At present, there is no clear, unified definition of the concept of medical risk at home and abroad. Duke University of the United States, the definition is more simple, is "the possibility of suffering damage", while the domestic refers to the process of medical malpractice. Domestic experts have recently made such a statement: the uncertainty of the medical process of hazardous factors, directly or indirectly lead to the possibility of patient death or disability is medical risk. Many studies have shown that uncertainties in the medical process are not always harmful, but only because medical personnel do not know enough about them or are unable to grasp the timing of their emergence. Professor Wang Beijing, legal adviser to the First Affiliated Hospital of Peking University, puts it in a more juridical way: the uncertainty brought about or caused by a medical act or occurring after its implementation, and the possibility of a patient's disinterested outcome is medical risk, which is a contingent rather than an inevitable result.
The lack of awareness is not one-sided
But compared with other industries, people do not pay enough attention to medical risks, and there is no national regulatory mechanism for medical risks in China. The safety of the civil aviation system has always been a matter of concern for everyone and has been the focus of social attention from time to time. In fact, after years of construction and improvement, China's civil aviation safety management system has matured, and its voluntary (confidential) reporting system for aviation safety (SCASS), as a complementary information system, has a series of characteristics conducive to the collection, analysis, and feedback of information, such as independence, voluntariness, confidentiality, non-punishability, regular reporting, and database processing. In a certain sense, whether or not to use airplanes as a means of transportation is optional, whereas medical care is about health, so closely related to basic life that it cannot be avoided.
Many medical school teachers have warned future doctors with the phrase "one foot in the hospital, one foot in the courtroom," but this educational legacy does not give medical professionals enough awareness of risk. In contrast, the shock of an incident is far more profound than conceptual education, and the damage and distress caused by a risk is often irreversible: in a case in Hubei province in 2000, a child with cerebral palsy who was born to a dragon and phoenix child sued a hospital for irresponsible nursing care, and the hospital was ordered to pay 2.86 million yuan in damages, but the harm suffered by the doctor and the patient can't be measured by money and made up for. In recent years, almost every medical dispute case involves medical technology, personal injury, financial compensation and even moral condemnation, and the issue of medical risk has appeared more and more frequently in the social focus. The First Affiliated Hospital of Peking University's legal adviser, Prof. Wang Beijing, believes that the main factors of medical risk in the continuous change is an important reason for the risk awareness of medical workers fade, medical workers have only perceptual understanding of the medical risk, the lack of rational understanding of the risk and legal awareness needs to be strengthened.
In the increasing number of medical disputes can be seen, the patients and their families on the medical risk of knowledge is quite limited. The patient's lack of medical expertise, high expectations of the doctor, inadequate communication between the doctor and patient are all reasons, the disease caused by the patient's bad mood is to make the patient and his family can not objectively look at the medical results of unsatisfactory, medicines and equipment may bring adverse reactions. Deng Liqiang, a lawyer of Huawei Law Firm, believes that patients and their families have no doubt about the diagnosis, treatment efficacy of medicine and the benefits it brings to the patients, but they do not know enough or even ignore the fact that there are risks in the medical process. More and more patients wrongly believe that as long as they come to the hospital is the same as transferring their own danger due to illness to the hospital or doctors.
Main cause is systemic
While the importance and necessity of studying medical risks is more widely recognized, work continues to explore their causes. Yin Dakui, president of the Chinese Medical Doctor's Association, believes that the plague, avian influenza, as well as the recent emergence of SARS, swine streptococcal infections are ecological changes in the environment caused by the disease, human beings in the use of nature at the same time is also changing and destroying the natural ecological imbalance, atmospheric pollution, the greenhouse effect has a serious impact on the living environment of human beings, prompting the emergence of new diseases; scientific and technological development has improved the level of medical treatment, but also for the medical behavior increases the risk. The development of science and technology has increased the level of medical treatment and diagnosis, but at the same time, it has also increased the risk of medical behavior; and the pressure of social responsibility and business pressure of medical institutions is also an important reason for the risk. Li Dachuan, Director of the Department of Medical Affairs of the Ministry of Health, pointed out that the limitations of medical science, the characteristics of the disease itself and other causes of risk have become the industry **** knowledge; hospital management factors, the doctor's level of practice can not be avoided; and drugs and medical devices need to pay attention to the factors. Wang Beijing, on the other hand, included the limitations of medical science, the status quo of recognizing diseases but not necessarily treating them, the spectrum of diseases is constantly changing, and the individual differences of patients in the factors of nature, as opposed to human behavioral deficiencies, including the level of management of health care institutions, the medical staff's medical behavior is not standardized, as well as the patient's expectations exceeding the existing level of medical care, and the behavior of participation in the treatment of the problematic elements.
Many studies have shown that systemic factors are the main cause of medical risks.The IOM report concluded that more than half of all adverse medical events are the result of preventable medical errors; most medical errors occur not because of the recklessness of the individual physician but rather because of biases in the healthcare system (e.g., lack of necessary training of the physician, long hours of work, ampoule profiles similar to those of the physician, lax management supervision etc.); the researchers believe that improving the healthcare system can prevent adverse events and ensure patient safety.
It has been reported that around 2002, four premature infants with retinopathy of the retina (ROP) after oxygen therapy sued a maternity hospital in Tianjin, and similar cases of blind children suing hospitals have been reported in Shanghai, Jiangsu, Zhejiang, and Heilongjiang. According to Chen Zhihua of the Beijing Bar Association's Medical Disputes Committee, who has studied many cases of ROP after oxygen therapy for premature infants, although the causes of retinopathy of prematurity are multiple (including prematurity, low body weight, and inappropriate oxygen therapy, etc.), we should not overlook the systemic causes of such cases: lack of knowledge and training of medical staff and lack of relevant oxygen therapy regulations; The occurrence of ROP is not always the fault of the physician, although we do not want to completely deny the individual factors of the medical staff. in April 2004, the Ministry of Health issued the "Guidelines on the Use of Oxygen for the Treatment of Preterm Infants and the Prevention and Treatment of Retinopathy" for the medical staff to follow in practice.
The role of government in risk management
Industry insiders recognize that improved management systems can make a big difference in eliminating preventable errors and reducing the incidence of medical risk, and that government departments, which exercise important management functions, are in the driver's seat. At present, some of the official or private forms of experience exchange are consciously focusing on the behavior and experience of foreign governments in the process of medical risk regulation, and then think about the corresponding role and function of our government.
It is understood that the Ministry of Health's "China's medical risk monitoring and early warning mechanism" has been formally launched in April this year, the Chinese Medical Doctor Association, the Ministry of Health Center for Evidence-based Medicine, the First Affiliated Hospital of Nanjing Medical University, Peking University Hospital, the Capital University of Medical Sciences, the five units and the Ministry of Health Department of Health*** with the organization of the subject, the design of the research and analysis of the same share. The launch of this project will undoubtedly make the relevant research scattered in various disciplines and fields more systematic and organized, and will also attract more social forces to participate in it. According to Dr. Liu Qilin of the China Medical Doctor Association, a member of the research team, the establishment of a medical risk monitoring and early warning mechanism in line with China's national conditions will provide a scientific basis for scientific decision-making by the national health administration and administration in accordance with the law. If a national medical risk monitoring network is established on the basis of this research result, it will help the macro management and regulation of the medical industry, reduce medical risks and improve medical quality.
Wang Beijing believes that the exercise of government management functions to reduce medical risk should start from two aspects, one is the implementation of mandatory norms in the form of legislation; the other is the use of departmental regulations to regulate specific medical behaviors (such as diagnosis, nursing care work). It is understood that July 1 this year, the official implementation of the "Interim Provisions on the Management of Physicians Outside Consultation," that is, belonging to the departmental regulations, "the management of the clinical application of special medical technology" is also being drafted, and the implementation of the previous implementation of the "Rules for the Implementation of the Regulations on the Management of Medical Institutions," the modification of the work is underway, and more special technical access to the contents of the hospital will be included in the treatment of the subject to be managed.
It can be said that it is by facing up to its own risks and shortcomings, and refining in the process of establishing monitoring and early warning mechanisms that the existing civil aviation safety management system has come into being. In the process of medical system reform and the direction of the social hotspot again, medical risk and patient safety issues related to the discussion appears to be more specific, more operational: medical risk has been the industry *** knowledge; foreign experience and lessons learned is not lack of reference value; medical institutions over the years of self-examination and industry associations (academic) will play a role in the government management to carry out the seminar work has a relatively mature platform. The platform is relatively mature for the governmental management to carry out the seminar. More importantly, there is more protection for patient safety, and the number of medical disputes will be reduced or resolved in a more reasonable manner, which will help to reduce the resistance and pressure of the healthcare reform process.