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并发症:认识、处理及应对人为失误。

Complications: acknowledging, managing, and coping with human error.

作者信息

Helo Sevann, Moulton Carol-Anne E

机构信息

Division of Urology, Southern Illinois University, Springfield, IL, USA.

Department of Surgery, University Health Network, University of Toronto, Toronto, ON, Canada.

出版信息

Transl Androl Urol. 2017 Aug;6(4):773-782. doi: 10.21037/tau.2017.06.28.

Abstract

Errors are inherent in medicine due to the imperfectness of human nature. Health care providers may have a difficult time accepting their fallibility, acknowledging mistakes, and disclosing errors. Fear of litigation, shame, blame, and concern about reputation are just some of the barriers preventing physicians from being more candid with their patients, despite the supporting body of evidence that patients cite poor communication and lack of transparency as primary drivers to file a lawsuit in the wake of a medical complication. Proper error disclosure includes a timely explanation of what happened, who was involved, why the error occurred, and how it will be prevented in the future. Medical mistakes afford the opportunity for individuals and institutions to be candid about their weaknesses while improving patient care processes. When a physician takes the Hippocratic Oath they take on a tremendous sense of responsibility for the care of their patients, and often bear the burden of their mistakes in isolation. Physicians may struggle with guilt, shame, and a crisis of confidence, which may thwart efforts to identify areas for improvement that can lead to meaningful change. Coping strategies for providers include discussing the event with others, seeking professional counseling, and implementing quality improvement projects. Physicians and health care organizations need to find adaptive ways to deal with complications that will benefit patients, providers, and their institutions.

摘要

由于人性的不完美,医学中存在着固有的错误。医疗保健提供者可能很难接受自己的易犯错性、承认错误并披露失误。对诉讼的恐惧、羞耻感、指责以及对声誉的担忧,只是阻碍医生对患者更加坦诚的部分障碍,尽管有大量证据表明,患者将沟通不畅和缺乏透明度作为医疗并发症后提起诉讼的主要原因。恰当的错误披露包括及时解释发生了什么、涉及了谁、错误为何发生以及未来如何预防。医疗失误为个人和机构提供了一个坦诚面对自身弱点的机会,同时也能改进患者护理流程。当医生宣誓遵守希波克拉底誓言时,他们就承担起了对患者护理的巨大责任感,而且往往独自承受错误的负担。医生可能会陷入内疚、羞耻和信心危机之中,这可能会阻碍他们识别那些能够带来有意义改变的改进领域的努力。医疗服务提供者的应对策略包括与他人讨论该事件、寻求专业咨询以及实施质量改进项目。医生和医疗保健组织需要找到适应性方法来处理并发症,这将使患者、医疗服务提供者及其机构都受益。

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