Radiology medical dispute prevention
Medical personnel should continue to improve their own business level, timely detection and improvement of shortcomings in the work, at the same time, the department to establish a sound system of rewards and punishments and management, to help the whole department staff to continue to improve and make progress, to clarify the dispute resolution pathway, to avoid misunderstandings between patients and doctors, and to resolve disputes efficiently, as far as possible to avoid and minimize disputes on the damage to the doctors and patients.
Abstract:
Analyze and summarize the common reasons for the emergence of radiology doctor-patient disputes, and targeted to put forward the corresponding preventive measures. Radiology doctor-patient disputes on the Chinese side of the common reasons mainly lies in the medical personnel responsibility is not strong, medical technology and nursing coordination is not coordinated, communication is not accurate, on behalf of the teaching is not serious and other human factors and equipment failure and other objective reasons, the patient's side is mainly personal culture, economy, quality reasons. For the medical side is prone to disputes in the key links and characteristics, by improving the service attitude, strict diagnosis and treatment operation procedures and regulations, optimize the inspection process, improve the level of business, improve the emergency response mechanism and the system of rewards and punishments, and at the same time to strengthen the health care personnel legal and self-protection awareness, as far as possible to avoid the occurrence of radiology medical disputes, to maintain a normal medical order, and to protect the safety of health care personnel and the rights and interests of the patients.
Keywords:
Radiology; medical disputes; medical services; doctor-patient relationship; departmental management
In recent years, the incidence of medical disputes has been on a rising trend year by year, which affects the normal medical order, and deteriorates the medical environment. It is reported that 70% ~ 80% of medical disputes are not medical errors, but due to the lack of service [1]. Due to China's current uneven distribution of medical resources, and the lack of implementation of a hierarchical referral system, resulting in large hospitals are often overcrowded, coupled with the lack of basic service consciousness of some health care personnel, do not pay attention to the way of communication with patients, ignoring the necessary protection of the legitimate rights and interests of patients, cold expression, impatient in the face of patient inquiries, or even the use of commanding tone of voice, which is prone to cause dissatisfaction of the patient and his family members and generate medical disputes [2]. The promulgation of the new "Medical Accident Handling Regulations", as well as the criminalization of medical malpractice, etc. suggests that the state is gradually from the legal level to improve the protection of legitimate medical and patient rights and interests, and health care workers should also take the initiative to summarize, and continue to strengthen the study of laws and regulations, and constantly improve their own quality of business, so as to avoid medical disputes as far as possible.
1 radiology medical disputes arising from the medical reasons
1.1 work of responsibility
such as the technician photographed the wrong patient, film loaded in the wrong bag, photographs of the omission of filming, mistakenly shooting or filming position incorrectly, the film on the label labeling error; physicians read the film carelessly, omitted diagnosis, the report is written in the wrong word, especially the Now hospitals use PACS system to write reports, in order to improve the report writing speed physicians often save some typical cases of the report template, in the corresponding disease can be pulled out of the template for modification, without having to write from scratch, but some physicians are not strong sense of responsibility, resulting in templates saved in some of the descriptions not suitable for the current patient is also retained. These can cause patient dissatisfaction, requiring the patient to return to the radiology department again to make up the films and modify the report in the less severe cases, which may lead to treatment errors.
1.2 Medical and technical cooperation
Clinical examination of special requirements and technologists can not be correctly understood, failed to communicate with the diagnostic physician or clinician in a timely manner, to clarify the method of examination, resulting in the film can not meet the clinician's requirements, the need to reshoot or add the photo and delayed the patient's time, increasing the patient's costs; the emergence of the problem, each other to shirk responsibility for the patient, family members, explain the caliber is not consistent, losing the patient's trust. The problem is that the caliber of the explanation is inconsistent, losing the trust of patients, causing misunderstandings and increasing the dissatisfaction of patients.
1.3 Communication between doctors and patients
Radiology is a large department, many different types of examination equipment scattered in different ` place in the hospital, the patient does not understand the difference between the examination equipment, the layout of the hospital is not very clear, resulting in travel to the corresponding examination location to produce difficulties, which in the examination of the beginning of the anxiety before the start. Inadequate information on matters that need to be prepared by the patient in advance before the examination and the examination time may lead to poor or failed examination results, bring danger to the patient, and cause misunderstanding among patients. Especially some examinations that may affect the examination results or even be dangerous to patients, such as allergy to contrast agent for enhanced CT, vascular complications caused by high-pressure injection of contrast agent, CT simulated enteroscopy that may cause intestinal perforation, etc. If the examination is not meticulously informed of the possible risks that may be present in the examination before the examination, it may lead to a dispute between the patient and the doctor in the event of a problem. In addition, all kinds of radiology examinations have their own characteristics and limitations, no one examination method can solve all the problems, and patients generally do not understand the examination methods, which puts forward higher requirements for the communication between radiologists and patients. For example, if a patient takes an X-ray of the ribs due to trauma, no fracture is seen at that time, but the patient has been suffering from chest pain, and the fracture line of the ribs is found in the review after a period of time, but the fracture sign cannot be seen in the review of the previous photographs, which may be related to the fact that the fracture was not displaced at that time, and the fracture broken end is gradually repaired and the local bone density is increased and is found to be related to the fracture, at this time, if the corresponding instructions are not added to the report of the initial examination and the necessary review is given Recommendations, or in the patient found that the problem returned to the hospital can not be accurately explained, it is easy to cause disputes.
1.4 Teachers' teaching
Teachers' teaching is sometimes too hands-off for interns or inexperienced medical technicians, allowing them to operate alone. But the inexperienced medical and technical personnel who are being taught are not experienced enough to operate and understand the various types of equipment, and are prone to improper operation, which affects the quality of the final image and leads to the failure of the examination and the need to redo it, or even cause harm and danger to the patients who are being examined, and these medical and technical personnel are lacking in experience in dealing with emergencies and communicating with the patients, which is prone to cause medical disputes.
1.5 Equipment safety
Radiology is the most concentrated department of large-scale precision medical equipment in the hospital, and there will be occasional unpredictable equipment failures, and most of the radiology departments of large hospitals have implemented the booking of the examination, especially the magnetic *** vibration of such a very time-consuming examination. And once the equipment malfunction, can not give the patient timely examination, especially on the appointment of the patient's medical arrangements to have an impact. Simple failure, patients may be able to complete the examination on the same day after a long wait, while serious failures need to change the appointment check time, this time the medical and technical staff if the explanation is not timely or not clear easily lead to patients do not understand, so as to produce dissatisfaction.
2 radiology medical disputes arising from the patient's reasons
2.1 cultural and economic reasons
The patient or family members of the half-understanding of the medical knowledge, do not understand the way and limitations of the imaging examination, the results of the examination have too high expectations, when the examination process or the results of the failure to meet their own requirements, it is considered to be a leakage or misdiagnosis; due to the economy, the patient or family members of the medical knowledge, do not understand the imaging examination and limitations, the examination results have high expectations. The patient's condition is such that he or she feels that the cost of the examination is high and questions it.
2.2 Personal reasons
A part of the patients affected by the environment, their own misunderstanding of the hospital, physicians, prejudice, once the situation is inconsistent with their own expectations that is considered to be the physician's problem, a small number of patients or family members lack of moral cultivation, do not speak of social morality, in order to achieve their own purposes and unreasonable, resulting in medical disputes [3].
3 Radiology medical disputes prevention
3.1 Change of service concept
Adapt to the medical environment, the concept of conversion, especially in the case of patients' self-protection awareness and growing legal awareness, recognize and respect the rights of the patient, take the initiative to give the necessary explanation of the examination and seriously treat the patient's raised Inquiries, recognizing that doctor-patient communication is also an important means and content of medical treatment. Through communication to regulate patients and their families on the diagnosis and treatment effect of high expectations, channeling over-excited emotions and psychological pressure, to increase understanding of the means and results of the examination, increase the trust between doctors and patients, improve the degree of cooperation of the patient, the examination success rate and the quality of the examination [4].
3.2 Diagnostic and therapeutic operating procedures and the implementation of rules and regulations
Effective implementation of the three-tier physician responsibility system, clear their respective responsibilities. Technologists encounter uncertainty in the operation, senior technologists, chief technicians and diagnostic physicians have the responsibility to give guidance. The report writing encountered difficult cases, there are difficult cases discussion mechanism, senior physicians have the responsibility to give the gatekeeper. Strengthen the management of films and medical documents. Anyone who finds any problems in the films or reports needs to notify the corresponding personnel at the first time and make corrections in time, so as to prevent the occurrence of omission, misdiagnosis, and errors in film taking and other responsible accidents. The establishment of a quality control system, a person in charge of film and report quality inspection and assessment, regularly summarized in the department.
3.3 Optimization of the examination process
Communicate with the hospital information center and clinical departments at any time to improve the design of the application form, and make clear the contents of the examination and the location of the examination department. Set up distinctive signs to facilitate the smooth examination of patients. In response to the situation that patients spend more time waiting for appointment registration, we emphasize the environmental design of the registration office, place sufficient seats, and add TVs and other equipment to ease the tension of patients while waiting. The addition of a voice call system clearly displays the examination and queuing situation in each examination room, so that patients can have a clear idea of what to expect. The realization of the report and film self-printing, a single self-service area, saving patients waiting for the physician to organize the report and film time, while the patients who have been examined out of the appointment waiting area, to alleviate the congestion of the appointment area.
3.4 Improvement of business level
Emphasize the training of basic theory and basic skills. Seriously carry out the training of residents and technicians, clear teaching teachers, responsibility to a person, regular assessment. The establishment of the academic atmosphere of the department, the organization of morning reading tablets, regular mini-lectures, strengthen business learning, timely understanding and mastering of the latest academic dynamics. Specialists regularly check the imaging diagnosis of patients with pathological results in the hospital, statistically diagnose the accuracy rate, organize and focus on the discussion of misdiagnosis cases, summarize the experience and improve the diagnostic level. Enhance the medical technology and nursing cooperation, on the machine physicians, technicians, nurses regularly organize business training, especially the contrast agent allergy judgment and rescue and other emergency critical situation response.
3.5 Improvement of the emergency mechanism
The establishment of the departmental emergency mechanism, specialists responsible for emergency problem solving. The whole section staff clear handling process after the emergence of unexpected problems. The staff involved in the first time must be unified understanding of the patient to explain and comfort, and timely notification of the department responsible for personnel. The person in charge should arrive at the scene as soon as possible, understand the situation, and try to give comfort to those whose responsibility is on the hospital side, arrange to make up and redo the examination, and solve the problem within the department. On the patient side of the responsibility, try to give explanations to lift the misunderstanding, on the unreasonable, unable to communicate with the person can be arranged to the hospital related coordination department mediation.
3.6 The implementation of the reward and punishment system
Based on the quality control results, the patient complaint rate, etc., on the ingestion of films, reports of high or low quality of technologists, physicians to give up or reduce the performance incentive coefficients to deal with the establishment of an excellent benchmark to encourage learning advanced, mobilize the enthusiasm of all the staff of the Department.
3.7 Strengthening of legal awareness and self-protection consciousness
Organize the whole department to study the "Physicians Law", "Regulations on the Treatment of Medical Accidents" and the relevant provisions of the hospital, to make clear the responsibilities of the medical staff defined by the law and the rights and obligations conferred [5,6], and to strengthen the self-protection, in particular the awareness of the forensics. For the examination that may have risks, the possible complications and medical accidents must be explained to the patients or their families before the implementation of the operation, and the patients are required to sign the informed consent, and the patients with serious conditions should also require the clinicians to be accompanied by the resuscitation equipments. In order to reduce medical disputes, medical technicians must strengthen the quality of medical ethics, change the concept of service, and improve the quality of medical care [7]. In today's high incidence of doctor-patient disputes, the departmental complaint rate is not only an important indicator for many hospitals to measure the department, but once it occurs, it may not only damage the interests of the patients, but also hurt the medical staff and interfere with the normal work of the department, so it needs to be paid attention to, especially the prevention. Medical staff should continue to improve their own business level, timely detection and improvement of shortcomings in the work, while the department to establish a sound system of rewards and punishments and management, to help the whole department continue to improve, progress, clear dispute resolution ways to avoid misunderstandings between doctors and patients and efficiently resolve disputes, as far as possible to avoid and minimize disputes on the damage to the doctor and the patient.
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