Research on the Identification Model of Medical Damage / 法医学杂志

OBJECTIVES@#To understand the perceptions of doctors, patients and forensic examiners on the current situation of medical disputes and medical damage identification in China, and to explore the medical damage identification model that is more conducive for the resolution of medical disputes.@*METHODS@#A questionnaire was designed, and in-service clinicians, forensic examiners and inpatients in Sichuan Province and Chongqing City were randomly selected from April to November 2019. SPSS 22.0 software was used to analyze the data of various survey results.@*RESULTS@#Compared with patients (24.92%), doctors (61.72%) believed that the current doctor-patient relationship was more tense than before; both doctors and patients were more inclined to choose voluntary consultation and people's mediation to resolve medical disputes; forensic examiners have the highest level of cognition of medical and health-related laws and regulations, followed by doctors and patients; 66.72% of doctors and 78.41% of patients believed that medical damage identification was necessary, and they were more inclined to entrust forensic identification institutions; different groups all believed that forensic examiners and doctors should participate in the identification together, 80.94% of doctors believed that the appraisal institutions should be responsible for the forensic opinion, not the appraiser.@*CONCLUSIONS@#It is suggested that the Medical Association identification and forensic identification should learn from each other and formulate basic unified rules for the identification of medical damage. It is suggested to standardize the behavior of medical damage forensic identification institutions and appraisers, to improve their own appraisal level, actively invite clinical medical experts for consultation in identification, and promote the standardized, scientization of forensic identification.

Comparison of Medical Dispute Resolution Mechanisms in China and Abroad / 法医学杂志

Medical disputes are one of the common problems concerned by the whole world. All countries and regions have established their own medical dispute resolution mechanisms, in accordance with their own national conditions. Medical dispute identification opinions, as one of the important bases for identifying the responsibilities of both doctors and patients, play a pivotal role in the process of dispute settlement. A reasonable medical dispute resolution mechanism and standardized medical dispute identification model can help resolve disputes flexibly and reduce the conflict between doctors and patients. This paper briefly compares the medical dispute resolution mechanism and identification mode of China and several other representative countries (the United States, Britain, France, Germany, Italy, Japan, etc.), and discusses their respective characteristics and shortcomings, to bring some enlightenment to the medical dispute resolution and identification in our country.

Application of Virtual Anatomy Technology in Postmortem Examination of Medical Dispute Cases / 法医学杂志

Objective To discuss the application value of CT scanning technology in cause of death determination of medical dispute cases. Methods From July 2017 to December 2018, postmortem CT imaging data of 12 medical dispute cases were collected. CT imaging diagnosis results and anatomy findings as well as differences between antemortem and postmortem CT diagnosis were compared. The advantages and disadvantages of CT routine tests of the cadavers in terms of the diagnosis of disease and damage were analyzed. Results The comparison between CT imaging diagnosis and anatomical findings showed that CT scans had advantages in the diagnosis of disease and damage with large differences in density changes, such as atelectasis, pneumonia, calcification, fracture and hemorrhage, etc. The comparison of CT diagnosis in antemortem and postmortem examination showed that the cadavers of medical dispute cases were well preserved and that postmortem CT scan was meaningful for the diagnosis of antemortem diseases. Conclusion Virtual anatomy technology has a relatively high application value in postmortem examination of medical dispute cases. It can provide effective information for the appraisers before the autopsy and can also provide a reference for cause of death analysis when the anatomy cannot be performed.

Practice and experience of preoperative conversation as involved by the office of doctor-patient relationship / 中华医院管理杂志

Effective communication between doctors and patients can reduce the occurrence of medical complaints and disputes. The office of doctor-patient relationship acts as the complaints management department of the medical institution and undertakes the management of medical complaints. Since 2017, our hospital has introduced the staff of the doctor-patient relationship office to participate in major preoperative conversations. The mode establishes a communication bridge between clinicians and surgical patients and their families, so that patients′ informed consent is more complete and more realistic, and the sufficiency and effectiveness of doctor-patient communication is enhanced. It has a positive effect on medical complaints and dispute risk prevention.

Social Perceptions of Quack in Qing Dynasty and Its Transformation in the Late Qing Period / 의사학

“Yong-yi” means “quack” in English, which generally refers to a doctor who does not have good medical skills. In the Ming and Qing dynasties in China, various criticism about “Yong-yi” became popularized, and by the late Qing period, “quacks” had become a serious social issue. The theory of traditional Chinese medicine was developed during the Ming and Qing dynasties, and local medical resources also increased. Moreover, the prevalence of medical book publishing led to the openness and generalization of medical knowledge. As a result, not only the number of doctors increased, but also the number of doctors who lack medical knowledge and clinical experience increased. However, at the outset, “Yong-yi” did not only mean doctors with poor medical skills. “Yong-yi” also reflected conflicts and contradictions between doctors. Doctors consistently criticized quacks in an attempt to maintain their identity as a “good” doctor or a Confucian doctor. In this sense, “Yong-yi” was used among physicians as an expression of discrimination and exclusion. The concept of “quackery” was also determined by the relationship between patients and doctors. In general, itinerant doctors, midwives and shaman doctors were regarded as “Yong-yi”; however, they served the medical needs of various patients. Thus, to some extent, “Yong-yi” were also useful medical resources. On the contrary, in certain situations, “shiyi,” physicians who serviced a family for generations and were generally believed to be reliable and as trustworthy doctors, were also labelled as quacks, especially when the patient did not trust them or was not satisfied with the treatment. Therefore, doctors' thoughts about “Yong-yi” did not always coincide with patients' thoughts about “Yong-yi.” However, by the late Qing period, the description of quacks in media reports found a singular connotation, and the divergent social image of quacks disappeared. By this time, quacks were uniformly described as ignorant and irresponsible Chinese medicine practitioners. Specifically, in one murder case in which a “Yong-yi” was accused as the murderer, the report unilaterally reported the patient's claims. Consequently, Chinese medicine practitioners who failed in their treatment of patients became labeled as “quack” doctors. In newspaper reports, “Yong-yi” no longer simply referred to individual cases of “quacks” but had come to represent the entirety of the Chinese medicine practitioner community. On the contrary, Western medical doctors who replaced the status of traditional doctors were positively portrayed. Pictorials also had similar perspectives with newspapers, supporting the narrative of the news with ironic drawings and articles. Overall, media reports regarding “Yong-yi” did not focus on reporting facts, but they had the purpose of making quacks a serious social problem.

Medical disputes analysis based on DRGs mortality risk ranking / 中华医院管理杂志

Objective@#To analyze cases in different groups of DRGs mortality risk ranking regarding overall medical dispute cases of the hospital from 2012 to 2017, and to study various groups of such ranking for these disputes as faced by different clinical departments, for the purpose of targeted intervention into medical risk exposures.@*Methods@#Inpatient medical dispute cases in 2012-2017 period were selected, and classified into the various mortality groups by the standards and definition of BJ-DRGs. These data were used to calculate medical dispute incidence in each group, and analyze the difference between internal medicine and surgery departments.@*Results@#Medical disputes of the hospital were mostly found in case groups of mortality free and those of low mortality risks, accounting for 66% of the total cases. This figure was the highest in surgical departments, having a percentage as high as 72%, and the CMI values of these cases were low as well (0.765 and 1.416 respectively).@*Conclusions@#As case groups of mortality free and low risks tend to attract disputes, the hospital is recommended to enhance the risk awareness and training of its medical staff and key medical regulations.

Challenge and solution to medical damage idntification / 中国法医学杂志

By the end of 2017, the Supreme People's Court issue a judical interpretation called Tort law of China·Medical damage liability. It formulates some new rules about identification. It stipulates qualification of new appraiser; clears requirement of medical fault judgment; clears the requirement of causal relationship; defines procedure of medical damage identification and so on. However, there exist the dual identification model. Under the new rules, medical damage identification will face new challenges, especially some stipulates about qualification of appraisers, and expert assistants' views become the basis of the verdict. Those will effect medical examiners' working directly in China. So, I put forward following suggestions: ①Medical identification must be scientific, public welfare, normative.②It is trend for medical damage identification back to peer review. ③A unified library of clinical expert appraisers should be establised. ④We should reasearch the theorys, principles and methods of medical damege identification.

An analysis of 445 lawsuits of medical damage liability disputes in Beijing / 中华医院管理杂志

Objective To identify departments involved, and the appraisal and compensation of such disputes in Beijing, for preventive recommendations. Methods A retrospective descriptive statistical analysis was carried out to retrieve and extract keywords from the first-instance judgments totaling 445 cases of medical damage liability disputes from 2014 to 2016 in Beijing. This analysis covered the age, disease, departments involved, liability judgment among other information. These cases were published at the website of China judgment documents. Results Patients with musculoskeletal connective tissue diseases, circulatory system disease and tumor accounted for the most lawsuits. The departments involved with more disputes were the department of gynecology and obstetrics (80/445, 18. 0％), orthopedics (69/445, 15. 5％), and emergency department(45/445, 10. 1％). 83. 8 percent of the disputes were found with medical quality problems;and 84. 3％ were lost with compensations. Conclusions It is imperative to elevate the diagnosis and treatment level on musculoskeletal connective tissue diseases, circulatory system disease and tumors, and take precautions against disputes at such key departments as gynecology and obstetrics department, orthopedics department, and emergency department. Other precautions include normalized medical record writing, medical risk disclosure, higher medical quality and patient safety.

Instance analysis on medical disputes in a provincial hospital of traditional Chinese medicine and related questionnaire survey / 中国中西医结合急救杂志

At present medical disputes still happen sometimes though governments at all levels, health departments and hospitals pay more and more attention to correctly guide patient's behavior, regulate doctor's behavior in diagnosis and treatment, purify therapeutic environment, strengthen legislation and protect the legitimate rights and interests of doctors and patients. The causes of medical disputes are great many, and the fundamental reason is that the medical behavior from the beginning to the end is related to the life and health, naturally accompanying medical risk and hiding dispute, therefore what we ought to do is not to absolutely eliminate the risk, but to reduce the risks and disputes. In this report, to explore the causes of medical disputes and risks and look for ways to reduce them, the survey of questionnaires was carried out and practical cases of medical disputes were analyzed in hospitals. Seventy-seven cases of medical disputes from 2013 to 2015 had been completed by arbitration or court decisions, and the final arbitral ideas were as follows: invalid doctor-patient communication, low technology and insufficient management were the main causes of medical disputes; the survey of 483 questionnaires on doctors and nurses in the hospital showed that in addition to the above 3 reasons, there were other deep reasons, namely heavy working intensity, low quality of patients or their family members, and the insufficient management runs through all the links in the way. Therefore, to reduce medical disputes, the following aspects should be commenced: effective communication between doctors and patients; improving doctors' clinical diagnosis and treatment ability; optimizing medical management; correcting medical work attitude;timely medical consultation; attaching importance to medical records; doctor's order leaving some leeway or allowing for unpredictable circumstances; constructing healthy hospital culture; paying attention to the physical and mental health of medical staff; actively improving the medical dispute settlement mechanism and related legal system construction.

Reflection on Disorder Phenomenon in Medical Dispute Handling / 中国医学伦理学

In the process of medical dispute handling,violent injury medical incident,medical disturbance,mediation confusion and other disorder phenomena have serious harms,and the lack of faith in rule of law and idea of rule of law,loss of government supervision responsibility,poor access to the rule of law and insufficient solutions and the lagging of related legal construction are the main causes of disorder phenomena.It should start from estab-lishing the awareness in the rule of law and idea of the rule of law,through strictly implementing government re-sponsibility,building diversified disputes resolution approaches and perfecting the relevant legal construction,pro-mote the medical disputes handling return to order and return to the rule of law channels.

Practice and Thought on Medical Dispute Mediation Committee as Third Party Participating in Pre - Operative Testimony Mechanism / 中国医学伦理学

Objective: To explore the effect and significance of medical dispute mediation committee as third party participating in pre - operative testimony mechanism. Methods: For 116 operations from Oct 2015 to May 2017, the medical dispute mediation committee as third party witnessed preoperative communication to patients and their families and signature, and we put forward suggestions for risk guarantee. Results: There were no medical disputes in any of the witness case, of which 43 cases purchased medical accident insurance and achieved risks transfer. Conclusion: Medical dispute mediation committee as third party participating in pre - operative testimony mechanism helps both doctors and patients clear risks, supervises the fulfillment of informed consent, promotes the landing of medical accident insurance, and achieves the recognition and transformation of medical risks.

Preliminary study on the application of medical accident insurance at a hospital in Tianjin / 中华医院管理杂志

This paper introduced the development of medical accident insurance at Tianjin Medical University General Hospital. The author summed up the achievements made in practice and analyzed the problems such as low risk awareness of the patients in their low proportion of insurance risk coverage ,lack of normalized industry standards ,and lack confidence. Other problems include the lack of top-level design of the system ,and high difficulty to plan insurance projects. The paper also recommends to strengthen the positive publicity and guidance ,to create a healthy atmosphere of public opinion;to improve the system ,standardize the industry supervision ;and encourage the introduction of policy proposals ,and to perfect the national medical risk sharing and compensation mechanism .

A comparative study of medical complaints and disputes between two tertiary general hospitals in Beijing and Lhasa / 中华医院管理杂志

Objective By comparing the medical complaints and disputes between the two tertiary general hospitals in Beijing and Lhasa, this paper proposed on how to build a harmonious doctor-patient relationship.Methods A study of annual reports of these two hospitals analyzed descriptively patient complaint rate, rate of medical disputes registered for court jurisdiction, makeup of medical disputes, and their solutions.Results In 2016, the patient complaint rate, and rate of medical disputes registered for court jurisdiction were 3.5/10 000 and 12.4/10 000 respectively, much higher than 0.8/10 000 and 1.1/10 000 of the Lhasa counterpart hospital.A significant gap was also found in the makeup of medical disputes, their solutions, and role of hospital leadership between the two hospitals.Conclusions Beijing is recommended to appoint hospital leader on duty, to assist in handling medical complaints and disputes, and ease doctor-patient contradictions.Lhasa is recommended to improve the medical dispute handling mechanism, improve medical service competency and management.

Research on Status and Pushing Approach of Credibility of the Third-party Mediation in Medical Disputes / 中国医学伦理学

The credibility of the third-party mediation agencies in medical disputes lies in their own advantages of efficiency,neutrality,professionalism and objectivity.However,because of the differences of actual operation,the credibility of the third-party mediation agencies often is questioned by both doctors and patients and the public.Aiming at these,this paper would study the status and the pushing approach of the third-party mediation agencies credibility from the perspective of professionalism and neutrality,legislation,fundraising channels and supervision.

The Communication Effect of Lawyer in Medical Dispute Litigation from View of Game Theory / 中国医学伦理学

This paper analyzed medical dispute litigation from the view of game theory.The adoption of mediation strategy for both hospital and patient was the Pareto optimal of this model.The adoption of court decision for both hospital and patient was the Nash equilibrium and its overall benefit was the Pareto suboptimal of this model.The communication of patient's lawyer can prompt the reconciliation between hospital and patient.On the one hand,it let the hospital realize the responsibilities they should bear,on the other hand let patients be willing to make concessions on the basis of the original claims,and finally made the two sides reach a reconciliation agreement,thus to make conflict between hospital and patient end in litigation and the overall benefits maximize.

Forensic data analysis on 34 death cases of medical disputes due to aortic dissecting aneurysm rupture / 复旦学报（医学版）

Objective To investigate the reasons for the death of patients,the relationship of medical disputes with their death by aortic dissecting (AD) aneurysm (known as AD) ruptures during diagnostic and therapeutic procedures and the judgement for contribute ratios.Methods A total of 34 sudden death cases due to AD were collected from 2001 to 2016 due to medical tangle and underwent forensic pathological analysis.Clinical data were checked according to the results of forensic pathology.The reasons for the death of patients and the relationship of medical disputes with their death and contribute ratios of medical disputes were analyzed according to literature reports.Results In the 34 cases,23 cases were from medical institutions at the country level,and 11 cases were from municipal medical institutions.All patients had other diseases,in whome 27 cases had definite hypertension,31 cases died of cardiac tamponade,and 3 cases of hemorrhagic shock.The pathological analysis showed that aorta cystic in the middle necrosis,coronary atherosclerosis and coronary artery stenosis (grade Ⅰ-Ⅳ).Fifteen cases had coronary and aortic atherosclerosis,and 1 case had pulmonary artery dissection.All cases were not given definite clinical diagnosis and effective treatment for AD.Therefore,there was cause-and-effect relationship between clinical procedures of misdiagnosis and mistreatment and the death of patients.Conclusions The pathogenesis of AD is complicated,and a lack of awareness in grass-roots doctors leads to the misdiagnosis and mistreatment easily primary care doctor.In medical disputes of sudden death induced by AD,clinical procedures of misdiagnosis and mistreatment lead to indirect causal relationship with the death of patients.

Ethics Anomie in Network Media Report of Medical Disputes and Its Countermeasures / 中国医学伦理学

At present,the network media reports of Chinese medical disputes appeared blowout growth,and also brought the loss of propriety,the loss of balance,the loss of justice and other ethical issues while it played the role of public opinion supervision in the medical disputes.In view of these,from the concept definition of ethics anomie in network media report of medical disputes,this paper analyzed and interpreted the ethics anomie in network media report of medical disputes,pointed out existing problems and further put forward creating the network media professional ethics norms,establishing a social supervisory system which integrates self-discipline and heteronomy,building a doctor-patient docking platform and other perfecting countermeasures.

Application of fine management in reducing medical disputes in emergency department / 中华急诊医学杂志

Objective To analyze the medical disputes occurred in the emergency department of our hospital,and discuss the fine management strategy.Methods The medical disputes occurred in 2015 were reviewed.We reviewed the related literature and analyzed the causes of medical disputes by brainstorming and fishbone diagrams.For the root causes,in 2016 to carry out the corresponding fine management.To compare the incidence of medical disputes in emergency department of our hospital before and after the implementation of 1 years,and compare the anxiety and depression scores of 62 emergency medical staff before and after the implementation of fine management.At the same time,satisfaction of emergency services for 60 patients were randomly investigated in 2015 and 2016.Results In 2016,after the implementation of fine management of medical disputes,the percentage of emergency medical disputes was significantly lower than in 2015,and the difference was statistically significant (P ＜ 0.05).Before and after the implementation of fine management,the SAS and SDS scores of emergency medical staff were significantly reduced,and the difference was statistically significant (P ＜ 0.05).At the same time,in the results of random survey,we found that in 2016,the satisfaction rate of patients with emergency technology and service were higher than that in the year of 2015,and the difference was statistically significant (P ＜0.01).Conclusion After fully understanding the causes of emergency medical disputes,the formulation and implementation of the appropriate management strategy can effectively prevent emergency medical disputes,improve the professional and the service satisfaction of emergency medical staff.

Enlightenment of the Third Party Mediation Mode of Foreign Medical Disputeson People' s Mediation of Medical Disputes in China / 中国医学伦理学

Objective:To discuss the problems that exist in the operation mechanism of the third -party media-tion mode of medical disputes in China and put forward suggestions for improvement , through comparative study of the third-party mediation mode of domestic and foreign medical disputes .Results:People's mediation mechanism of medical disputes in our country still hadsome problems .For example , mediation talents were insufficient;propa-ganda was inadequate;mediation results were difficult to implement;mediation support funds couldn ' t be guaran-teed, and so on.Conclusion:It is recommended to improve the remuneration of employees and standardize the staff selection system;increase propaganda and raise public awareness;improve the judicial confirmation system and en-hance the guarantee of agreement;save regulation cost and increase multi -financing channels .

Discussion on the "Five Points" in the Construction of Harmonious Mediation Mechanism / 中国医学伦理学

After several in -depth investigations on the third party mediation mechanism of "Guangdong mode" in Guangdong Harmony Medical Dispute Mediation Committee and combined with the analysis of the domes-tic and foreign medical dispute disposal experience , this paper summed up five points that successful construction of harmonious mediation mechanism should grasp .The five points include the fairness of harmonious mediation thoughts , the feasibility of harmonious mediation paths , the justice of harmonious mediation mechanism , the suita-bility of harmonious mediation environment and the success of harmonious mediation results .Only when grasp these five points, couldit create a gradually harmonious doctor -patient relationship .