Arenas-Márquez Humberto, Anaya-Prado Roberto
Servicio de Cirugía y Nutrición Especializada, Hospital de Ginecoobstetricia, Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social. Guadalajara, Jalisco.
Cir Cir. 2008 Jul-Aug;76(4):355-61.
Surgery is an extreme experience for both patient and surgeon. The patient has to be rescued from something so serious that it may justify the surgeon to violate his/her integrity in order to resolve the problem. Nevertheless, both physician and patient recognize that the procedure has some risks. Medical errors are the 8th cause of death in the U.S., and malpractice can be documented in >50% of the legal prosecutions in Mexico. Of special interest is the specialty of general surgery where legal responsibility can be confirmed in >80% of the cases. Interest in mortality attributed to medical errors has existed since the 19th century; clearly identifying the lack of knowledge, abilities, and poor surgical and diagnostic judgment as the cause of errors. Currently, poor organization, lack of team work, and physician/ patient-related factors are recognized as the cause of medical errors. Human error is unavoidable and health care systems and surgeons should adopt the culture of error analysis openly, inquisitively and permanently. Errors should be regarded as an opportunity to learn that health care should to be patient centered and not surgeon centered. In this review, we analyze the causes of complications and errors that can develop during routine surgery. Additionally, we propose measures that will allow improvements in the safety of surgical patients.
手术对患者和外科医生来说都是一种极端的体验。患者必须从极其严重的状况中被拯救出来，这种严重程度可能使外科医生为了解决问题而违背自己的道德准则。然而，医生和患者都认识到手术存在一些风险。医疗差错是美国第八大死因，在墨西哥超过50%的法律诉讼中都能记录到医疗事故。特别值得关注的是普通外科专业，在超过80%的案例中都能确认法律责任。自19世纪以来，人们就对归因于医疗差错的死亡率感兴趣；明确将知识不足、能力欠缺以及手术和诊断判断失误认定为差错的原因。目前，组织不善、缺乏团队合作以及与医生/患者相关的因素被认为是医疗差错的原因。人为差错不可避免，医疗保健系统和外科医生应该公开、好奇且持续地采用差错分析文化。差错应被视为一个学习的机会，即医疗保健应以患者为中心而非以外科医生为中心。在本综述中，我们分析了常规手术过程中可能出现的并发症和差错的原因。此外，我们提出了能够提高手术患者安全性的措施。
