1、醫療事故是指在診療護理過成中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 Hongzhu醫療事故是指在診療護理過成中Outline The current situation of medical accidents in China The survey of medical errors in

2、 2008 What can medical professionalism do for patient safety?醫療事故是指在診療護理過成中Medical accidents medical errors Medical accidents are 醫療事故是指在診療護理過成中，因醫務人員診療護理過失，直接造成人員死亡、殘廢、組織器官損傷導致功能障礙的。 Be classified into 4 grades Subjective and objective reasons Errors, disobey rules, cause harm Medical errors is der

3、eliction of duty and technological negligence in the process of 醫療差錯是指在診療護理過成中，醫務人員雖有失職行為或技術過失，但未給病員造成死亡、殘廢、組織器官損傷導致功能障礙的不良后果。醫療事故是指在診療護理過成中The reasons of medical accidents26 cases of a hospital in 2003Itemcasespercentage（%）misdiagnosis、missed diagnosis & delayed treatment623.1Operative indicati

4、on choice, operation method and mishandling the observation after operation1661.5Improper use of drugs and adverse reaction27.7Carelessness, disobey the concerned rules27.7醫療事故是指在診療護理過成中The current states of medical accidents 47.8% happens on holiday and in the evening Most statistics shows that acc

5、idents happen often in the orthopedics, obstetrics and gynecology . Mainly elders and youth 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. 醫療事故是指在診療護理過成中The histor

6、y of medical accidents in China Period of exploration1949-1956. over punishment, limited compensation for 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

7、. Period of legalization1978 to now。1987, Measures ; 2002, Statues醫療事故是指在診療護理過成中The reality that patients face Medical 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 me

8、dical errors rank 8th in the death reasons. In China, major factors for medical error are: skills, incompetence, faultiness of the basic regulations and imperfect supervision 醫療事故是指在診療護理過成中The attitude of physicians to medical errorsthe combined survey in Harbin, Beijing, Jinan, and ShanghaiSharing

9、results醫療事故是指在診療護理過成中sample （396） beijing：140（眼科、產科等） shanghai：58（內科和外傷） jinan：100（婦兒、外科、內總、五官、，門診各20） harbin：98醫療事故是指在診療護理過成中5.According to your observation, the rate of medical error around you? A. 05% B.510% C.1015% D.其他：如 %90%以上選擇以上選擇A. One special point, beijing baby delivery：38.8% select B，or

10、C。Harbin pediatrics: 37.5%醫療事故是指在診療護理過成中6.After medical error happened, you found how your colleagues to deal withA.dont let leader knowsB dont let colleague knows C.dont tell patient first, but observe and check carefully D.Tell department, but keep secret to outside E.others： 選擇C：33.3% 【132（396）】

11、選擇D： 36.4% 【144（396）】醫療事故是指在診療護理過成中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選擇A和B居多，其中B要多于A。 B A醫療事故是指在診療護理過成中8.IF happened by yourself, how much percent you should take responsibility? %，other factors, pleas

12、e fill at least three items Most: 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 the work exchange time. eg. Some patients not polite, and rude, so physicians very wo

13、rried, and usually esay to make something wrong醫療事故是指在診療護理過成中9.If dont want to tell colleage and leader, what is the main reasons A. afraid leader think uncompetent； B. afraid colleague think lower level; C. afraid affect the promote of position D. afraid punishment on bonus Eothers明顯地，選擇A C和D 疑問：現實

14、中的醫生差錯發生，與相繼的醫院、科室對其的經濟處罰，到底是否進行了客觀的區分和考慮醫療事故是指在診療護理過成中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 doctor, sue doctors.（nothing is impossible）醫療事故是指在診療護理

15、過成中Special point Hard to answer, some not serious, or one take several questionnaires But still there exist many true response. Something like communicate with them Different depts, and hospitals, sometimes can show the obvious differences. If sample large enough, can find some factors related to ho

16、spital education environment, and different hospital rules and its relationship with medical error醫療事故是指在診療護理過成中醫療差錯對待，醫師職業精神的核心問題之一誰的利益至上？ 新型的利益沖突患者生命安全利益 Vs 醫生的經濟利益和名譽等其他利益 目前不利的表現： 觀念上的扭曲都清楚這是客觀存在的事實，但又認為不能“承認”； 行政管理措施：報告則意味著處罰經濟和名譽（如美國的高額賠付的風險賠償機制也在一定程度上制約著醫療事故的自愿報告；我國的“面子”方面、“被歧視”等心理； 有空子可鉆：不報告

17、有可能對自己沒有負面的影響。 客觀上，不信任的醫患關系，更加阻礙了醫療差錯的報告，也因此喪失了醫生從差錯中學習的機會。 我國，仍然缺乏認錯、反省、互相理解等機制和傳統。患者對差錯也缺乏客觀的認識。醫療事故是指在診療護理過成中Share experience Shouldnt inform the patients. Otherwise it will lead such results: misunderstanding by patients, mistrust by patients, quarreling with doctors, prosecution, battery, etc.

18、（nothing is impossible） Dont report to the hospital administrators. Otherwise you will be punished. 醫療事故是指在診療護理過成中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.

19、Administrative measures: report means punishment Exploit 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, reflec

20、tion and mutual understanding. Patients have no objective knowledge of medical errors. 醫療事故是指在診療護理過成中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 medica

21、l errors, the psychological stats after errors, etc. 醫療事故是指在診療護理過成中The construction of Error report systemvisible 任仲杰，the report system of medical error and medical accident in U.S ，中華醫院管理雜志，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. It 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 lov