The human body is very complex, and everyone's anatomical structure, illness and basic diseases are different. Postoperative complications will inevitably occur, such as postoperative incision infection, fat liquefaction, incision dehiscence, bleeding, intestinal obstruction, anastomotic leakage, myocardial infarction, lung infection, cerebral infarction and other complications.
No doctor in the world dares to say that his patients have never had complications, and surgical complications are inevitable. We can only minimize the occurrence of complications. Taking the simplest appendectomy as an example, the incidence of complications can also reach 10% to 20%.
Both doctors and patients can cause complications. Let's take appendectomy as an example If the appendix is perforated, there is a lot of pus in the abdominal cavity and pelvic cavity, which contains a lot of bacteria. It is easy to cause infection and suppuration of incision after operation. No matter how careful the doctor is, there will still be infection, because this operation is an infection operation.
Some patients, especially obese patients, have thick subcutaneous fat, so the incision is easy to heal badly, because the blood supply of subcutaneous fat is very poor, and ischemia is easy to occur after operation, which leads to unhealed incision and liquefaction of incision fat. If you are a diabetic, the microcirculation is worse and this problem is more likely to occur.
Of course, in addition to the disease itself, it is also related to doctors. The more skilled and careful the surgeon, the lower the risk of complications. This is why people like to go to big hospitals for surgery and find big experts for surgery.
Having said that, Dr. Zeng just wants to tell you that both doctors and patients want to reduce the incidence of complications, and it is best not to have complications, but sometimes it is difficult to avoid them. If complications occur, we should actively deal with them and deal with them as soon as possible. Doctors and patients are not opposites, but diseases are our common enemy!
Surgical complications are a problem that all doctors don't want to happen, but it is difficult to avoid them completely. Therefore, whether medical disputes caused by surgical complications should be compensated has become the focus of attention of both doctors and patients. As a senior surgeon and engaged in medical management for many years, I would like to talk about my personal experience on this issue. Does the hospital want compensation? The key is whether there is a fault in surgical treatment.
1, the occurrence of surgical complications, there is no fault in the medical behavior of medical staff, and medical institutions do not need compensation.
(2) Medical personnel have fulfilled their reasonable diagnosis and treatment obligations in emergency situations such as rescuing dying patients; For example, if a patient comes to the hospital with serious multiple injuries due to a sudden car accident, the hospital starts a green channel, and multidisciplinary cooperation gives the patient all rescue measures such as blood transfusion and surgery, which ultimately cannot save the patient's life, and the hospital does not assume responsibility.
(3) Due to the medical level at that time, it was difficult to make diagnosis and treatment. For example, a patient who had a sudden myocardial infarction on the plane could not have died before arriving at the hospital despite the on-site first aid and emergency flight help from the crew. The crew is not liable for compensation.
3. After the occurrence of surgical complications, even if compensation is not required according to the law, medical institutions will try their best to help the families of patients with special difficulties, for example, (1), giving humanitarian aid in one lump sum; (2) Help family members to apply for various government relief funds; (3) Provide help to facilitate family members to apply for various social assistance funds such as drip irrigation.
4. Of course, in the following cases, the medical behavior of medical staff is at fault and needs compensation.
(1) The operation risk was not informed before the operation. For example, according to the conditions of hospital equipment, this kind of operation is not available, and the doctor reluctantly performs the operation. Or the doctor has gone beyond the management authority of operation classification without the permission of the hospital. In the event of surgical complications, patients should be compensated. Even if there are no complications, as long as the doctor's violation of the medical technology management system is discovered by the hospital organization, he will be severely punished.
(2) The obligation not to inform the risk of surgical complications before operation. The common complications of surgical diseases in teaching materials are not reflected in the doctor's consent form, and the patients and their families are not informed before operation. In the event of surgical complications, medical institutions should pay compensation.
(3) the obligation to avoid the risk of surgical complications during surgery. For example, patients with multiple common bile duct stones are treated with choledochotomy, and the risk of residual stones is informed before operation. In addition, the hospital has some methods to avoid the risk of residual stones during operation, such as intraoperative ultrasound, choledochoscopy and angiography, but none of them are used, resulting in residual stones in the bile duct of patients. The hospital wants compensation.
(4) Failure to fulfill the obligation of active assistance. For example, in some clinics or small medical institutions, anaphylactic shock occurred during minor surgery, and the patient was busy transferring to a higher hospital and did not do a good job in anti-shock rescue, resulting in ineffective rescue and death, which should be compensated.
Finally, I want to emphasize that "medical quality and medical safety" is an eternal theme in the medical field. It is the core of hospital grade evaluation and year-end performance evaluation by health authorities. It is the most important content of hospital assessment and supervision of departments and personal work. Medical quality and medical technology are the keys to hospital survival and personal development of medical staff. Neither the hospital nor the surgeon himself wants surgical complications. The real surgical complications are mostly caused by doctors' unintentional mistakes, inevitable factors and patients' special physique. But in any case, if there is a mistake, you must bear the responsibility. Once there are surgical complications, it is the best way for patients or their families to seek compensation through legal channels. There are many reasons for surgical complications, some are inevitable, some can be avoided as much as possible, and some are caused by human errors or negligence.
The management of complications caused by different reasons is different. Whether to compensate depends on the reason.
For example, I once introduced a very simple invasive operation in clinic, lumbar puncture, which is to insert a needle into the subarachnoid space and extract cerebrospinal fluid through the patient's spinal space. This is also a minor operation. This operation is helpful to the diagnosis of intracranial diseases and can also play a therapeutic role. This operation also has complications: 1. Headache (because cerebrospinal fluid can reduce intracranial pressure, leading to headache); 2 Anesthesia allergy, this operation is local anesthesia, and lidocaine is used. Very few people are allergic to this medicine, so there is no need to do a skin test, so some people may be allergic. 3. Spinal cord injury, the doctor's puncture site is wrong, resulting in stabbing the bone marrow. After all, infection is to connect a closed space of human body with the outside world and insert a needle, so there is a risk of infection.
Ok, let's analyze it.
If there are complications and headaches after the operation. This is basically inevitable, which is determined by people's physiological structure, so you can't blame the doctor for having a headache, lying flat, drinking more water and taking more rest.
If the spinal cord is injured, it depends on whether it is caused by the doctor's illegal operation, because according to the regulations, puncture at the specified position will not hurt the spinal cord unless the physiological structure of the person changes. If the doctor operates illegally, for example, he is just an intern and punctures the patient himself without the supervision of a clinician, and the puncture is not within the prescribed scope, resulting in complications of spinal cord injury, then the patient's family can apply for compensation.
However, if the doctor's operation completely conforms to the procedures and norms, it is because the patient's physiological structure is different from ordinary people, and doctors cannot avoid it. In this case, there is no reason to claim compensation.
So, it depends on the reason. Before the operation, the doctor will also tell the patient what complications may occur during the operation and get the patient's consent. If patients and their families cannot accept the risk of surgery, they can choose not to do it.
However, even if you sign a notice of surgical complications and risks, it doesn't mean that doctors can't be punished if they make mistakes.
What are you thinking about? Before the operation, you will sign an agreement or a notice, which will clearly tell you the possible risks of the operation. You can be a patient if you like.
Every surgeon doesn't want to see the complications in the operation. Being a doctor is also very painful, but patients and their families need to remember that doctors are not gods and not everything can be controlled. As long as they undergo surgery, there is a risk of potential complications. As doctors, what we can do is to minimize complications and make a comprehensive medical evaluation of patients before operation. In this way, patients, family members and medical teams can make targeted preparations before, during and after surgery to reduce the risk of potential complications.
As for whether to compensate, as a doctor, there is no problem of compensation as long as he strictly follows the surgical guidelines. If everyone needs compensation for surgical complications, it is estimated that no doctor is willing to operate, so there is no need to treat the disease at all. In the eyes of patients and their families, postoperative complications are medical accidents, which require doctors to spend time and energy to communicate. For example, when it comes to medical knowledge, we will try to use fewer words and more pictures. In addition, when explaining the illness to patients or doing informed consent for surgery, we must talk about risks. And emphasize to patients that in case of emergency and need treatment, medical staff will try their best to take effective measures.
After all, doctors and patients are human beings, and they all make mistakes. Technology should be mature, but doctors are in different time and space. For example, if you have surgery at night and in the morning, or if the patient/doctor is very tired, the effect of the surgery may be different, but it is sometimes difficult to tell the patient. Of course, this also puts forward higher requirements for doctors. I think since I have chosen the profession of doctor, I should not have any complaints. There is no best, only better. In terms of medical quality, it is no exaggeration to always take medical quality into account.
In addition, doctors need love and comfort, especially for cancer patients with diseases. It is particularly important to comfort patients' psychology after operation and further survival. On the other hand, the strength of the hospital team is also needed to improve the quality of medical care and reduce disputes between doctors and patients.