医疗纠纷诉讼视角下某三甲医院医患沟通问题及解决对策研究  

The Problems and Solutions of Doctor-patient Communication in the Grade-A Tertiary Hospital from the Perspective of Medical Dispute Litigation

作　　者：高静 夏宇曦[1] 周利平[1] 袁逸文[1] 胥雪冬[1] GAN Jing;XIA Yuxi;ZHOU Liping;YUAN Yiwen;XU Xuedong(Department of Medical Affairs, Peking University Third Hospital, Beijing 100191, China)

机构地区：[1]北京大学第三医院医务处,北京100191

出　　处：《中国医学伦理学》2020年第10期1216-1221,共6页Chinese Medical Ethics

摘　　要：医患沟通在医疗纠纷的预防与处理中具有重要作用。以2019年10月正式实施的由北京市市场监督管理局发布的《医疗行为关键控制点编码规范》为依据,对某三甲医院近六年医疗纠纷诉讼结案案件进行回顾性分析和研究,发现医患沟通问题主要集中三方面:第一,涉及多科诊疗患者的医患沟通存在不足;第二,诊疗过程中关于患者病情、诊疗方案、诊疗风险的告知不够充分;第三,临床教学中患者隐私权重视不够。结合实践,提出了提高医师“告知”意识,把握“告知”重点内容、推广“提前介入”谈话机制,促进第三方见证下医患沟通、重视多科诊疗患者,沟通充分,规范流程、关注病历书写规范,完善纠纷闭环管理及加强医务人员在临床教学工作中保护患者隐私权意识等建议供医务工作者参考。Doctor-patient communication plays an important role in the prevention and treatment of medical disputes.Based on the Coding Guidelines for Critical Events in Medical Behaviors officially implemented in October 2019 by Beijing Municipal Administration of Market Supervision,a retrospective study was conducted on the cases of medical disputes settled in a grade-A tertiary hospital in the past six years.It was found that the communication problems between doctors and patients were mainly in three aspects:firstly,there was insufficient communication between doctors and patients involved in multidisciplinary diagnosis and treatment;secondly,in the diagnosis and treatment process,the information about the patient’s condition,diagnosis and treatment plan,and diagnosis and treatment risks were not sufficient;third,the patient’s right to privacy was not paid enough attention to in clinical teaching.Combining practice,it was proposed to improve physicians’awareness of“information”,to grasp the key content of“information”,to promote“early intervention”conversation mechanism,to promote doctor-patient communication under the witness of a third party,to pay attention to multi-disciplinary diagnosis and treatment patients,communicate adequately and standardize procedures,to focus on the writing norms of medical records and improve the closed-loop management of disputes and strengthen the awareness of protecting patients’privacy in clinical teaching,etc.,which can be as references for medical workers.

关 键 词：医患沟通 说明告知 医疗纠纷 诉讼 鉴定 

分 类 号：R197.32[医药卫生—卫生事业管理]