Joint Consultation by a Neurogeneticist of Movement Disorders and a Psychodynamic Psychotherapist: An Occasion for Subjectivization.

We set out to model a joint therapeutic setting meant to address both medical care and the transferential processes at stake in specialized neurogenetics consultations. Previous authors have explored joint consultation settings with a specialized physician and a psychodynamically oriented psychotherapist, however, few have attempted to provide a model of its transfero-countertransferential dynamics. We aim to do the latter by focusing on a subset of patients to whom such consultations are offered "on the spot." We want to explore situations in which they initially deny the transference's contribution to their complaint, when addressing it would instead prove to be beneficial to them, even medically speaking. Standard neurogenetics consultations put the physician in a double-bind position. These patients' conflicting complaint both manifests transferential expectations and denies them by adhering to medical elements. Since the physician's challenge is to avoid colluding with the patient's denial, a joint setting would enable him to address the medical content of the patient's complaint while simultaneously letting its transferential elements emerge, allowing for the psychotherapist to use them to induce subjective integration (subjectivization). We conceptualize this jointly induced subjectivization by drawing on Fain's work on primary hystericization of the complaint (inspired by Freud's late indications). We finish with an example of subjectivization of a family's complaint based on an adolescent's limb tremor, which had no genetic or neurological etiology. Its seemingly conversional nature appeared in light of her father's reaction to our subjectivizing response: his latent transference was likely underlying his daughter's symptom.

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.

A study of medical complaints against five tertiary general hospitals in Shandong province / 中华医院管理杂志

Objective To analyze the causes, characteristics and solutions of medical complaints against five tertiary general hospitals in Shandong province, and provide references for the hospitals to improve their quality of care and to build a harmonious relationship between doctors and patients. Methods A retrospective analysis method was used to analyze the causes, solutions and subjects of 1 049 medical complaints against five tertiary general hospitals in Shandong province from 2012 to 2015. Results Among the departments complained, orthopedics(165 cases, 15.7% ), and obstetrics and gynecology(136 cases, 13.0% )topped the rest. The causes of complaints mainly focued on the quality and effect of surgery(355 cases, 33.8% ), diagnosis and treatment(269 cases, 25.6% ), and service attitude(204 cases, 19.4% ). For outpatient/emergency departments, the patients mostly complained on " service attitude" (125 cases, 36.1% ), while the causes of complaints by inpatients were mainly " quality of surgery and effects" (332 cases, 44.8% ). In terms of the dispute solution pathways, consultation between doctors and patients became the most useful one(353 cases, 84.5%), and the third-party mediation approach(56 cases, 13.4% )also played an important role. Conclusions The hospitals should comprehensively strengthen their medical quality management, improve the quality of " service contact" and patient satisfaction. They are also recommended to establish a perfect complaint handling mechanism for higher patient satisfaction. The government should set up specialized courts for medical disputes and improve the efficiency of judicial solution of such disputes.

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.

Análisis de 7 años de la queja en gineco-obstetricia por la Comisión Estatal de Arbitraje Médico en Oaxaca, México / 7-year analysis of the complaint in gynecology-obstetrics by the State Commission of Medical Arbitration in Oaxaca, Mexico

ANTECEDENTES: Se realizó la revisión de 7 años del Sistema de Quejas Médicas en la Comisión Estatal de Arbitraje Médico del Estado de Oaxaca, México, entidad autónoma y calificada para dirimir el proceso de inconformidad durante el fenómeno de la atención médica. Se analizaron todas las quejas, formas de resolución y en especial se identifico la queja en gineco-obstetricia. OBJETIVO: Caracterizar la inconformidad en la queja del usuario en la especialidad de gineco-obstetricia. MÉTODO: Investigación documental, descriptiva, transversal, retrospectiva y sin implicaciones éticas, efectuada mediante el análisis de bases de datos del SAQMEDO de enero de 2008 a abril de 2015. Se seleccionaron todos los expedientes de quejas médicas de la especialidad, entre todas las presentadas. RESULTADOS: El Instituto Mexicano del Seguro Social fue la entidad más frecuente en quejas médicas seguida por la medicina privada. Por octavo año consecutivo la ginecología y obstetricia prevalece como líder en quejas de los usuarios, sumando en el actual análisis 100 de 438 quejas. El origen de las quejas resulta de la deficiencia en la otorgación del servicio institucional y privado que contabilizó el 69% de los casos. CONCLUSIONES: La falta en el proceso de la evaluación del desempeño ha sido fundamental en la repetición de la queja en gineco-obstetricia. A lo largo de 8 años se ha repetido el modelo vicioso, sin que las instituciones hagan algo a cambio. De continuar ignorando el problema de manera local conseguiremos que éste ciclo se perpetúe.

BACKGROUND: It has been made a complete analysis of 7 years in the State Commission of Medical Arbitration in Oaxaca, one of the southern states in México. This Commission is the legal entity to judge the process of malpractice. The study was aim to identify the obstetrics and gynecology complains. OBJECTIVE: Characterize the medical complain in the obstetrics and gynecology specialty. METHOD: It was conducted a documentary research, descriptive, transversal, retrospective and without ethical implications, through analysis of databases of the State Commission of Medical Arbitration of Oaxaca, corresponding to 2008 -2015 activity report; we selected records were medical complaints in the specialty of gynecology-obstetrics. RESULTS: The Mexican Institute of Social Security Services became the most demanded medical provider closely followed by the private practice. Obstetrics and gynecology was the most demanded medical specialty for 8th uninterrupted years. From 438 claims 100 accounted to this specialty. The failure to give or perform the service was the origin of the complains. CONCLUSION: Absence of risk assessment and supervision of competence in the performance of the medical process were the most forthcoming issues when malpractice were continue to identified. Eight in a row years of failure to amended these vicious process speaks for itself. Lots of hard work are to be consider as a reliability strategy.

PDCA Cycle and its use in the control of hospital medical complaints / 中华医院管理杂志

A study of PDCA Cycle in managing hospital medical complaints may introduce such a cycle into the medical complaints control system of a hospital, effectively handling the medical complaints process. Since 2006 when the cycle was introduced into the hospital for medical complaints control, such complaints have been cut back significantly by the end of 2009. Furthermore, such complaints are under control from the start, and prevented from growing into medical disputes, effectively improving quality of care. Such a cycle can effectively avoid medical complaints, enhance medical safety, and build a harmonious doctor-patient relationship.