上海地区医疗纠纷影响因素及启示——基于医生、患者和疾病视角。
The influence factors of medical disputes in Shanghai and implications - from the perspective of doctor, patient and disease.
机构信息
Department of Psychology, Education College, Shanghai Normal University, Shanghai, 200234, China.
Medical Department, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, China.
出版信息
BMC Health Serv Res. 2022 Sep 7;22(1):1128. doi: 10.1186/s12913-022-08490-5.
OBJECTIVE
This study aimed to explore the causes and factors behind medical disputes that occurred across eight hospitals in Shanghai over a three-year period (January 2018 to December 2020), thus providing targeted suggestions for amelioration.
METHODS
Stratified sampling was employed to collect 561 cases in which medical disputes occurred at two tertiary hospitals, two secondary hospitals, and four primary hospitals in Shanghai. The causes were analyzed using descriptive statistics, while the factors affecting the dispute level (i.e., 1 through 4, with 1 being most severe) were analyzed via one-way ANOVA and logistic regression analyses. RESULTS: Doctors and patients variously contributed to the medical disputes; 86.1% were related to doctors, while 13.9% were related to patients. For doctors, there are seventeen factors that influenced medical disputes. In particular, the insufficient communication (28.82%) is the most prominent factor in the doctors' factors. For patients, there are seven factors that influenced medical disputes. In particular, the misunderstanding of medical behavior (43.48%) is the most prominent factor in the patients' factors. Of all investigated medical disputes, 406 were level 4 (78%), 95 were level 3 (18%), and 19 were level 2 (4%); there were no level 1 disputes. The reasons for different level placements included the disease classification, treatment effect, diagnosis and treatment regulation violations by doctors, and low technical levels.
CONCLUSIONS
In addition to strengthening training about clinical and communication skills, the hospitals should establish quality control mechanisms for case records and construct rapid, standardized referral mechanisms. The doctors should attach great importance to the quality and urgency of treatment given to critically ill patients, who must be informed about their prognoses in a timely manner to avoid medical disputes and physical deterioration. The patients should actively cooperate with their doctors in the treatment process, moderate any unrealistic expectations that patients may have about the outcomes. During the COVID-19 pandemic particularly, doctors and patients should strengthen empathy and mutual trust more, then defeat disease together.
目的
本研究旨在探讨 2018 年 1 月至 2020 年 12 月期间上海市 8 家医院发生的医疗纠纷的原因和影响因素，从而为改进提供针对性建议。
方法
采用分层抽样法，收集上海市 2 家三级医院、2 家二级医院和 4 家一级医院发生的 561 例医疗纠纷病例。采用描述性统计方法分析原因，采用单因素方差分析和 logistic 回归分析方法分析影响纠纷程度（1～4 级，1 级最严重）的因素。
结果
医患双方均为医疗纠纷的原因，其中 86.1%与医生有关，13.9%与患者有关。对于医生来说，有十七个因素影响医疗纠纷。特别是沟通不足（28.82%）是医生因素中最突出的因素。对于患者来说，有七个因素影响医疗纠纷。特别是对医疗行为的误解（43.48%）是患者因素中最突出的因素。在所调查的医疗纠纷中，四级（78%）406 例，三级（18%）95 例，二级（4%）19 例，无一级纠纷。不同级别纠纷的原因包括疾病分类、治疗效果、医生诊疗规范违规和技术水平低。
结论
除加强临床和沟通技能培训外，医院还应建立病案质量控制机制，构建快速、规范的转诊机制。医生应高度重视危重病患者的治疗质量和及时性，及时告知患者预后，避免医疗纠纷和病情恶化。患者在治疗过程中应积极配合医生，适度降低对治疗效果的不切实际的期望。特别是在 COVID-19 疫情期间，医生和患者应更加加强同理心和相互信任，共同战胜疾病。
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