1 the concept of medical risk
1. 1 Definition of medical risk from the perspective of hospital management
(1), "Damage during diagnosis and treatment" Medical risk refers to the uncertainty of events that may lead to loss and disability and all possible unsafe events, such as medical accidents, medical errors, medical accidents and complications.
(2) "Medical Accidental Injury Theory" Medical risk refers to the patient's physical damage caused by unintentional, accidental and unplanned medical accidents in diagnosis and treatment, which is different from medical accidents (medical errors) caused by doctors' mistakes in diagnosis and treatment.
(3) "Total Loss Theory" Duke University in the United States defines medical risk as "the possibility of suffering losses". This kind of loss can be not only the harm to patients, but also the cost of hospital's claim, including the loss of market share.
(4) The theory of "fault damage" refers to the risk of unsafe events such as death, disability, physical tissue, physiological function and mental health damage caused by medical mistakes or negligence in the process of medical service.
The above four medical risk concepts are of great significance to the medical safety management of hospitals. In order to comprehensively manage medical risks, it is necessary to redefine the connotation and extension of medical risks, so that the unified concept of medical risks can be applied to clinical medical risk control, medical tort civil litigation and social security.
1.2 Definition of medical risk from the perspective of comprehensive management
According to the theory of risk sociology, the basic characteristics of risk are objective potential, loss size and uncertainty of occurrence or not. Different fields have basically the same understanding of the concept of risk, and believe that the core essence of risk is uncertainty. However, the scope and emphasis of different research fields are different, and the definition of risk concept extension shows obvious differences. The key to define the concept of medical risk is to clarify its extension, that is, to clarify the scope, nature and content of medical damage, and to make necessary amendments to the connotation of risk according to the characteristics of this field.
(1), non-essential medical injuries Injury epidemiology defines injury as injury, which is called injury because of the transmission or interference of energy (mechanical energy, thermal energy, electrical energy, chemical energy or radiation energy, etc.). ) Exceeding the human body's tolerance, leading to tissue damage, suffocation leading to hypoxia, and stimulation leading to mental trauma. According to this definition, medical damage can be defined as: physical injury, mental trauma and corresponding property damage caused by medical behavior.
From the point of view of clinical medicine, the damage caused by diagnosis and treatment includes two situations: one is necessary medical damage, and the other is unnecessary medical damage. Necessary medical damage refers to limited damage caused to patients for diagnosis and treatment of diseases, such as skin and subcutaneous tissue damage during lumbar puncture and injection, and normal tissue and organ damage during radiotherapy, chemotherapy and surgical treatment of cancer patients. Unnecessary medical damage refers to damage that does not help to achieve the purpose of diagnosis and treatment, or even runs counter to the purpose of diagnosis and treatment. If the necessary medical damage exceeds a reasonable limit, it belongs to unnecessary medical damage.
Necessary medical damage is bound to happen. Doctors and patients can clearly foresee this situation and make limited choices. Sometimes they have no choice, even if they are unwilling, they can only accept it, which is not within the scope of medical risks. Unnecessary medical damage is in a potential state before it occurs. Whether the damage occurs and the size of the damage can be predicted but not determined. The nature of unnecessary medical damage completely conforms to the characteristics of risk, and also clearly defines the scope of medical risk.
The results of unnecessary medical damage include diseases (also called iatrogenic diseases), disability and even death, and corresponding property losses. From the object of damage, it does not include the damage to other specific personality rights (such as name right and privacy right), but from the cause of damage, it is limited to the behavior of diagnosis and treatment, and does not involve other factors in the process of diagnosis and treatment, such as the quality of drugs and medical instruments and equipment. For the right to life, there is no necessary reason for medical damage unless euthanasia is stipulated by legislation.
(2) Possibility and uncertainty possibility in medical risks are uncertain but predictable event states, most of which can be expressed by probability values, but the probability does not reach the dangerous state with high probability; Uncertainty is an event state that can neither be determined nor predicted. Generally, it cannot be expressed by probability, and even if it can be expressed by probability, the probability value is very small (small probability event). Without expanding the explanation of "uncertainty", it is inaccurate to regard uncertainty as the connotation of risk alone.
Through the above analysis, medical risk can be defined as the possibility or uncertainty of unnecessary medical damage caused by diagnosis, treatment and nursing behavior.