医疗告知不足的类型分析及应对策略  

Type analysis and coping strategies of insufficient medical notification

作　　者：周钰山 何福逵 王茜[1] ZHOU Yushan;HE Fukui;WANG Qian(School of Public Health and Wellness,Hubei University of Medicine,Hubei Province,Shiyan442000,China)

机构地区：[1]湖北医药学院公共卫生与健康学院,湖北十堰442000

出　　处：《中国医药导报》2024年第26期178-181,185,共5页China Medical Herald

基　　金：教育部人文社会科学研究规划项目(16YJAZH 056)。

摘　　要：目的探讨医疗损害责任纠纷案件中医方在医疗过程中告知不足的具体表现,为提高医方告知能力,避免医疗纠纷提供新思路。方法以中国裁判文书网公开数据为研究资料,检索2012年1月至2022年12月浙江省范围内涉及告知不足、告知不充分、未尽告知义务、告知不全、如实告知等关键词的医疗损害责任纠纷案件判决书226份,使用文本分析法逐一阅读筛查,最终得到符合研究范畴即由法院判决医方确实存在告知不足类过失的案件131例。结果医方在131例医疗损害责任纠纷案件中存在告知不足过失160例次,主要有手术告知不足71次(44.4%)、病情告知不足38次(23.8%)、风险告知不足33次(20.6%)、健康宣教告知不足9次(5.6%)、药物使用告知不足6次(3.7%)和出院转院告知不足3次(1.9%)等6类93种告知不足表现。医疗告知受多种因素影响,具有多层次的特点,告知的重点是医疗风险,告知的难点是口头告知,告知的标准是全面。结论医疗告知是患者知情同意的重要环节,必须符合法律法规规定和医学伦理要求。建议加强对医疗告知不足的多学科融合研究,加大对医务人员的医疗告知再培训力度,提高医患沟通能力,尝试推行医务人员保护道歉制度模式,避免医疗纠纷。Objective To explore the specific performance of the Chinese medical party in the medical process of insufficient notification in the case of medical damage liability disputes,and to provide new ideas for improving the notification ability of the medical party and avoiding medical disputes.Methods The public data of China Judgement and Documentation Network as the research material were taken,226 judgments of medical damage liability dispute cases involving the key words of insufficient notification,insufficient notification,failure to fulfill the duty of notification,incomplete notification,and truthful notification within the scope of Zhejiang Province from January 2012 to December 2022 were searched,textual analysis to read and screen each case was used.In the end,there were 131 cases that fit into the scope of the study,i.e.,cases in which the court ruled that the medical practitioner was indeed negligent in the category of insufficient information.Results In 131 cases of medical damage liability disputes,there were 160 cases of insufficient notification,including 71 cases(44.4%)of insufficient notification of surgery,38 cases(23.8%)of insufficient notification of condition,33 cases(20.6%)of insufficient notification of risk,9 cases(5.6%)of insufficient notification of health education,6 cases(3.7%)of insufficient notification of drug use,and 3 cases(1.9%)of insufficient notification of discharge and transfer,etc.And 93 types of insufficient notification performance in six categories.The focus of informing was medical risk,the difficulty of informing was oral informing,and the standard of informing was comprehensive.Medical notification was in-fluenced by a variety of factors and was characterized by multiple levels;the focus of notification is medical risk,the difficulty of notification was verbal notification,and the standard of notification was comprehensiveness.Conclusion Medical notification is an important part of a patient’s informed consent and must comply with laws and regulations and medical ethic

关 键 词：医疗损害 医疗告知 知情同意 告知不足 医患沟通 

分 类 号：R-05[医药卫生]