的“绿色通道”。患者在医院感到孤立无援后，就想着用激烈的方式来获得解决。
宁波模式可以借鉴
据悉，早在几年前，宁波就已成立了调解医疗纠纷的“绿色通道”，“绿色通道”到底由谁来负责处理呢？蒋士浩说，政府部门会赋予“医疗纠纷处置理赔中心”一定的权力，由处置理赔中心全权负责处理医疗纠纷。处置理赔中心会自行招聘一批临床医学、卫生法学和保险等专业资质的专职工作人员，还会聘请相关医学和法律专家组建专家库，为医疗争议的调查、评估和协商提供技术咨询服务，真正做到有序公正地处理医疗纠纷。
蒋士浩说，处置理赔中心把被动处理变为了主动处理，第一时间介入，二十四小时值班，一定时间内作出结论，并对如何作出处理有一整套程序和规定，这在很大程度上不仅提高了医疗纠纷的处理效率，也得到社会和当事人的认同。
蒋士浩说， 医学鉴定是一个澄清医疗纠纷是非真相的科学客观、公平公正的途径，是处理医疗纠纷的重要依据，省医学会近年来鉴定的案例逐年增长。他希望政府部门能为社会建立一个主动介入医疗纠纷处置的绿色通道，让医疗纠纷诉求有平台，其次是希望发生了医疗纠纷后能借鉴医学鉴定对是非的评判走正常的维权途径。
医院里那些高危科室
因为有着许多不可控，或者难控的风险和意外发生，医生几乎成了一种“高危行业”。而在医院众多的科室中，一些科室“危险指数”要更高一些。一位专家告诉记者：“医院内骨科、妇产科都是医疗纠纷敏感科室。”
记者拿到的一份资料显示，2012年，江苏南京市，共受理了医疗事故技术鉴定104例，98例出具鉴定报告，其中一半以上涉及到三级医疗机构。98例中涉及的学科20余个，主要分布：骨科20例；神经内科7例；神经外科6例；普外科、泌尿外科各5例；产科、心胸外科各4例。
一名专家表示：“以上科室为医疗纠纷敏感科室。另外还要加上急诊科，经常有医护人员被打，虽然可能称不上医疗纠纷，但是医患确实容易出现过激举动。”
南京一位医患沟通专家说，与一般的科室相比，骨科比较直观，患者可直接看到、感受到治疗效果和情况，而骨科医学上的‘愈后’与患者的理解常会存在差别。”患者手里还有所谓‘证据’，就是片子，有的患者也能看得懂，认为骨头就是没有接好，愈合也不好。“
南京鼓楼区医患纠纷专职调解员李凤花说，有的医生话说得太满，“承诺术后就能下地走路，结果人家一躺几个月都没有起来。医生拿片子过来一看，骨头什么的都接得对的，但有的病人就是站不起来。”
妇产科则是另外一个高危的科室，专家说，与带病就诊的患者心态不同，孕产妇是健康人，在孕育、生产过程中若出现偏差，心理上就很难接受。
赞