儿科医疗纠纷成因及医疗防御对策研究
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摘要
近年来儿科医疗纠纷的发生率呈明显增高趋势,医疗侵权诉讼的数量急剧上升,紧张的医患关系使矛盾不断升级,暴力冲突时有发生。频频发生的医疗纠纷严重干扰医疗机构和科室正常的工作秩序,成为社会关注的热点和焦点。
为了更好的控制儿科医疗纠纷的发生,将儿科医疗纠纷化解于萌芽状态。如何建立良好的儿科医患关系以及风险管理防御体系,有效的防止医疗纠纷的发生,达到为患儿治病、维护和谐医疗环境的目的成为了我们研究的重点。
目前国内对于医疗纠纷的研究主要集中在探究现有医疗执业环境下医疗系统整体的医疗纠纷成因及防范处理。针对某一科室医疗纠纷成因的系统研究,尤其儿科医患关系及医疗纠纷的研究甚少,以往的研究主要集中在护患关系上,针对儿科医务人员整体与患方关系及纠纷成因的研究,以及医疗机构针对儿科纠纷防御体系的构建更是空白。
本论文选取长春市和杭州市作为研究区域,通过对两市儿科专门医院以及设有儿科的省级以上综合医院的医务人员以及患者家属进行具有针对性,较为具体详实的问卷调查,了解我国南北方地区儿科医患关系现状。在比较和分析的基础上,阐述当前儿科医疗纠纷的原因,揭示儿科医患关系中存在的不和谐因素。经过相关文献的查阅,此种南北地区对比分析儿科医患关系、医疗纠纷的研究方法尚属首次,这也是本文的创新点所在。
本论文结合我国基本国情,适用责任承担理论下医师注意义务以及医疗工作归因理论,通过对两地区医务人员及患者家属调查问卷进行统计分析,依据现有的医疗纠纷处理方面的法律法规,针对儿科提出减少或避免医疗纠纷的方法和措施。为进一步研究儿科医疗防御,实现对儿科医疗纠纷的干预和阻断,建立有效控制医疗纠纷法律体系提供建议,旨在建立完善的儿科医疗纠纷防御体系。
In recent years, It show significantly increasing trend of the pediatric medical disputes and the number of medical tort lawsuit is rising sharply.The strained doctor-patient relationship make contradictions grow in breadth and in depth Violence often occurred. The medical disputes,which have frequently happened interference the normal working order of the medical institutions and departments is becoming the focus of social attention.
In order to control the occurrence of pediatric medical disputes better and resolve it in the bud. Research interests included:how to create a good pediatric doctor-patient relationship and risk management defense system, effectively prevent the occurrence of medical disputes, attain the objectives of children treatment, and maintain harmonious medical environment.
In domestic the study of medical disputes focused on exploring the causes and prevention of medical disputes in the health system under the current medical practice environment. There are few of system researches on the pediatrics doctor-patient relationship and causes of pediatrics medical disputes. Previous studies focused on the nurses-patients relationship.
This thesis chose Changchun and Hangzhou as the study area. From the two cities of specialized hospital and above the provincial level with the pediatric medical staffs in general hospitals.we chose medical workers and family members of patients.Through the investigation by questionnaires, which were targeted,specific and detailed, to find out the current doctor-patient relationship in the South and North regions.
Explained the reasons of the current causes of the pediatric medical disputes and revealed the factors of disharmony pediatric medical disputes under the basis of comparison and analysis. After consulted the related literatures, it is the first time to analysis doctor-patient relationship and medical disputes comparison north and south area.This is also the innovative point of paper.
This paper combines the basic national conditions of China. It is suitable for the accountability theory for the doctor duty of care, and medical working attribution theory. After statistical analysis of the questionnaires by medical staffs and family members of patients of two cities, according to the existing dealing with medical malpractice laws and regulations, we proposed measures to reduce or avoid the methods and measures of medical disputes for the pediatrics. Establish and improve pediatric medical malpractice defense system.
为了更好的控制儿科医疗纠纷的发生,将儿科医疗纠纷化解于萌芽状态。如何建立良好的儿科医患关系以及风险管理防御体系,有效的防止医疗纠纷的发生,达到为患儿治病、维护和谐医疗环境的目的成为了我们研究的重点。
目前国内对于医疗纠纷的研究主要集中在探究现有医疗执业环境下医疗系统整体的医疗纠纷成因及防范处理。针对某一科室医疗纠纷成因的系统研究,尤其儿科医患关系及医疗纠纷的研究甚少,以往的研究主要集中在护患关系上,针对儿科医务人员整体与患方关系及纠纷成因的研究,以及医疗机构针对儿科纠纷防御体系的构建更是空白。
本论文选取长春市和杭州市作为研究区域,通过对两市儿科专门医院以及设有儿科的省级以上综合医院的医务人员以及患者家属进行具有针对性,较为具体详实的问卷调查,了解我国南北方地区儿科医患关系现状。在比较和分析的基础上,阐述当前儿科医疗纠纷的原因,揭示儿科医患关系中存在的不和谐因素。经过相关文献的查阅,此种南北地区对比分析儿科医患关系、医疗纠纷的研究方法尚属首次,这也是本文的创新点所在。
本论文结合我国基本国情,适用责任承担理论下医师注意义务以及医疗工作归因理论,通过对两地区医务人员及患者家属调查问卷进行统计分析,依据现有的医疗纠纷处理方面的法律法规,针对儿科提出减少或避免医疗纠纷的方法和措施。为进一步研究儿科医疗防御,实现对儿科医疗纠纷的干预和阻断,建立有效控制医疗纠纷法律体系提供建议,旨在建立完善的儿科医疗纠纷防御体系。
In recent years, It show significantly increasing trend of the pediatric medical disputes and the number of medical tort lawsuit is rising sharply.The strained doctor-patient relationship make contradictions grow in breadth and in depth Violence often occurred. The medical disputes,which have frequently happened interference the normal working order of the medical institutions and departments is becoming the focus of social attention.
In order to control the occurrence of pediatric medical disputes better and resolve it in the bud. Research interests included:how to create a good pediatric doctor-patient relationship and risk management defense system, effectively prevent the occurrence of medical disputes, attain the objectives of children treatment, and maintain harmonious medical environment.
In domestic the study of medical disputes focused on exploring the causes and prevention of medical disputes in the health system under the current medical practice environment. There are few of system researches on the pediatrics doctor-patient relationship and causes of pediatrics medical disputes. Previous studies focused on the nurses-patients relationship.
This thesis chose Changchun and Hangzhou as the study area. From the two cities of specialized hospital and above the provincial level with the pediatric medical staffs in general hospitals.we chose medical workers and family members of patients.Through the investigation by questionnaires, which were targeted,specific and detailed, to find out the current doctor-patient relationship in the South and North regions.
Explained the reasons of the current causes of the pediatric medical disputes and revealed the factors of disharmony pediatric medical disputes under the basis of comparison and analysis. After consulted the related literatures, it is the first time to analysis doctor-patient relationship and medical disputes comparison north and south area.This is also the innovative point of paper.
This paper combines the basic national conditions of China. It is suitable for the accountability theory for the doctor duty of care, and medical working attribution theory. After statistical analysis of the questionnaires by medical staffs and family members of patients of two cities, according to the existing dealing with medical malpractice laws and regulations, we proposed measures to reduce or avoid the methods and measures of medical disputes for the pediatrics. Establish and improve pediatric medical malpractice defense system.
引文
[1]卫生部公布第四次国家卫生服务调查主要结果http://www.moh.gov.cn /publicfiles/business/htmlfiles/mohbgt/s3582/200902/39201.htm
[2]刘雅莉,景涛,田金微.新西兰医疗风险防范及监管机制现状的循证评价——完善诉论体系,防范医疗风险[J].中国循证医学杂志,2006,6(9)：673-681.
[3]郑雪倩,魏亮瑜,张宝珠,王旭,王霞.国内医疗纠纷调查与国外医疗纠纷处理[J].中国医院,2007,7(11)：2.
[4]儿科医疗纠纷的思考与对策http://www.slrmyy.com/script/news/ Detail.asp? N_ID=640
[5]段建华,王惠珊.中国流动儿童分布及卫生保健状况[J].华南预防医学,2010,(1)：57-60.
[6]张亨菊,李耀.美国儿童保健概观[J].山东医科大学学报(社会科学版),1994,(4)：35-37.
[7]张辉,张颖,宋桂德,李佳萌.自动出院危重婴儿死亡漏报追踪调查[J].中国慢性病预防与控制,2007,(4)：390-391.
[8]陈美雅.医疗纠纷诉讼外解决机制比较研究[J].法律与医学杂志,2006,(3)：181-190.
[9]Thoms Eric J:Incidence and Types of Adverse Events and Negligent Care in Utah and Colorado. Med Caer forthcoming spring 2000.
[10]卢瑞芬,谢启瑞.医疗经济学[M],学富文化出版社,2000：217.
[11]American Academy of pediatrics:Committee on Drugs and Com-mittee on Hospital care. Prevention of medication errors in thepediatric inpatient setting[J]. Pediatrics,1998,102:428-430.
[12]严运楼.国外儿童青少年医疗保障的实践与借鉴[J].中国学校卫生,2008,(5)：471-473.
[13]美国新法案扩大儿童医保范围,造福400多万儿童http://www.chinayhjf. com/article/2009/02/13/1234496313.html
[14]詹廖明义编著..医疗疏失的真相[M].安立出版社,2004,9：21.
[15]大城孟,福田弘,高岡正幸.医事纷争实务[M].京都：金芳堂,2004.7.3-6,166,7,56,4.
[16]植木哲著,冷罗生等译.医疗法律学[M].北京：法律出版社,2006,8：37,41.
[17]赵敏.日本医疗纠纷现状及法律处理评介[J].医院院长论坛,2010,(1)：59-63.
[18]奚晓明主编.《中华人民共和国侵权责任法》条文理解与适用[M],人民法院出版社,2010,1：385.
[19]2008年全国消协组织受理投诉情况统计分析http://www.cxnews.cn /gb/node2/scoop/node263/2009_315/node609/userobjectlai101731.html
[20]政府法制参阅(专报)2008年第129期.http://www.chinalaw.gov.cn/ article/dfxx/dffzxx/sh/zffzcvzb/200811/20081100117768.shtml
[21]印石.医患关系紧张程度及其原因——二论医患关系[J].卫生经济研究,2003(2)：14-16.
[22]郑雪倩,魏亮瑜,张宝珠,王旭,王霞.国内医疗纠纷调查与国外医疗纠纷处理[J].中国医院,2007,(7)：2-4.
[23]广东每年增加三成医疗纠纷http://life.dayoo.com/health/201102/23/60551_15317926.htm
[24]张红梅,彭淑梅,王波.儿科医疗纠纷原因分析与防范[J].现代医院,2008,8(5)：111-112.
[25]张文显,李步云.法理学论丛：第一卷[M].北京：法律出版社,1999：436.
[26]张会幈.不同侵权责任承担方式的构成要件[J].河北法学,2009,(5)：104-113.
[27]胡燕华主编.医疗事故的防范与处理法律实务[M].湖北：华中科技大学出版社,2003.
[28]古津贤主编.医疗侵权法论[M].吉林：吉林大学出版社,2008.
[29]杨传兰.不作为侵权责任承担的法理分析[J].西南农业大学学报(社会科学版),2008,(1)：29-32.
[30]熊进光.侵权行为法上的安全注意义务研究[M].法律出版社2007：18.
[31]张民安.现代法国侵权责任制度研究[M].法律出版社2007：181.
[32]李大平.医师注意义务的概念及其与医疗过失行为的关系——医师的注意义务系列研究(1)[J].法律与医学杂志,2004,(4)：278-281.
[33]李大平.医师注意义务产生的渊源——医师的注意义务系列研究(2)[J].法律与医学杂志,2005,(1)：8-11.
[34]刘文渊,刘永芳.归因理论在医护实践中应用的综述[J].实用医药杂志,2005,(4)：366-367.
[35]时蓉华.现代社会心理学[M].上海：华东师范大学出版社,2000.
[36]凯利的归因模型[J].中国医院院长,2006,(14)：78.
[37]郭振芳.归因理论研究综述[J].科技信息(科学教研),2007,(32)：215.
[38]史卫燕.归因理论流派及相关研究综述[J].消费导刊,2009,(20)：159.
[39]周晓虹.现代社会心理学[M].上海：上海人民出版社,1997.365.
[40]B·韦纳.论心理理论的建构和动机归因理论的整合[J].华东师范大学学报,教育科学版2001,(3)：17-29.
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[45]谢娟,朱方.积极防范和化解医疗纠纷努力构建和谐医患关系[J].中国医院管理,2008,28(6)：48-49.
[4]我国缺儿科医生逾20万培养机制空白12年http://www.lawtime.cn/news /radian/20110217/59133.html
[47]部分基层医院儿科出现萎缩医师面临老龄化难题http://www.chinadaily. com.cn/hqsj/shbt/2011-02-21/content_1810252.html
[48]梁勤儒,韩玲,贺素磊,李晶,李一明.正视综合医院儿科困境组建更多儿童医院[J].中国医院管理,2009,(5)：3-4
[49]罗刚,闫龑.综合医院儿科为何低谷徘徊[N].健康报,2006,6,7.
[2]刘雅莉,景涛,田金微.新西兰医疗风险防范及监管机制现状的循证评价——完善诉论体系,防范医疗风险[J].中国循证医学杂志,2006,6(9)：673-681.
[3]郑雪倩,魏亮瑜,张宝珠,王旭,王霞.国内医疗纠纷调查与国外医疗纠纷处理[J].中国医院,2007,7(11)：2.
[4]儿科医疗纠纷的思考与对策http://www.slrmyy.com/script/news/ Detail.asp? N_ID=640
[5]段建华,王惠珊.中国流动儿童分布及卫生保健状况[J].华南预防医学,2010,(1)：57-60.
[6]张亨菊,李耀.美国儿童保健概观[J].山东医科大学学报(社会科学版),1994,(4)：35-37.
[7]张辉,张颖,宋桂德,李佳萌.自动出院危重婴儿死亡漏报追踪调查[J].中国慢性病预防与控制,2007,(4)：390-391.
[8]陈美雅.医疗纠纷诉讼外解决机制比较研究[J].法律与医学杂志,2006,(3)：181-190.
[9]Thoms Eric J:Incidence and Types of Adverse Events and Negligent Care in Utah and Colorado. Med Caer forthcoming spring 2000.
[10]卢瑞芬,谢启瑞.医疗经济学[M],学富文化出版社,2000：217.
[11]American Academy of pediatrics:Committee on Drugs and Com-mittee on Hospital care. Prevention of medication errors in thepediatric inpatient setting[J]. Pediatrics,1998,102:428-430.
[12]严运楼.国外儿童青少年医疗保障的实践与借鉴[J].中国学校卫生,2008,(5)：471-473.
[13]美国新法案扩大儿童医保范围,造福400多万儿童http://www.chinayhjf. com/article/2009/02/13/1234496313.html
[14]詹廖明义编著..医疗疏失的真相[M].安立出版社,2004,9：21.
[15]大城孟,福田弘,高岡正幸.医事纷争实务[M].京都：金芳堂,2004.7.3-6,166,7,56,4.
[16]植木哲著,冷罗生等译.医疗法律学[M].北京：法律出版社,2006,8：37,41.
[17]赵敏.日本医疗纠纷现状及法律处理评介[J].医院院长论坛,2010,(1)：59-63.
[18]奚晓明主编.《中华人民共和国侵权责任法》条文理解与适用[M],人民法院出版社,2010,1：385.
[19]2008年全国消协组织受理投诉情况统计分析http://www.cxnews.cn /gb/node2/scoop/node263/2009_315/node609/userobjectlai101731.html
[20]政府法制参阅(专报)2008年第129期.http://www.chinalaw.gov.cn/ article/dfxx/dffzxx/sh/zffzcvzb/200811/20081100117768.shtml
[21]印石.医患关系紧张程度及其原因——二论医患关系[J].卫生经济研究,2003(2)：14-16.
[22]郑雪倩,魏亮瑜,张宝珠,王旭,王霞.国内医疗纠纷调查与国外医疗纠纷处理[J].中国医院,2007,(7)：2-4.
[23]广东每年增加三成医疗纠纷http://life.dayoo.com/health/201102/23/60551_15317926.htm
[24]张红梅,彭淑梅,王波.儿科医疗纠纷原因分析与防范[J].现代医院,2008,8(5)：111-112.
[25]张文显,李步云.法理学论丛：第一卷[M].北京：法律出版社,1999：436.
[26]张会幈.不同侵权责任承担方式的构成要件[J].河北法学,2009,(5)：104-113.
[27]胡燕华主编.医疗事故的防范与处理法律实务[M].湖北：华中科技大学出版社,2003.
[28]古津贤主编.医疗侵权法论[M].吉林：吉林大学出版社,2008.
[29]杨传兰.不作为侵权责任承担的法理分析[J].西南农业大学学报(社会科学版),2008,(1)：29-32.
[30]熊进光.侵权行为法上的安全注意义务研究[M].法律出版社2007：18.
[31]张民安.现代法国侵权责任制度研究[M].法律出版社2007：181.
[32]李大平.医师注意义务的概念及其与医疗过失行为的关系——医师的注意义务系列研究(1)[J].法律与医学杂志,2004,(4)：278-281.
[33]李大平.医师注意义务产生的渊源——医师的注意义务系列研究(2)[J].法律与医学杂志,2005,(1)：8-11.
[34]刘文渊,刘永芳.归因理论在医护实践中应用的综述[J].实用医药杂志,2005,(4)：366-367.
[35]时蓉华.现代社会心理学[M].上海：华东师范大学出版社,2000.
[36]凯利的归因模型[J].中国医院院长,2006,(14)：78.
[37]郭振芳.归因理论研究综述[J].科技信息(科学教研),2007,(32)：215.
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