目的 分析骨科医疗纠纷的原因及特点，为医疗纠纷的防范提供参考。 方法 收集2010年1月－2011年12月四川华西法医学鉴定中心涉及四川省各级医疗机构的骨科医疗纠纷鉴定案例55例，进行回顾性分析。 结果 55例骨科医疗纠纷中2010年25例，2011年30例；医源性医疗纠纷41例（74.5%），非医源性医疗纠纷14例（25.5%）。医源性医疗纠纷中医疗机构存在的问题主要以手术操作不当及失误为主（15例，占27.3%），其次为医患沟通不到位（8例，占14.5%）。 结论 骨科医疗纠纷防范的关键在于医务人员认真履行其诊疗义务。
ObjectiveTo explore the teaching effects of scene simulation of medical disputes in clinical skills training. MethodsBetween September 2012 and June 2013, 93 clinical medicine undergraduates in Grade 2010 (8-year study) were randomly divided into the scene simulation teaching of medical disputes group (n=47) and the control group with traditional training (n=46) for clinical skills training. Teaching effects were assessed by clinical skills operation tests. ResultsThrough scene simulation teaching of medical disputes, the trainees' clinical disposal ability, operating skills, communication skills, cultural knowledge, and legal knowledge dimension scores were all significantly better than previous tests (P<0.05). ConclusionScene simulation of medical disputes has an obvious advantage in clinical skills training.
ObjectiveTo provide some basic data for studies in the future on the prevention of medical disputes by exploring its patterns and reasons. MethodsFifty-five processed medical disputes cases accepted between 2012 and 2014 were retrospectively analyzed for their patterns and causes. ResultsThe number of males in the medical disputes was higher than that of females (male: 60.0%, female: 40.0%), and patients at the age of 40-70 also led in the disputes (aged 40-50: 20.0%, aged 50-60: 18.2%; aged 60-70: 20.0%). There were more medical disputes in the department of cardiology (20.0%), orthopedics (16.4%), otolaryngology (12.7%), and gynecology (10.9%). ConclusionThere are differences in gender and age of the patients as well as departments in terms of medical disputes. We should try to discover the regular patterns of these disputes. Besides those existing medical indexes, we should establish other warning systems through psychological and sociological status of medical staff and patients for reducing medical disputes, which can surely help the administration of medical quality intervention on medical disputes.
目的：探讨《医疗事故处理条例》颁布后医疗纠纷法医学鉴定的相关特点，启示医务人员在防范医疗纠纷时应注意的相关问题。方法：对四川华西法医学鉴定中心2002年～2006年受理的356例医疗纠纷法医学鉴定资料进行回顾性研究。结果：(1)《医疗事故处理条例》实施以来，医疗纠纷案例逐年增多，个体诊所和三级医院医疗纠纷比例和过错率降低，二级医院和一级医院医疗纠纷率和医疗过错率增加；(2)误诊误治等医疗技术方面的过失是导致医疗事故的主要原因；骨科、妇产科和普外科等手术科室的医疗风险最大；(3)医疗纠纷死亡的患者尸检主要集中在儿童和中青年。各年龄段常见死因不同。三级医院在医院临床死因诊断与法医尸检诊断上符合率最高；(4)侵犯患者知情同意权的现象比较多见；(5)疾病自然转归是被鉴定为非医疗事故的最常见原因；结论：《医疗事故处理条例》颁布后，医疗纠纷法医学鉴定案例逐年增多；目前医疗纠纷的特点和产生原因有了新的变化，其中尤以侵犯患者知情同意权和医患沟通障碍突出。
【摘要】 目的 探讨新生儿死亡医疗纠纷中临床及法医病理学特点,启示儿科医护人员在防范此类医疗纠纷时应注意的相关问题。方法 对四川大学华西基础医学与法医学院法医病理教研室1998年1月—2007年12月的60例新生儿死亡尸检案例进行回顾性统计分析。结果 60例中除3例非正常死亡外,57例为自然性疾病死亡。其中出生后24 h死亡32例(56.1%),死亡男婴40例(70.2%)。死亡原因主要为胎粪吸入综合征、肺透明膜病、肺出血等窒息性疾病(49.1%)。其中医疗过失性纠纷21例(36.8%),医疗过失的原因主要为观察不仔细、处理不及时、误诊漏诊、产前检查或助产处理不当、告知不足等。涉及纠纷的医院以市级医院居多(58.7%)。结论 医护人员应严格遵守诊疗常规和操作规范,对新生儿加强监护,及时抢救,同时应积极与家属沟通,以减少医疗纠纷的发生。
ObjectiveTo understand the cognition and mediation tendencies of health care workers in terms of third-party mediation for medical disputes, analyze the factors influencing the trust of both doctors and patients on third-party mediation, and propose suggestions on building third-party mediation mechanisms for medical disputes. MethodsBetween August and December 2012, we made the cognition questionnaire on third-party mediation for medical disputes based on the past medical literature, and the knowledge of doctor-patient relationship as well as third-party mediation agency's organizational structure (including locations and management authorities), staffing, mediation basis, validity sources and fund ensuring. We performed the random cluster sampling survey on all health care workers in five hospitals of different levels. The original data were put into the computer for statistical analysis by SPSS 18.0. ResultsThe knowledge of health care workers on third-party mediation was high. They believed that the best place for solving medical disputes should be the court or judicial administrative department, and the management authorities should be health administrative departments. In case of mediation failure, the majority of health care staff chose to continue to solve the dispute through legal channels. For the effectiveness of mediation conclusion, most health care workers tended to believe in the form of arbitration. They thought that mediators should have professional background of medicine and law; the majority of those surveyed doctors tended to accept forensic conclusions as a basis for mediation. For determining the compensation, doctors were in favor of Applicable Regulations for Medical Malpractice. Over 40% of medical staff believed that third-party mediation should be financed by government financial allocation, and more than half of the medical staff believed that it should be paid by the insurance company. ConclusionThird-party mediation should be set in and managed by the court or judicial and administrative departments. Mediator group should be formed by professionals of law and medical sciences. In the mediation process, it is recommended that the focus of controversy should be identified by forensic identification in order to form a clear division of responsibilities and high mediation efficiency. We recommend that the government introduce in financial allocations at all levels on the basis of medical liability insurance system, and force medical institutions to purchase medical liability insurance through the regulations of law, in order to provide funding support for the operation of third-party mediation organizations. Meanwhile, medical liability insurance companies should be operated under strict supervision to avoid their interference on the mediation work.
ObjectiveTo understand patients’ cognition of third-party mediation model for medical disputes, analyze the factors influencing the trust of patients on third-party mediation, and propose recommendations for building third-party mediation mechanisms. MethodsFrom November 2013 to April 2014, we referred past literature to design a relevant questionnaire on the cognition of third-party mediation for medical disputes. Patients who had reached the end of the treatment were surveyed by random cluster sampling. The raw data were put into the computer for statistical analysis by SPSS 18.0. ResultsAfter giving out 500 questionnaires, we acquired 486 effective questionnaires. The result showed that 61.52% of the patients knew of third-party mediation; 55.35% of the patients considered that thirdparty mediation should be set in and supervised by the court or judicial administrative department; if the mediation failed, 57.41% of the patients chose to resolve the dispute through legal channels, and 67.90% of the patients tended to confirm the force of mediation conclusion by arbitration; 70.58% of the patients considered that mediators should have professional background of medicine and law; 73.05% of the patients tended to take conclusions of forensic identification as the basis for mediation; 64.81% of the patients were biased to take Tort Liability Act as the basis for determining the compensation; 53.70% of the patients believed that financial allocations could solve the fund problems of third-party mediation, while 38.48% of the patients thought the funds should be provided by insurance companies; 91.15% of the patients thought the medical institutions should purchase medical liability insurance, and 54.32% of the patients thought insurance companies should not intervene the process of meditation. Conclusions Government should provide financial allocations to ensure the funds of third-party mediation. Besides, medical insurance should be brought in as a supplement. Medical institutions should purchase medical liability insurance to solve problems caused by medical disputes. Third-party mediation should be set in and supervised by the court or the judicial administrative department. Mediators should have professional background of medicine and law. Conclusions of forensic identification should be the basis for third-party mediation.
目的：从法医学角度探讨医疗纠纷的成因并提出相关防范措施。方法：对2000年～2005年四川大学华西法医学鉴定中心鉴定的共288例医疗纠纷资料进行回顾性整理分析。结果：近年来医疗纠纷有逐年增多的趋势。医疗纠纷的常见原因有医德医风问题、医疗技术或设备不过关、医务人员的失职或失误等。低级别医疗机构医疗纠纷所占比例相对较高。外科、妇产科等科室医疗纠纷所占比例较高。结论：通过增强医德修养，提高医务人员技术水平，强化医务人员自我保护意识，改善医患关系等措施，能够减少医疗纠纷发生。
ObjectiveTo provide references in the forensic identification of injury and cerebrovascular malformation involved death cases, and to reduce the relevant medical dispute by exploring the forensic pathological features, identification of medical dispute as well as relationship between injury and disease. MethodsWe collected 33 cases of cerebrovascular malformation from January 2006 to December 2014 in West China Center of Forensic Medicine, including details of cases, clinical medical record and forensic pathology examination, and then the cases were retrospectively analyzed. ResultsIn the 33 cases, the average age of the individuals was 37.4 years old, and the male/female ratio was 23/10. Nineteen patients (57.6%) died within 1 hour. Seventeen patients with mixed pathological type of cerebrovascular malformation dominated (51.5%). Medical dispute happened in 7 cases (21.1%), 4 of which were identified to be led by medical fault and 3 with no medical fault. Relationship between injury and disease was analyzed in 11 cases (33.3%), in which injury was identified to take full responsibility in 1 case, inductive cause of death in 9 cases, and no relationship between injury and death in 1 case. ConclusionComprehensive and systematic investigation of forensic pathology plays an important role in the proper settlement of medical disputes as well as the identification of cause of death and relationship between injury and disease.