Xu Qian, Lyu Yuwen, Zhang Xinzhu, Liu Junrong
School of Medical Humanities, China Medical University, Shenyang, 110122, China.
School of Marxism, Guangzhou Medical University, Guangzhou, 511436, China.
BMC Health Serv Res. 2025 Aug 20;25(1):1112. doi: 10.1186/s12913-025-13177-8.
Improper medical decision-making is a key issue in healthcare disputes worldwide. In China, medical malpractice lawsuits related to improper decision-making are on the rise, but research on the patterns and underlying factors of such litigation is limited. This study aims to analyze the characteristics and patterns of medical decision-making malpractice cases in China, with the goal of providing reference points for judicial processes and offering policy recommendations to prevent and mitigate doctor-patient conflicts.
This study selected medical damage liability dispute cases from the China Judgments Online platform between 2018 and 2024. Python was used for data cleaning, Chinese word segmentation, and stop-word filtering. A total of 439 cases involving improper medical decision-making were included for analysis. A Latent Dirichlet Allocation (LDA) topic model was applied to identify major themes, and differential analysis was conducted to explore the relationships among hospital level, identification method, damage outcomes, and degree of responsibility.
In medical decision-making lawsuit cases, judicial identification requests were predominant, and patient death was more likely to trigger litigation. The medical parties often bore secondary responsibility. Statistically significant differences were found between hospital level and degree of responsibility (P = 0.034 < 0.05) and between hospital level and damage outcomes (P = 0.008 < 0.01). The LDA topic model revealed six main themes in the cases: medical behavior, evidence analysis, damage compensation, treatment effectiveness, patient rights, and legal applicability. Cluster analysis identified the main causes of improper decision-making, including insufficient informed consent, improper treatment plans, inadequate examinations, poor monitoring of conditions, insufficient consultations, incorrect diagnoses, improper medication, insufficient assessment, and lack of thorough patient history inquiry.
Improper medical decision-making is closely related to the responsibility awareness and communication skills of healthcare providers. Insufficient informed consent and improper treatment plans are the primary causes of improper medical decision-making. Effective communication between doctors and patients is a common problem across hospitals at all levels. To reduce improper medical decision-making, the following measures are recommended: emphasizing informed consent to reduce decision-making risk, strengthening team collaboration to improve decision-making ability, conducting thorough examinations to reduce uncertainty, developing individualized treatment plans, and promoting clinical decision support systems to avoid information omission.
不当医疗决策是全球医疗纠纷中的关键问题。在中国，与不当决策相关的医疗事故诉讼呈上升趋势，但对此类诉讼的模式及潜在因素的研究有限。本研究旨在分析中国医疗决策失误案件的特点和模式，为司法程序提供参考依据，并提出预防和缓解医患冲突的政策建议。
本研究从中国裁判文书网平台选取了2018年至2024年的医疗损害责任纠纷案件。使用Python进行数据清理、中文分词和停用词过滤。共纳入439例涉及不当医疗决策的案件进行分析。应用潜在狄利克雷分配（LDA）主题模型识别主要主题，并进行差异分析以探讨医院级别、鉴定方式、损害后果和责任程度之间的关系。
在医疗决策诉讼案件中，司法鉴定申请占主导地位，患者死亡更容易引发诉讼。医方往往承担次要责任。医院级别与责任程度之间（P = 0.034 < 0.05）以及医院级别与损害后果之间（P = 0.008 < 0.01）存在统计学显著差异。LDA主题模型揭示了案件中的六个主要主题：医疗行为、证据分析、损害赔偿、治疗效果、患者权利和法律适用性。聚类分析确定了不当决策的主要原因，包括知情同意不足、治疗方案不当、检查不充分、病情监测不佳、会诊不足、诊断错误、用药不当、评估不足以及患者病史询问不全面。
不当医疗决策与医疗服务提供者的责任意识和沟通技巧密切相关。知情同意不足和治疗方案不当是不当医疗决策的主要原因。医患之间的有效沟通是各级医院普遍存在的问题。为减少不当医疗决策，建议采取以下措施：强调知情同意以降低决策风险，加强团队协作以提高决策能力，进行全面检查以减少不确定性，制定个性化治疗方案，以及推广临床决策支持系统以避免信息遗漏。
