1 The current situation of doctor-patient relationship
At present, the doctor-patient relationship is relatively tense, last year, June to July, the Chinese Society of Hospital Management of the country's 270 hospitals at all levels of the relevant survey, according to the survey statistics: the country's third-class hospitals each year, the demand for compensation for the occurrence of medical disputes have about 100 cases, to the court of lawsuits, there are about 20 to 30 cases, in Beijing may reach more than 40 cases a year. In Beijing, it may reach more than 40 cases a year. About 20 cases occurred in secondary hospitals every year, and about 3 cases went to the court, while the amount of compensation for the third-class A hospitals is generally about 1 million a year. And now the amount of compensation is getting higher and higher.
73.33% of the hospitals in the country have patients and their families with violence, beating, threatening, abusing medical personnel; 59.63% of the hospitals have patients dissatisfied with the results of the treatment, gathered a number of people in the hospital siege, threatening the personal safety of the president; 76.67% of the hospitals have patients and their families refused to leave the hospital after the end of the diagnosis and treatment and non-payment of hospitalization fees; 61.48% of the hospitals have patients and their families refused to leave the hospital after the end of the treatment and non-payment of hospitalization fees. 61.48% of hospitals have occurred after the death of the patient, the patient's family members in the hospital wreaths, burning paper, set up hearth and so on.
Recently, the emergence of "professional medical trouble", the emergence of doctors to work to ask security guards to escort, hospitals to open the door to ask the police stationed and other phenomena, so that this should be harmonious and mutual understanding of the doctor-patient relationship, but tense to such an extent that in the Standing Committee of the National People's Congress group to consider the Law on Punishment of Public Security Administration, some members of the call for the law, the law should be the hospital security management. The law should be the hospital security management content singled out, special provisions.
2 Analysis of the causes of the current situation of doctor-patient relationship
Doctor-patient relationship from a general point of view, is basically harmonious in the existence of local disharmony, harmony is the mainstream, disharmony is a tributary. The causes of doctor-patient relationship is complex, there is a lack of medical resources, the masses "difficult to see the doctor", "see the doctor expensive", the patient has a view; there is a poor quality of medical care, service attitude is not good, the masses are not satisfied; there are also more complex social factors. Both the system, the mechanism of the problem, but also the ideological aspects of the problem, as well as management and supervision is not effective and other reasons, the main reasons are the following aspects.
2.1 Social and governmental factors
2.1.1 Inadequate government financial input China's population accounts for 22% of the world's total population, while the total cost of health only accounts for 2% of the world's total cost of health; the proportion of financial input to the current year's expenditure of the hospitals, the provincial level and above hospitals at 5%, city and county hospitals are generally in the 1%, the township health centers in the 1% to 5% between. In 2003, it was reported that China's total medical expenses amounted to 660 billion yuan, with the government bearing only 17 percent of the burden, and more than two-thirds of China's population relying on themselves to pay for medical care, accounting for 56 percent of total health expenditures; the proportion of the government's budgetary expenditures in China's total health costs had dropped from about one-third in 1978 to 17 percent in 2003, while residents' health expenditures rose from 20 percent in 1978 to more than 50 percent in 2003. more than 50% in 2003. the third national health service survey in December 2004 showed that medical service in China has become the third largest consumption of the population. This compares with 80 to 90 percent in Europe, 45.6 percent in the United States (with full coverage for the elderly, the poor, and the disabled), and 56 percent in Thailand. Numerous developing countries such as India, Cuba, North Korea, Sudan, Myanmar, etc. to implement universal free medical care.
2.1.2 Inadequate medical insurance system Although China's basic medical insurance system for urban workers and the new rural cooperative medical system have made significant progress, for a developing country with a population of 1.3 billion, it is still a long way to go to establish a universal medical insurance system. Under China's current health care system, most patients receive health care services at their own expense, and this way of paying for health care services makes patients have high expectations of the expected results of medical services, and the vast majority of doctor-patient disputes are caused by the fact that medical costs do not correspond to the expected results of the patient, even if the doctor tries his best to treat each patient, a certain proportion of patients still do not achieve satisfactory results due to a variety of reasons. Even if the doctor tries his best to treat every patient, a certain percentage of patients will not be satisfied with the treatment results for various reasons. For patients who have spent a high amount of medical expenses, it is inevitable that they will have some thoughts if they do not get satisfactory treatment results. In developed countries, due to the developed economy, most of the medical expenses are borne by insurance companies and national governments, and it is not necessary for individuals to pay high medical expenses, so it is easy for patients to accept this reality psychologically. Therefore, China's medical insurance system is in its infancy, imperfect and low affordability of basic medical insurance are also factors that lead to tensions between doctors and patients.
2.1.3 Imperfect medical risk-sharing mechanism Medical service, due to its own industry characteristics, determines that it is a high-risk industry, especially the application of certain advanced, high-risk medical technology, despite the best efforts of medical staff can not guarantee that no error. Therefore, it is particularly necessary to provide a risk-sharing mechanism for medical practices. The United States is a country with very advanced medical technology, and the same will happen in the case of patients suing doctors, but usually there will be no siege of hospitals, assault on medical personnel, because doctors and patients have *** with the insured medical liability insurance. If the court decides that compensation is needed due to a medical error, the insurance company will also pay for it; if there is a lawsuit to be filed, the insurance company will also pay for the lawyer's fees. The situation in Japan is more or less the same. With the protection of medical risk insurance, most doctors will have a clear conscience. More importantly, in the event of a medical dispute, patients and their families will not go directly to the hospital or the doctor; they only need to hire a lawyer to negotiate with the court and the insurance company, which effectively avoids conflicts between doctors and patients. Hospitals and doctors can also devote themselves to the research and treatment of diseases. If the insurance company pays out more due to medical malpractice or incident, the immediate consequence for the doctor may be an increase in premium for the next payment cycle, or the insurance company may no longer provide coverage for the doctor, resulting in the doctor losing his/her job. Obviously, such a sharing relationship also constitutes a strong monitoring of the quality of care provided by doctors.
2.1.4 Mismatched laws and regulations for resolving doctor-patient disputes The Regulations on the Handling of Medical Accidents, which came into effect on September 1, 2002, are a big improvement over the previous Measures for the Handling of Medical Accidents, but the implementation of the regulations over the past few years has shown that the relevant legal provisions on the handling of medical disputes in China are too principled to be easy to operate, and they need to be constantly improved and supplemented. For example, the concept of "medical malpractice" is still subject to serious ambiguities between the medical system and the courts. In addition, the Supreme People's Court "on civil litigation evidence of a number of provisions of the judicial interpretation, the provisions of the medical behavior caused by tort litigation, the implementation of the presumption of fault and the presumption of causation, so that medical malpractice findings belong to the scope of the reversal of the burden of proof of the medical institutions, do not have to be the victim of the evidence. This judicial interpretation by the Supreme Court places too heavy a burden on medical institutions, expanding their liability. There is still controversy over whether the reversal of the burden of proof for medical malpractice should be implemented. The above differences and disputes in the treatment of medical disputes directly or indirectly affect the establishment of a harmonious doctor-patient relationship.
2.2 Hospital factors In the market economy, the hospital's keenness and pursuit of economic benefits are also factors that lead to tensions between doctors and patients. With the gradual deepening of health reform, the hospital will become an autonomous economic entity, out of their own interests, often focusing on the pursuit of economic benefits, so that the phenomenon of forgetting the righteousness of profit. The production and circulation of medicines and medical equipment related to hospital services are in disorder, and prices are inflated; some enterprises operate in violation of the law and misrepresent their costs, resulting in inflated government pricing; there are many links in the chain of production and sales, and prices are raised at various levels; some unscrupulous drug dealers increase the sales volume of medicines and medical equipment by giving kickbacks and commissions to doctors, etc.; and the current mechanism of adding a percentage to the income from medicines in hospitals has induced the hospitals to buy and sell expensive medicines, and the doctors to prescribe large prescriptions, excessive examinations and treatments, and to increase the number of patients. large prescriptions, and excessive examinations and treatments. At present, from the medical industry as a whole, the medical equipment is more and more sophisticated, medical technology is more and more high, but, "people-oriented" service concept is not synchronized to keep up, the doctor and patient conflicts are increasingly intensified.
2.3 Physician factors A survey shows that only 27% of doctors are basically satisfied with the current practice environment, the higher the level of the hospital, the higher the proportion of doctors who are dissatisfied with the practice environment. In the senior title doctors, nearly 70% of doctors do not have a high evaluation of the current practice environment, 48.6% of doctors do not have a sense of professional pride and sense of achievement, many doctors do not want to let their children from medicine.
The burnout of medical personnel brought about by high pressure and heavy workload is a problem that cannot be ignored. For a long time medical personnel team building lack of humanistic quality training, the practice of building measures have not been implemented, resulting in some medical personnel in the service process of the attitude of hard, the potential crisis between doctors and patients with poor communication escalated, evolved into medical disputes, doctor-patient relationship continues to deteriorate.
2.4 Patient factors Patient rights awareness. According to a survey conducted by the China Social Research Institute on nearly 6,000 residents in Beijing, Shanghai, Tianjin, Chongqing, Wuhan and Guangzhou for four consecutive years, Chinese consumers' awareness of their rights is increasing. In the event of damage to rights and interests, 94% of consumers said they would take the initiative to take various actions to protect their legitimate rights and interests. In addition, people's health awareness has increased. With the improvement of living standards, people are more and more concerned about their own and their family's health, paying more attention to diseases and early diagnosis and treatment, and thus have higher expectations for the effectiveness of the treatment of diseases. The rapid development of modern medicine, molecular medicine, genetic medicine, cloning technology and so on come one after another, but the new unknown diseases also continue to appear, the medical field is full of unknowns and variables, coupled with differences in the medical technology of medical personnel, domestic and foreign unanimously recognized that the rate of medical diagnosis is only about 70%, all kinds of emergency and serious illnesses, the success rate of 70% to 80%, a considerable portion of the causes of the disease Unknown, difficult to diagnose, and even a high rate of misdiagnosis, treatment is hopeless, this is the helplessness of medicine, any hospitals and doctors can not cure all diseases, the treatment process and results of the disease there are always two possibilities of success and failure, many patients and their families do not understand the special nature of medicine and helplessness, the medical effect of the expectations are too high, and therefore can not correctly deal with the helplessness of medicine. In addition, the patient's awareness of participation in the medical process has increased, the overall rise in social and cultural levels, the information developed to make it more convenient for patients to understand the information related to the disease, patients require more information about their own treatment programs, medication and prognosis.
3 Countermeasures to build a harmonious doctor-patient relationship
Doctor-patient communication requires the government, medical institutions (medical staff) and patients tripartite **** construction, understanding and trust. As long as the good treatment of patients, strengthen communication, put themselves in the shoes of patients, to provide patients with warm, careful, loving and patient service, will win the respect and recognition of patients to us, the harmonious doctor-patient relationship will certainly be established.
3.1 The government to assume the responsibility of public **** health and safeguard the rights and interests of the public health is to build a harmonious doctor-patient relationship based on Accelerating the development of health care, and strive to solve the problem of the masses, "difficult to see a doctor, expensive to see a doctor" is to build a harmonious doctor-patient relationship of the fundamental measures. It should be seen, the current health work in the existence of the basic contradiction is the masses more and more high health demand and the level of medical service supply is seriously insufficient between the contradiction, the centralized manifestation is the masses of difficult to see a doctor, see a doctor is expensive. The discordant doctor-patient relationship, doctor-patient conflicts, doctor-patient disputes, and even doctor-patient clashes, are the concrete manifestation of this contradiction. Although at present the vast majority of medical institutions are public hospitals, but the normal operation of a considerable number of hospitals mainly rely on the fees collected for the provision of medical services to patients, the purchase of hospital equipment, the expansion of the scale of the hospital by the accumulation of fees, medical services by the hospitals to dispose of their own income. The direct consequence of this mechanism is that hospitals focus excessively on economic income and neglect the interests of the public. This is also an important cause of tension between doctors and patients. If we want to build a harmonious doctor-patient relationship, we must study how to improve the operation mechanism of hospitals, maintain the public welfare nature of hospitals, and adhere to the purpose of serving the people. Must adhere to take the road of development of health care for China's national conditions, adhere to the purpose of health care for the general public health services and public welfare nature, play the leading role of the government to protect the masses of basic medical care, reform of the medical service system, conversion of the operating mechanism of the public health care institutions, to strengthen the government's supervision of the health care services industry, and vigorously develop the cause of rural and community medical and health services, and so on.
3.2 Strengthening the internal management of the hospital is to build a harmonious doctor-patient relationship to ensure the establishment of a harmonious doctor-patient relationship between doctors and nurses is the key, health care workers first of all have to have good medical technology and professional ethics, which is a prerequisite for obtaining the trust of patients. Secondly, to understand and respect the patient. Because the process of seeking medical treatment is relatively difficult, during this period, the patient will bear a lot of mental and economic pressure, very much in need of medical personnel's understanding and care. Then, learn to communicate with patients. Misunderstandings and conflicts between doctors and patients are largely caused by the lack of communication skills of some health care workers. Fourth, pay attention to the image and etiquette of medical personnel. The hospital environment, the medical staff's instrumentation image, can give patients a first impression, beautiful environment to patients to increase the sense of comfort. Medical staff to the patient's appropriate address is to establish the beginning of good communication. Patients are full of respect and trust for enthusiastic, open, sincere, humorous, credible, loyal and responsible medical staff. And often hate hypocrisy, disrespect, selfishness, jealousy, stubbornness, pride, cold medical staff.
Adhere to the social benefit guidelines to create a hospital of integrity. Medical institutions at all levels should adhere to the social benefits as the highest guidelines, adhere to reasonable inspection, reasonable medication, reasonable fees, strictly prohibit a variety of "billing fees"; efforts to reduce the cost of medicine to patients, the establishment of the medical cost of sunshine system, and conscientiously do a good job of charging consulting work, so that the patient and his family members at any time to query the cost of the situation, so that the patient can rest assured that the effective measures to eliminate the patient in the process of medical treatment. Take effective measures to eliminate the phenomenon of "three longs and one short" in the process of patients' consultation, such as long time for registration, long time for payment, long time for medicine and short time for consultation; strictly implement the system of centralized bidding for medicines, and put an end to the phenomenon of drug dealers promoting medicines in the hospitals with money; implement the system of doctors' and patients' agreement, and strictly prohibit medical personnel from accepting "red packets" and accepting "red packets" and "red packets" of medicine. The system of doctor-patient agreement, strictly prohibit medical personnel from receiving "red packets" and accepting "food treats"; hire social supervisors to supervise the hospital's medical ethics and medical style.
3.3 Patient understanding and tolerance is the key to building a harmonious doctor-patient relationship Harmonious doctor-patient relationship involves both the doctor and the patient, relying solely on the efforts of the medical staff is not enough, which requires the patient to be able to comprehensively and correctly understand the doctor's profession. Some patients think that into the hospital is equal to enter the safe, that since the hospital is a cure, then the cure is not good, of course, is the hospital and the doctor's fault. In fact, doctors are not omnipotent, not all diseases can be cured, for some difficult cases, in some cases, the doctor is also unable to do anything. Therefore, there are times when doctors need more understanding and tolerance from patients. Many patients look at hospitals, doctors, often only the results do not look at the process, especially the lack of risk-taking consciousness, the expectations of medical results are too high, and even beyond the current level of medical technology, a lot of medical disputes is therefore. In fact, the human body is a very complex organism, in the process of surgery and after surgery, there will be many unexpected problems, which has nothing to do with the doctor's medical skills and sense of responsibility. Lack of awareness of this on the part of patients will lead to conflicts with doctors. Only the community to the medical profession of hard, heavy and high risk to give a full understanding, only between doctors and patients mutual understanding, mutual respect and interdependence, in order to truly realize a harmonious doctor-patient relationship.
3.4 Strengthen communication with the media, correctly guide public opinion is to build a harmonious doctor-patient relationship platform The news media is a bridge between us and the community. Medical and health work is the hot spot of social concern, but also the focus of news propaganda. We should attach great importance to communication with the media, provide accurate and comprehensive information to the media in a timely manner, so that the media can understand the real situation in a timely manner, and play a correct role in guiding public opinion. For the media to reveal the problems in health care work, we must insist on not protecting the shortcomings, not cover up the ugly, insist on the correct treatment, learn from the past, and proactively take improvement measures. We should learn the knowledge and skills of news dissemination, learn to communicate with the media, and constantly improve the level of publicity work. To sincerely hope that the news media adhere to the correct guidance of public opinion, objective and truthful reporting of medical and health service activities, not deliberately speculate on individual medical disputes, we *** with efforts to build a harmonious doctor-patient relationship, to maintain a healthy and orderly medical order.
Building a harmonious doctor-patient relationship is a long-term task. We must adhere to the constant attention, do to build a harmonious doctor-patient relationship promoter, so that the people can see the tangible results, and strive to build mutual respect, mutual understanding, warm and harmonious doctor-patient relationship, for the construction of a harmonious socialist society to contribute to the greater strength.