基于医患关系的医务人员法律地位研究
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摘要
研究目的
在转型的社会背景下,医患关系虽然总体是好的,但局部出现的医患关系紧张情况正呈现出逐渐扩大的趋势,如何构建和谐的医患关系已成为社会的热点问题。原有的对医务人员法律地位的界定显然已不适应社会的现状和发展。因此明确医务人员的法律地位,理清医务人员的权利和义务,确定医务人员的责任范围和责任构成,对于保护医务人员合法权益,促进医患关系的理性与和谐具有重要意义。
研究方法
在文献查阅与分析的基础上采取定量与定性相结合的研究方法,对医患关系中医务人员的法律地位现状进行了研究。定量研究主要采用典型现场调查方法,选取武汉市2家三甲医院随机对其480名医务人员进行问卷调查；选择武汉市1家三甲医院随机对其420名门诊和住院患者进行问卷调查。对所有现场调查的问卷进行编码赋值后采用Epidata3.1完成双人双机录入,随后导入SPSS12.0统计软件对数据进行统计学分析,主要是描述性分析、卡方检验。此外还从湖北省卫生厅直接收集2005年和2006年两年“全省医疗纠纷调查情况汇总表”。定性研究包括对武汉市6位三级医院院长,6位卫生行政管理官员,4位司法机构法律专家以及3位大学法学教育的法律专家共19位专家进行的非结构化深度访谈；召集组织卫生官员、医院业务院长、医院医疗纠纷处理人员、临床科主任、医疗机构法律顾问各2人,一共10人就医疗职业环境、保护医务人员的法律地位的对策等有关问题进行专题小组讨论。
研究结果
1、医患关系中医务人员法律地位研究的内涵
将“医务人员”的范围界定为医疗机构中具有执业资格的各级各类医师、护士、药剂人员和其他卫生技术人员,不包括行政后勤人员；将研究范围限于医患关系中的医务人员法律地位研究。医患关系的法律性质,在某些特殊情况下属于行政法律关系,但在绝大多数一般情况下是一种平等的民事法律关系。在研究探讨一般医患关系中医务人员法律地位的时候,应全面综合考虑其在民事法律关系中的地位。但随着我国法制建设的不断健全和完善,以后建立专门的医事法来调整医忠关系将是一个趋势。对医患关系中医务人员法律地位的研究即是对医疗机构中具有执业资格的各级各类医师、护士、药剂人员和其他卫生技术人员在医患关系中享有的权利和承担义务进行研究。
2、实证研究分析结果
(1)问卷调查中医患双方认识上的异同：医患双方对法律赋予其自身的权利和义务的认知、医疗纠纷发生原因的认知、医疗纠纷处理的总体认识和发生医疗纠纷后最担心的问题上存在明显差异。但医患双方对医疗纠纷解决途径上选择基本相同,主要都是选择协商解决。
(2)调整医患关系的相关法律法规系统分析：我国目前尚无一部专门调整医患纠纷、医疗损害责任认定及赔偿标准的基本法律体系；现行法律对医疗机构及其医务人员的权利义务进行明确规定的只有《执业医师法》和《护士条例》,而其它一些法律条文只是在对医务人员执业行为和职责的规范规定中体现出医务人员的权利义务。总体来看医患关系中有8项医务人员应享有的权利和13项应履行的义务。通过立法分析再结合访谈和专题小组讨论的资料来看,医务人员权利保障缺失的问题比较严重,而如何依法妥善处理医疗纠纷是我国现阶段有效保障医务人员法律地位的关键。
3、医务人员法律地位的影响因素分析
影响医务人员法律地位的因素大体来说包括四大方面：(1)法律制度因素：立法上缺乏科学统一,对医务人员权利的规定相对于义务的规定来说偏少；司法上出现法律适用困境,程序繁琐,偏向患方；执法上对医务人员正当合法权益的保护力度不够。(2)社会因素：医疗卫生体制相对滞后,社会医疗保障体制不健全,保险制度缺失；我国医学教育模式存在缺陷；医学高新技术的发展给医患关系带来一些负面影响；社会信任危机严重,媒体和社会舆论导向不当。(3)医方因素：医疗质量存在缺陷；医务人员服务态度有待提高；医德医风存在问题；医疗机构医疗纠纷处理和防范制度不健全。(4)患方因素：患者对医疗的风险认识不足,其就医观念也发生了变化；患者的维权意识增强,医闹现象严重。
对策建议
1、加大国家法律保障
立法上要通过制定统一的医疗执业法来统一医患法律关系的性质,对医患双方权利义务进行统一立法规定,特别是要以全面发展的眼光将医师、护理人员、药剂师、其他卫生技术人员均纳入“医务人员”的范畴,对他们的权利和医务进行分类规定；要强调对医务人员人格尊严权和人身安全权的保护；在制定统一的执业立法时应重点解决高额赔偿和司法鉴定技术问题。此外还要健立健全医疗损害保险制度体系,将医疗责任保险和特殊医疗损害保险纳入法定保险。司法机关在司法过程中要不受其他因素影响,仅依照相关法律法规的规定,客观公正的做出判断,平等公正地对待医患双方。公安机关在执法过程中应加大对医务人员的保护力度,切实执行相关法律中对医务人员人身安全等基本权利保护的条款。
2、加强社会配套制度建设
政府要加快深化医疗卫生体制改革,加大对医疗卫生的投入,完善公立医院的补偿机制和运行机制；加快推进医疗保障体系建设；健全医疗纠纷多元化解决机制即第三方调解机制。医学院校应以现在新的生物医学心理模式进行医学教育模式的变革,在医学教育中加强人文素质教育；医疗机构也应在医务人员的继续教育中加强对医务人员的综合素质、相关法律法规等方面教育和培训。在整个社会中需要重建政府信任和人际信任；在大众舆论方面,重视对社会信任的宣传和引导；确保媒体舆论报道的客观公正性。
3、建立健全医疗损害保险制度
医疗损害保险制度分为“医疗责任保险”和“特殊医疗损害保险”两部分。“医疗责任保险”是相对于医疗损害责任主体——医方而言的,包括医疗机构和以医生为核心的医务人员的责任保险,是对医方医疗责任风险的保障。“特殊医疗损害保险”是相对于医疗损害相对人——患者而言的,具体包括医疗意外保险和严重并发症保险,是对患者疾病诊疗意外风险的保障。
4、加强医务人员自律维权
医疗机构要加强医疗纠纷处理制度建设,强化医务人员的法律意识,加强医务人员职业道德教育,提高医务人员素质和修养；要严格工作制度,加强医疗质量管理；建立一整套完善而严格的工作制度;建立医疗告知制度,做好与患者的沟通。
5、加强全社会和谐文化建设
建立良性的舆论监督机制,消除社会偏见；加强对患者医学和法制方面的教育和宣传；加强对患者自身权利和义务的教育和宣传；患者也应主动转变观念
Objective
In the context of social transformation, although physician-patient relationship is good generally, but the relations between doctors and patients show a rising trend year by year. How to build a harmonious relations between doctors and patients which has become a hot issue. The existing definition legal status of medical personnel apparently did not match the current status and development. Comparing with the reality changes, the concepts of changes have some lags, which make medical staff in a very awkward position, but also face many problems, so clearing the legal status of medical personnel, clarifying the rights of medical personnel and obligations, determining the responsibility scope of medical staff and responsibilities constitute, all of them as above are important to protect the legitimate rights and interests of medical staff, and promote the rational and harmonious relations between doctors and patients.
Methods
This study adopted qualitative and quantitative methods to analyse all of the data on the base of Literature Analysis, and author assimilated and analyzed some basic theoretical knowledge of the legal status related doctor-patient relationship and medical staff by literature search. We chose typical on-site investigation as quantitative research methods, and then questionnaire surveyd 480 medical personnels in two tertiary hospitals in Wuhan with typical on-site survey methods; and chose 420 out-patients and in-patients with questionnaire in a certain tertiary hospital in Wuhan. All of the questionnaire data were coded and valued assignment, and then used Epidata3.1 and SPSS 13.0 statistical software for statistical analysis; some of them mainly used descriptive analysis and chi-square test. In addition, we collect directly "the province's medical malpractice case investigation summary" between 2005 and 2006 from Health Department of Hubei Province. We discussed with six health administrative officials, six presidents of the tertiary hospitals, four legal experts of the Judiciary Law and three University of Education by unstructured interviews. And then, we collected Three hospital medical staff disputes, clinical directors of medical departments, and legal advisers by focus group discussions; interviewing six presidents of tertiary hospitals, four legal experts of the Judiciary Law and three University of Education, six health administrative officials by unstructured interviews. And then, we collect two Health officials, president of the hospital, the hospital medical staff disputes, clinical director of medical organizations, the legal adviser of the 2, a total of 10 people to the medical professional environment, protect the legal status of medical personnel issues related to countermeasures by focus group Discussion.
Results
1. The connotation of studies about legal status of medical personnel in doctor-patient relationship.
The author limits the boundary of "medical personnel" which includes doctors, nurses, pharmaceutical personnel and other health workers with any kind of license, and not administrative staff and support crew, and confines to study legal status of medical personnel in the doctor-patient relationship. I believe that the doctor-patient relationship in some special cases is administrative law relationship, but in most cases the general doctor-patient relationship is civil legal relationship. In the study of general the legal status of medical personnel in doctor-patient relationship, their legal status should be focused on the status of civil legal relations. Though, during ongoing perfect and complete legal system building, it will be a trend to build a specialized medical relative law to adjust doctor-patient relationship. The study about legal status of medical personnel is to study licensed doctors, nurses, pharmaceutical personnel and other health workers'right and obligation.
2. empirical research's analyzed outcomes
(1) cognitional difference between doctors and patients in questionnaire survey:there are obvious diversities among cause cognition about happening of medical tangle, total cognition about dealing with medical tangle and the most worried aspects after the happening of medical tangle. But doctors and patients choose the same ways, most of ways are compromise settlement, to solve medical tangle.
(2) systematical analysis about relative law and regulations to adjust doctor-patient relationship:in present, there is no specialized basic law system about adjust doctor-patient tangle, responsibility confirm and criteria for compensation for medical injury in China; The regulations and the impact of existing legal documents related to the rights and obligations of medical personnel regulations are systematically analyzed. Based on the interviews and panel discussions, considered the present practices of legislation and resolving medical disputes, it is believed that the missing of right guarantee of medical personnel still is a serious problem.
3. The results of empirical research and analysis
Through analyzing cognitive attitudes of medical staff and patients to medical dispute and the data of medical malpractice of Hubei Province provided by the Health Department, we can see that the self-evaluation of medical staffs own career is low and they hold a common recognition that the current doctor-patient relationship is tensely; most of the medical staff hold that the doctor-patient relationship is a special relationship of health care supply and demand, not the simple supply and demand relationship; the understanding of doctor-patient relationship from medical staff and patients are quite different; when medical dispute occurs, the medical institution and the patients are more inclined to negotiated privately to get the settlement, but not willing to take administrative mediation or judicial proceedings. And the patient usually requires medical institutions to provide financial compensation, and once the demands are not met, patients and their families will often take some damage to the legitimate medical institutions and medical personnel, such as the disrupting the normal order in medical institutions, even beating the medical staff.
4. The analysis of influencing factors on the legal status of medical personnel is based on summarization and analysis of quantitative and qualitative data. Influencing factors on the legal status of medical personnel were defined by this process. There are four major aspects, factors of institution of law, social factors,factors of hospital and staff and factors of patients.
(1) Factors of institution of law include the lack of unified laws, difficult dilemma of judicial application, lack of law enforcement on the protection of legitimate rights and interests of medical staff.
(2) Social factors include the lagging behind of health care system, the lack of sound social health insurance system, lack of insurance system; shortcomings of medical education model, some negative impact on doctor-patient relationship produced by medical high-tech development, society serious crisis of confidence, inappropriate media and public guide.
(3)Factors of hospital and staff include quality deficiencies of medical care, the poor attitude of medical staff, medical ethics problems, lack of sound medical treatment and prevention system.
(4)Factors of patients include the inadequate understanding of health care risk; the changing of concepts on medical treatment, the rights conciousness increased and bring serious medical trouble to the medical institution.
Conclusions and Suggestions
According to various factors of the legal status of medical personnel, this article proposes some suggestions that can protect the legal status of medical staff, generally speaking, there are five suggestions, first is to increase the national legal protection, second is to make more effort on the construction of social cooperative system, third is to establish insurance system against medical damages, forth is to strengthen the concepts for self-discipline and keeping rights of medical staff and the fifith is to improve the haromonious relationship between doctors and patients.
(1) strengthen the national legal protection, there are three aspects, establishing unified medical practising law by the legislative branch; treating doctors and patients equally and fairly in judicial process; protecting medical staff through law enforcement.
(2) make more effort on the construction of social cooperative system, there are seven aspects as followed, enhancing healthcare system reform, accelerating the construction of medical insurance system, improving the diversity of medical dispute resolution mechanism, changing patterns of medical education, rebuilding social trust, mechanism establishing sound administration system for patients' opinions and creating a harmonious relationship for doctors and patients.
(3)establish insurance system against medical damage,, which includes establishing both hospital liability insurance and special insurance against medical damages. The hospital liability insurance is for safeguarding the medical staffs, and the special insurance against medical damages is for the patients.
(4)strengthen the concepts for self-discipline and keeping rights of medical staff themselves, specifically including the following, to improve construction of medical dispute resolution system; to better the medical personnel's legal consciousness; to strengthen the ethics education on medical staff to improve the inner quality of medical personnel; to ensure strict system of work to strengthen the medical quality management; to establish medical inform system for patients to know their health situation; keep a good communication between doctors and patients.
(5)improve the heromonious relationship between doctors and patients, specifically including\medical knowledge promotion for patients; clearify the rights and obligations of patients; patients should try to change their attitudes on doctor-patient relationship.
在转型的社会背景下,医患关系虽然总体是好的,但局部出现的医患关系紧张情况正呈现出逐渐扩大的趋势,如何构建和谐的医患关系已成为社会的热点问题。原有的对医务人员法律地位的界定显然已不适应社会的现状和发展。因此明确医务人员的法律地位,理清医务人员的权利和义务,确定医务人员的责任范围和责任构成,对于保护医务人员合法权益,促进医患关系的理性与和谐具有重要意义。
研究方法
在文献查阅与分析的基础上采取定量与定性相结合的研究方法,对医患关系中医务人员的法律地位现状进行了研究。定量研究主要采用典型现场调查方法,选取武汉市2家三甲医院随机对其480名医务人员进行问卷调查；选择武汉市1家三甲医院随机对其420名门诊和住院患者进行问卷调查。对所有现场调查的问卷进行编码赋值后采用Epidata3.1完成双人双机录入,随后导入SPSS12.0统计软件对数据进行统计学分析,主要是描述性分析、卡方检验。此外还从湖北省卫生厅直接收集2005年和2006年两年“全省医疗纠纷调查情况汇总表”。定性研究包括对武汉市6位三级医院院长,6位卫生行政管理官员,4位司法机构法律专家以及3位大学法学教育的法律专家共19位专家进行的非结构化深度访谈；召集组织卫生官员、医院业务院长、医院医疗纠纷处理人员、临床科主任、医疗机构法律顾问各2人,一共10人就医疗职业环境、保护医务人员的法律地位的对策等有关问题进行专题小组讨论。
研究结果
1、医患关系中医务人员法律地位研究的内涵
将“医务人员”的范围界定为医疗机构中具有执业资格的各级各类医师、护士、药剂人员和其他卫生技术人员,不包括行政后勤人员；将研究范围限于医患关系中的医务人员法律地位研究。医患关系的法律性质,在某些特殊情况下属于行政法律关系,但在绝大多数一般情况下是一种平等的民事法律关系。在研究探讨一般医患关系中医务人员法律地位的时候,应全面综合考虑其在民事法律关系中的地位。但随着我国法制建设的不断健全和完善,以后建立专门的医事法来调整医忠关系将是一个趋势。对医患关系中医务人员法律地位的研究即是对医疗机构中具有执业资格的各级各类医师、护士、药剂人员和其他卫生技术人员在医患关系中享有的权利和承担义务进行研究。
2、实证研究分析结果
(1)问卷调查中医患双方认识上的异同：医患双方对法律赋予其自身的权利和义务的认知、医疗纠纷发生原因的认知、医疗纠纷处理的总体认识和发生医疗纠纷后最担心的问题上存在明显差异。但医患双方对医疗纠纷解决途径上选择基本相同,主要都是选择协商解决。
(2)调整医患关系的相关法律法规系统分析：我国目前尚无一部专门调整医患纠纷、医疗损害责任认定及赔偿标准的基本法律体系；现行法律对医疗机构及其医务人员的权利义务进行明确规定的只有《执业医师法》和《护士条例》,而其它一些法律条文只是在对医务人员执业行为和职责的规范规定中体现出医务人员的权利义务。总体来看医患关系中有8项医务人员应享有的权利和13项应履行的义务。通过立法分析再结合访谈和专题小组讨论的资料来看,医务人员权利保障缺失的问题比较严重,而如何依法妥善处理医疗纠纷是我国现阶段有效保障医务人员法律地位的关键。
3、医务人员法律地位的影响因素分析
影响医务人员法律地位的因素大体来说包括四大方面：(1)法律制度因素：立法上缺乏科学统一,对医务人员权利的规定相对于义务的规定来说偏少；司法上出现法律适用困境,程序繁琐,偏向患方；执法上对医务人员正当合法权益的保护力度不够。(2)社会因素：医疗卫生体制相对滞后,社会医疗保障体制不健全,保险制度缺失；我国医学教育模式存在缺陷；医学高新技术的发展给医患关系带来一些负面影响；社会信任危机严重,媒体和社会舆论导向不当。(3)医方因素：医疗质量存在缺陷；医务人员服务态度有待提高；医德医风存在问题；医疗机构医疗纠纷处理和防范制度不健全。(4)患方因素：患者对医疗的风险认识不足,其就医观念也发生了变化；患者的维权意识增强,医闹现象严重。
对策建议
1、加大国家法律保障
立法上要通过制定统一的医疗执业法来统一医患法律关系的性质,对医患双方权利义务进行统一立法规定,特别是要以全面发展的眼光将医师、护理人员、药剂师、其他卫生技术人员均纳入“医务人员”的范畴,对他们的权利和医务进行分类规定；要强调对医务人员人格尊严权和人身安全权的保护；在制定统一的执业立法时应重点解决高额赔偿和司法鉴定技术问题。此外还要健立健全医疗损害保险制度体系,将医疗责任保险和特殊医疗损害保险纳入法定保险。司法机关在司法过程中要不受其他因素影响,仅依照相关法律法规的规定,客观公正的做出判断,平等公正地对待医患双方。公安机关在执法过程中应加大对医务人员的保护力度,切实执行相关法律中对医务人员人身安全等基本权利保护的条款。
2、加强社会配套制度建设
政府要加快深化医疗卫生体制改革,加大对医疗卫生的投入,完善公立医院的补偿机制和运行机制；加快推进医疗保障体系建设；健全医疗纠纷多元化解决机制即第三方调解机制。医学院校应以现在新的生物医学心理模式进行医学教育模式的变革,在医学教育中加强人文素质教育；医疗机构也应在医务人员的继续教育中加强对医务人员的综合素质、相关法律法规等方面教育和培训。在整个社会中需要重建政府信任和人际信任；在大众舆论方面,重视对社会信任的宣传和引导；确保媒体舆论报道的客观公正性。
3、建立健全医疗损害保险制度
医疗损害保险制度分为“医疗责任保险”和“特殊医疗损害保险”两部分。“医疗责任保险”是相对于医疗损害责任主体——医方而言的,包括医疗机构和以医生为核心的医务人员的责任保险,是对医方医疗责任风险的保障。“特殊医疗损害保险”是相对于医疗损害相对人——患者而言的,具体包括医疗意外保险和严重并发症保险,是对患者疾病诊疗意外风险的保障。
4、加强医务人员自律维权
医疗机构要加强医疗纠纷处理制度建设,强化医务人员的法律意识,加强医务人员职业道德教育,提高医务人员素质和修养；要严格工作制度,加强医疗质量管理；建立一整套完善而严格的工作制度;建立医疗告知制度,做好与患者的沟通。
5、加强全社会和谐文化建设
建立良性的舆论监督机制,消除社会偏见；加强对患者医学和法制方面的教育和宣传；加强对患者自身权利和义务的教育和宣传；患者也应主动转变观念
Objective
In the context of social transformation, although physician-patient relationship is good generally, but the relations between doctors and patients show a rising trend year by year. How to build a harmonious relations between doctors and patients which has become a hot issue. The existing definition legal status of medical personnel apparently did not match the current status and development. Comparing with the reality changes, the concepts of changes have some lags, which make medical staff in a very awkward position, but also face many problems, so clearing the legal status of medical personnel, clarifying the rights of medical personnel and obligations, determining the responsibility scope of medical staff and responsibilities constitute, all of them as above are important to protect the legitimate rights and interests of medical staff, and promote the rational and harmonious relations between doctors and patients.
Methods
This study adopted qualitative and quantitative methods to analyse all of the data on the base of Literature Analysis, and author assimilated and analyzed some basic theoretical knowledge of the legal status related doctor-patient relationship and medical staff by literature search. We chose typical on-site investigation as quantitative research methods, and then questionnaire surveyd 480 medical personnels in two tertiary hospitals in Wuhan with typical on-site survey methods; and chose 420 out-patients and in-patients with questionnaire in a certain tertiary hospital in Wuhan. All of the questionnaire data were coded and valued assignment, and then used Epidata3.1 and SPSS 13.0 statistical software for statistical analysis; some of them mainly used descriptive analysis and chi-square test. In addition, we collect directly "the province's medical malpractice case investigation summary" between 2005 and 2006 from Health Department of Hubei Province. We discussed with six health administrative officials, six presidents of the tertiary hospitals, four legal experts of the Judiciary Law and three University of Education by unstructured interviews. And then, we collected Three hospital medical staff disputes, clinical directors of medical departments, and legal advisers by focus group discussions; interviewing six presidents of tertiary hospitals, four legal experts of the Judiciary Law and three University of Education, six health administrative officials by unstructured interviews. And then, we collect two Health officials, president of the hospital, the hospital medical staff disputes, clinical director of medical organizations, the legal adviser of the 2, a total of 10 people to the medical professional environment, protect the legal status of medical personnel issues related to countermeasures by focus group Discussion.
Results
1. The connotation of studies about legal status of medical personnel in doctor-patient relationship.
The author limits the boundary of "medical personnel" which includes doctors, nurses, pharmaceutical personnel and other health workers with any kind of license, and not administrative staff and support crew, and confines to study legal status of medical personnel in the doctor-patient relationship. I believe that the doctor-patient relationship in some special cases is administrative law relationship, but in most cases the general doctor-patient relationship is civil legal relationship. In the study of general the legal status of medical personnel in doctor-patient relationship, their legal status should be focused on the status of civil legal relations. Though, during ongoing perfect and complete legal system building, it will be a trend to build a specialized medical relative law to adjust doctor-patient relationship. The study about legal status of medical personnel is to study licensed doctors, nurses, pharmaceutical personnel and other health workers'right and obligation.
2. empirical research's analyzed outcomes
(1) cognitional difference between doctors and patients in questionnaire survey:there are obvious diversities among cause cognition about happening of medical tangle, total cognition about dealing with medical tangle and the most worried aspects after the happening of medical tangle. But doctors and patients choose the same ways, most of ways are compromise settlement, to solve medical tangle.
(2) systematical analysis about relative law and regulations to adjust doctor-patient relationship:in present, there is no specialized basic law system about adjust doctor-patient tangle, responsibility confirm and criteria for compensation for medical injury in China; The regulations and the impact of existing legal documents related to the rights and obligations of medical personnel regulations are systematically analyzed. Based on the interviews and panel discussions, considered the present practices of legislation and resolving medical disputes, it is believed that the missing of right guarantee of medical personnel still is a serious problem.
3. The results of empirical research and analysis
Through analyzing cognitive attitudes of medical staff and patients to medical dispute and the data of medical malpractice of Hubei Province provided by the Health Department, we can see that the self-evaluation of medical staffs own career is low and they hold a common recognition that the current doctor-patient relationship is tensely; most of the medical staff hold that the doctor-patient relationship is a special relationship of health care supply and demand, not the simple supply and demand relationship; the understanding of doctor-patient relationship from medical staff and patients are quite different; when medical dispute occurs, the medical institution and the patients are more inclined to negotiated privately to get the settlement, but not willing to take administrative mediation or judicial proceedings. And the patient usually requires medical institutions to provide financial compensation, and once the demands are not met, patients and their families will often take some damage to the legitimate medical institutions and medical personnel, such as the disrupting the normal order in medical institutions, even beating the medical staff.
4. The analysis of influencing factors on the legal status of medical personnel is based on summarization and analysis of quantitative and qualitative data. Influencing factors on the legal status of medical personnel were defined by this process. There are four major aspects, factors of institution of law, social factors,factors of hospital and staff and factors of patients.
(1) Factors of institution of law include the lack of unified laws, difficult dilemma of judicial application, lack of law enforcement on the protection of legitimate rights and interests of medical staff.
(2) Social factors include the lagging behind of health care system, the lack of sound social health insurance system, lack of insurance system; shortcomings of medical education model, some negative impact on doctor-patient relationship produced by medical high-tech development, society serious crisis of confidence, inappropriate media and public guide.
(3)Factors of hospital and staff include quality deficiencies of medical care, the poor attitude of medical staff, medical ethics problems, lack of sound medical treatment and prevention system.
(4)Factors of patients include the inadequate understanding of health care risk; the changing of concepts on medical treatment, the rights conciousness increased and bring serious medical trouble to the medical institution.
Conclusions and Suggestions
According to various factors of the legal status of medical personnel, this article proposes some suggestions that can protect the legal status of medical staff, generally speaking, there are five suggestions, first is to increase the national legal protection, second is to make more effort on the construction of social cooperative system, third is to establish insurance system against medical damages, forth is to strengthen the concepts for self-discipline and keeping rights of medical staff and the fifith is to improve the haromonious relationship between doctors and patients.
(1) strengthen the national legal protection, there are three aspects, establishing unified medical practising law by the legislative branch; treating doctors and patients equally and fairly in judicial process; protecting medical staff through law enforcement.
(2) make more effort on the construction of social cooperative system, there are seven aspects as followed, enhancing healthcare system reform, accelerating the construction of medical insurance system, improving the diversity of medical dispute resolution mechanism, changing patterns of medical education, rebuilding social trust, mechanism establishing sound administration system for patients' opinions and creating a harmonious relationship for doctors and patients.
(3)establish insurance system against medical damage,, which includes establishing both hospital liability insurance and special insurance against medical damages. The hospital liability insurance is for safeguarding the medical staffs, and the special insurance against medical damages is for the patients.
(4)strengthen the concepts for self-discipline and keeping rights of medical staff themselves, specifically including the following, to improve construction of medical dispute resolution system; to better the medical personnel's legal consciousness; to strengthen the ethics education on medical staff to improve the inner quality of medical personnel; to ensure strict system of work to strengthen the medical quality management; to establish medical inform system for patients to know their health situation; keep a good communication between doctors and patients.
(5)improve the heromonious relationship between doctors and patients, specifically including\medical knowledge promotion for patients; clearify the rights and obligations of patients; patients should try to change their attitudes on doctor-patient relationship.
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