What do you say about medical dispute case discussions?

Those things that are discussed in the hospital.

The author | the rushing emergency room old Liu

The source | Medical Pulse

I recently saw an article discussing the issues discussed in cases of encountering medical disputes. The reason was that a teacher from the medical office asked, "Every medical dispute case discussion can not discuss the problem, the process is perfect, the ending is regrettable!" "As a teacher of medical punishment and management disputes, it is impossible to understand all professional knowledge, organize case discussions, and dare not speak indiscriminately."

This week, let's talk about medical disputes and case discussions in the hospital.

How is the Medical Dispute Case Discussion different from other case discussions?

The case discussion system belongs to the hospital work system, and the Ministry of Health revised the "Hospital Work System and Personnel Job Responsibilities" in 2010, and the revised medical record discussion system includes:

1. Clinical case (clinical pathology) discussion

1.1 Hospitals shall select appropriate cases in the hospital or cases that have been discharged (or died) to hold regular or irregular clinical case (clinical pathology) seminars.

1.2 Clinical case (clinical pathology) seminars can be held in one department or jointly with several departments. When hospitals with the capacity hold jointly with the Department of Pathology, it is called "Clinical Pathology Seminar".

1.3 At each hospital clinical case (clinical pathology) seminar, preparations must be made in advance, and the department responsible for the treatment should sort out the relevant materials, make a written summary as much as possible, and send it to the participants in the discussion in advance to prepare for the speech.

1.4 The meeting is presided over by the director of the attending department or the attending physician, who is responsible for introducing and answering questions about the condition, diagnosis, treatment, etc. and putting forward analytical opinions (medical records are reported by the resident). The meeting concludes with a summary by the moderator.

1.5 Clinical case (clinical pathology) seminars should be recorded and may be included in the medical record in full or in summary.

2. Discussion of discharged cases

2.1 Hospitals with the capacity (grade II A or above) shall hold regular (1 to 2 times a month) discharge case seminars as the final review of discharge medical records.

2.2 The symposium on discharged cases may be held in separate sections (presided over by the director or director (deputy director) physician) or in the ward (group) (presided over by the chief (deputy director) physician or attending physician), with the participation of residents and interns in charge.

2.3 The discharge case seminar will review the medical records of discharge during this period in turn.

a. Whether there are any errors or omissions in the recorded content.

b. Whether it is arranged in regular order.

c. Determination of discharge diagnosis and treatment results.

d. Whether there are problems and what lessons have been learned.

3. Seminar on difficult cases

3.1 All difficult cases shall be presided over by the chief of the department or the chief (deputy director) physician, and the relevant personnel shall participate.

3.2 Seriously discuss, clarify the diagnosis as soon as possible, and propose a treatment plan.

4. Preoperative case seminar

4.1 For major, difficult and newly performed surgeries, preoperative discussion must be carried out.

4.2 Presided over by the chief of the department or the chief (deputy director) physician, the surgeon, anesthesiologist, the head nurse, the nurse and related personnel shall participate, and if necessary, the medical management department personnel shall participate.

4.3 Formulate surgical plans, postoperative observations, nursing requirements, etc.

4.4 The discussion is recorded in the medical record. General surgery should also be discussed accordingly.

5. Seminar on deaths

5.1 All cases of death should generally be held within one week after the death of the patient, and special cases should be discussed in a timely manner. Autopsy cases are performed one week after the pathology report is made.

5.2 Presided over by the section chief, with the participation of medical care and related personnel, and if necessary, the participation of medical management department personnel.

5.3 The purpose of the discussion is to analyze the causes of death and draw lessons learned from the experience and lessons learned in the process of diagnosis and treatment.

5.4 There should be a complete record of the discussion, signed and confirmed by the head of the department and the superior physician, and included in the medical record.

It can be seen from this that the case discussion is either to clarify the diagnosis, formulate the best treatment plan, or summarize the experience after treatment and find deficiencies.

Case discussions involving medical disputes are different from regular case discussions, in addition to summarizing experience and finding deficiencies, the most important thing is to find faults, distinguish responsibilities, and formulate dispute resolution plans. Most importantly, it is necessary to form the opinions and opinions to be expressed by the medical party when the mediation of the Medical Investigation Commission, court litigation or forensic hearing is formed.

What issues need to be discussed in the discussion of medical dispute cases?

In addition to similar content to other discharged cases or deaths, case discussions involving medical disputes need to form a unified situation statement and a consistent statement of views.

He once attended a forensic hearing, and the patient visited the gastroenterology clinic and emergency department of the medical department, and gave several consultations in the cardiology department when he was in the emergency department. The patient presents twice within 48 hours, after which the patient dies. At the hearing, representatives from all three departments of the medical department were sent to participate, and when the medical party stated its opinion, there was no unified opinion, but each department stated separately.

Each department explained the situation of the receiving patients and expressed the opinion that "their own department is not responsible". When arguing that their departments were not responsible, the doctors did not pay any attention to the other departments of their hospitals. Overall, it sounds like the three departments blame each other and are full of loopholes. In the end, it did not play a defensive role at all, but provided more unfavorable evidence to the identification experts outside the medical record. In Lao Liu's view, "pig teammates" are really "pit".

The medical department teacher, as the moderator, should lead the entire discussion process. After all, this kind of discussion is not a regular academic discussion, and in the end, the methods of handling disputes and the defense opinions must be discussed, and finally a unified statement of opinions should be formed. It would be nice to have the hospital's legal counsel participate, interpreting the case from a legal point of view, allowing the doctor to understand the deficiencies and learning how to deal with disputes.

Issues that need to be discussed during the discussion include:

1. Is the patient's diagnosis clear, correct and comprehensive? Does the diagnosis still comply with routines or guidelines?

2. Is the admission department correct? Is it consistent with the main diagnostic department?

3. Is the patient's attending physician a doctor with relevant qualifications? Are the surgeries performed consistent with the qualifications of the hospital and the qualifications of the doctors?

4. Does the treatment plan conform to the diagnosis and treatment routine, textbook, clinical guidelines or expert consensus? Is there any other literature supporting the non-compliant treatment regimen?

5. Have you fulfilled your obligation to inform? Is the notification in place? Is the informed consent form complete, signed and properly preserved?

6. Are medical records and nursing records perfect? Is there a fault in the observation and care of the condition?

7. What are the consequences of the patient's damage? Are the consequences of damage related to medical fault?

8. How high is the incidence of postoperative complications? Is the complication of this case avoidable?

9. What treatments will be required in the future for patients with disabilities? How long is the treatment or rehabilitation period?

Medical dispute case discussion avoids "polarization"!

Due to the lack of knowledge of medical dispute resolution, medical mediation, medical litigation, etc., clinicians often polarize during discussions.

One type of doctor will deeply review the deficiencies, deeply reflect, find out their various "faults", and assume that N kinds of situations may avoid the consequences of damage. This kind of review-type discussion may be good for improving the level of diagnosis and treatment and preventing the risk of diagnosis and treatment, but it cannot be used as a statement of opinion in response to disputes.

If you say in the judicial appraisal, "If you can pay attention to the use of so-and-so methods during surgery, you may not harm so-and-so", then basically the fault is real. Excessive recognition of errors will cause the expert or judge to believe that the damage is avoidable, but the doctor has not done it, then the fault is obvious.

Another type of doctor is more "confident", stubbornly arguing in the face of the consequences of damage, discussing how good their skills are and how correct the treatment plan is. As for the reason for the poor efficacy, it is blamed on the patient himself, which is the poor prognosis caused by the development of the patient's own disease. Or shifting the blame to other departments, such as dying in the ICU after surgery, will shift the responsibility to poor postoperative treatment.

The methods and methods of discussion of both cases are not very helpful to the resolution of medical disputes, and it may be the right way to look at the problems existing in the process of diagnosis and treatment more objectively and fairly, to draw out responsibilities, and to find out how to deal with disputes. The introduction of expert group review in this kind of case discussion is a more effective means, such as the business dean leading experts who are not involved in the dispute department as experts as expert groups, and each department explains the diagnosis and treatment process, finds deficiencies, and explains possible faults.

The expert group is to give an opinion similar to the appraisal opinion, draw out the responsibilities, and form a unified caliber of situation explanations under the guidance of lawyers. For the medical fault that the patient may point out, give a defense opinion and find literature to support the argument. In the end, a unified opinion is formed, no matter which aspect of the reply to the affected party, or the state of opinion is the same as the opinion of the opinion letter. In this way, the effect of case discussion can be exerted.

Consultant Xiang Haiman, a lawyer at Beijing Quanzhi Law Firm (formerly Beijing Renchuang Law Firm), has long been engaged in medical legal research and practice, and has rich experience in medical law. (The original title is: Medical dispute cases can not be discussed, what do you need to say?) 丨Medical Eye Watching Method)

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