美国应对医疗差错的主动沟通解决模式及伦理启示  

Introduction of Communication-and-resolution Programs Dealing with Medical Errors in the U.S.and Ethical Reflection

作　　者：张卫中 张丹婷[2] ZHANG Weizhong;ZHANG Danting(Department of Medical Affairs,Hangzhou Wuyunshan Hospital/Hangzhou Institute of Health Promotion,Hangzhou 310008,China;Department of Propaganda and United Front,Taizhou First People's Hospital,Taizhou 318020,China)

机构地区：[1]杭州市五云山医院/杭州市健康促进研究院医务部,浙江杭州310008 [2]台州市第一人民医院宣传统战部,浙江台州318020

出　　处：《医学与哲学》2024年第22期43-46,62,共5页Medicine and Philosophy

摘　　要：美国的主动沟通解决模式要求临床医师和医疗机构向患者主动揭露差错并道歉,充分沟通并共同面对由此引发的各种后果,及时提供赔偿和心理社会支持,最后致力于医疗质量的持续改进。相对于防御性医疗,该模式尊重患者的自主权利、遵循不伤害的医学原则、发扬了医生的职业道德和促进医患关系的发展。该模式的成功应用提示医学伦理委员会应积极参与日常的医疗技术临床应用,医务人员应终身学习医学伦理学知识,医疗机构应加强伦理委员会的建设并建立以临床伦理学为导向的医疗质量安全体系。The U.S.proactive communication-and-resolution programs requires that clinicians and healthcare institutions disclose medical errors to patients,offer apologies,engage in thorough communication,and collaboratively address the consequences,including timely compensation and psychosocial support,with a focus on continuous quality improvement.Compared to defensive medicine,this model upholds patient autonomy,adheres to the principle of non-maleficence,promotes physicians'professional ethics,and fosters stronger doctor-patient relationships.The successful implementation of this model suggests that ethics committees should actively participate in routine clinical applications of medical technologies,healthcare professionals should pursue lifelong learning in medical ethics,and healthcare institutions should strengthen ethics committee roles and establish framework of medical quality and security based on clinical ethics.

关 键 词：医疗差错 主动沟通解决模式 医学伦理学 医疗质量安全 

分 类 号：R-05[医药卫生]