On May 17, the medical drama "the surgery" came to an end. As the story moves, the debate over the professionalism of medical drama has waned, with more voices on the doctor-patient debate.
The personage inside course of study, according to the evaluation of the play reflects the true reality of the doctor-patient relationship, each character story behind, hiding their creators to ease the doctor-patient relationship of sincerity.
How to solve the medical problems and promote the harmony of the doctor? This year on March 20, issued by the general office of the state council put forward the legislation of the state council in 2017 work plan, strive for years to the revision of the regulations on the medical accident treatment. Special legislative work plan by the regulations of the revised focus, on the prevention and treatment medical malpractice disputes, protect the lawful rights and interests of patients and medical institutions and medical personnel, etc.
Many experts for "prevention" content of the revised regulations, thinks that the revision of the regulations to reduce the incidence of medical accidents, relieve the strain on the doctor-patient relationship, avoid medical disputes upgrade or even worse, in the protection of lawful rights and interests of patients at the same time, can strengthen medical institutions and medical personnel risk prevention consciousness, creating high quality medical service system.
The regulations do not apply in part
The malpractice handling regulations promulgated by the state council, effective as of September 1, 2002, made the medical quality management, medical accident report, the hospital management and a series of complaints system, establish and perfect the medical institutions internal related rules and regulations, etc.
The regulation has been carried out for nearly 15 years, and there are many rules that have inconsistent or conflicting laws.
Beijing Ding Wang guo-wen ding law firm lawyers, come into contact with a lot of medical case, he told the reporters, they are now in accordance with the enforcement of the provisions of the tort liability law in 2007, "byelaw of medical accident treatment in medical accident damage compensation standard and other rules no longer apply.
In October 2015, the national health and family planning commission on the basis of the regulations on the medical accident treatment, drafted by the medical dispute prevention and handling regulations (SongShenGao) ", submitted to the state council and to solicit opinions from the public, to replace "byelaw of medical accident treatment.
There has been a lot of change in the draft from the original regulations: the treatment of medical disputes has increased the channels for people to mediate; To draw on the common practice of international peer evaluation, the health industry considers the medical accident as an important basis for administrative processing. Delete the original part of medical malpractice compensation, medical institutions for medical liability insurance, and put forward the principle of medical damage appraisal plan, etc.
Although there have been a lot of progress and improvement in the draft, some of the provisions in the draft review remain controversial.
"Part information is still not enough refining, identifying the dualization problems still exist, poor medical disputes non-litigation way, easy to cause the 'big big big loss, nao' small loss, don't make not to compensate etc. Bad phenomenon." Liu xin, director of the center for medical law and ethics at the China university of political science and law, said that the review should be improved on the basis of thorough research.
The information is not transparent
"The doctor asked only two words, and he made a list and called the next patient." In wangjing hospital of zhou li (a pseudonym) said that she felt sick one morning, the doctor did not wait for her turn the condition to say that finish, just watching a disease, let a person heart is very uncomfortable.
"Patients suffering from disease, poor mood is an urgent need to comprehensive diagnosis and the doctor, the doctor a day to see a lot of patients, for many disease is normal, and the time arrangement is compact, unable to elaborate with each patient." Wang zhaolu, director of the office of the hospital for the medical treatment of the Chinese academy of Chinese medical sciences, acknowledged that many disputes have not yet been done.
In addition, wang chaulu, who has been in the hospital for six years, believes there is an important reason for the problem of doctor-patient disputes. Due to technical barriers, patients do not understand the medical knowledge, doctors don't know patients demand, lead to distrust, mutual suspicion, serious and even a lot of tragedy.
On May 5, 2016, the guangdong people's hospital of oral and maxillofacial surgery newly retired zhong-wei Chen doctor followed a cut, after the rescue invalid death, reason is that the perpetrators think 25 years ago had been zhong-wei Chen "broken teeth".
"Apart from a few professional 'doctors', the information is not transparent in the course of the procedure, which is the trigger for the deterioration of the doctor-patient relationship." "Said ding.
Reporter noted that the original regulations in medical records can be divided into subjective objective medical records, medical records and only allowing patients to copy the objective medical records, don't allow patients to consult the subjective case history. The draft review continued the rule.
Many experts believe that this is not proper.
Liu pointed out that this violates the right to know that the patient should be entitled to, and it can also cause the mistrust between doctors and patients. "Should break records the distinction between subjective and objective, give your rights of parties consult, copy the complete medical records, can help patients to understand the hospital diagnosis rules, etc., to increase transparency." Rebekah.
"If there is put forward to check the records, we shall be permitted, and most likely after implementation of electronic medical records, patients can get what they want as long as the Internet information, to distinguish between the subjective and objective medical records." It can also reverse the improvement of medical quality and improve the lag of the writing of medical records, according to wang.
Guo-wen ding proposal, doctor-patient communication channels should be built, including the hospital actively public express medical procedures, operation rules and system details, for demand information timely inform patients, patients should consciously abide by the system of the hospital, etc. At the same time, promote the medical institutions should be improving the quality of service, improve the doctor moral quality, strengthen medical personnel self-discipline, humanistic care for patients, enhance the communication between patients and medical staff, communication and understanding, to help build trust each other in the benign interaction of the doctor-patient relationship.
Encourage patient hospitals to buy insurance
"Give red money not to buy insurance, not only in the heart, but also buy 1000 yuan operation insurance to be able to pay up to 250,000 yuan." Mr. Wang used to say to the families of those who were eager to give the red envelope.
Medical accident treatment inevitably involve compensation, professional and complex medical questions, the doctor-patient relationship is sensitive and subtle, compensation is to reach the fundamental interests of the patients with problem, more need to be careful to handle.
"After the medical dispute, patients thought that legal process takes time, find some direct medical institutions' rights or seek medical workers' claims. The hospital to avoid trouble, will pay, so a vicious circle." "Mr Wang points out.
"If a third-party settlement is established, the liability of the medical malpractice is separated from the compensator, and the patient and the patient can reduce the positive conflict." 'the insurance system is the best solution,' Mr. Liu said.
SongShenGao article 47 regulation, establish and improve the medical risk sharing mechanism, exert medical dispute handling insurance mechanism in the work of the third party pay and the role of socialization of medical risk share. Medical institutions shall participate in medical liability insurance according to relevant requirements. Encourage patients to participate in insurance such as medical accident.
"Which included in the medical insurance system, relative to the original rules, is a great progress, but the medical liability insurance system in China there is still a great gap." Bass said.
At present, many hospitals in foreign countries have introduced insurance systems, and some have offered to buy insurance on the initiative, liu said. But in our country, insurance system in the medical industry is not fully popularization, single species, medical accident compensation and insurance premiums do not have the advantage that the hospital didn't buy the enthusiasm.
"The hospital should buy medical liability insurance for the doctor, let the doctor confidently, can set his mind at to diagnosis and treatment, and encourage patients to buy insurance, but due to a lack of enforcement, many hospitals hasn't caused take seriously." Wang Chaolu think, should be forced to buy insurance, medical institutions and, according to the principle of who carry out who is responsible, to not buy insurance, head of the medical institutions and start the accountability system, etc.
"Building a pilot cities or areas, on the basis of full investigation, according to the different requirements of hospital refinement insurance types, establish a variety of insurance business, such as medical liability insurance, medical accident insurance and medical insurance, etc." Rebekah.
There are insufficient funds for mediation
SongShenGao chapter iii discussed with rules on the medical dispute mediation, clearly stipulated people's governments at various levels shall establish a people's mediation system of prevention and treatment of medical disputes.
"The people of the medical dispute mediation committee mainly undertake the city medical dispute mediation, legal aid, risk control and prevention advice, such as work, was organized by the third party experts, has the public welfare, neutral and professional opinions, reducing red tape, easier to resolve contradictions." Wang Chaolu said.
"Despite this, many people do not understand the advantages of the people's mediation system in medical disputes, and even know little about the system." Mr Wang points out that there needs to be more publicity about this, and the spread of its benefits.
"In addition, the people's mediation system has many weaknesses need to be resolved. A lot of local grassroots medical dispute mediation committee to a serious shortage of funds, is difficult to effectively carry out its work." Bass said.
Wang Chaolu suggested that local governments deal with the people's conciliation committee intensify security, transfer of fixed capital, in proportion to the doctor-patient relationship tense region should increase the funds safeguard, the special fund is special, and adhere to the principle of management who is responsible for the higher authorities in violation of provisions of the relevant department, effectively subsidies implementation to use.
"The establishment of various committees should be designed to avoid arbitrary and arbitrary, and summarize the experience of success and improve the local situation." Wang Chaolu said.
Qualification to rebekah, coping mediators also establish a certain threshold, emphasize certain professional background, the introduction of professional talents, establish strategic cooperative relations with medical institutions, officials should comply with the time request updated knowledge, on the mediation program, mediation method pays attention to the concept of practical give priority to, treat theory of dispute solution not only efficiency, but in effect theory, really protect the benefit of both doctors.
Local legislation has been first visited
In recent years, tianjin, zhejiang, hunan, guangdong, guizhou, Shanghai, jiangxi and other provinces and cities have issued the medical dispute prevention and treatment of local laws, regulations, and to the effective prevention and handling medical disputes, protect the lawful rights and interests of both doctors has played a positive role.
The regulations on the prevention and treatment of medical disputes in jiangxi province, which came into force on May 1, 2014, are the first local regulations on the handling of medical disputes in China. The regulations clearly stipulate that after a medical dispute, the patient's family shall have the right to photocopy the medical records. We should establish and improve the communication mechanism for doctors and patients, set up a unified complaint window and reception area, and be equipped with specialized personnel. We will encourage the insurance underwriting agency to develop diversified medical liability insurance products.
Come into force on January 1, 2015 the tianjin medical disputes disposal ordinance of the most outstanding innovation, mainly reflected in the introduction of medical liability insurance claims and medical dispute mediation committee mechanism, through the establishment of the people's conciliation committee in medical disputes, exploration has established a new way of medical dispute treatment, good practice in the repair of the doctor-patient relationship.
"It is also the intention of China to amend the legislative law to make the case for local legislation. Guo-wen ding pointed out that the local legislation in advance, can first trial related mechanism in this area, and draw useful experiences in practice, laws and regulations to develop well, pipe doesn't work, can solve practical problems, can be derived from the experience of local legislation, to strengthen and improve the host law legislation, improve the quality of legislation.
"Because of the country's economic and social development is not balanced, the legislation also relatively have differences, and measure the quality of legislation, to look at and reflect the objective law, conform to the law of the people's will, to solve practical problems." According to wang, local legislation is a good way to find out the problem and solve the problem.
"National legislation, according to local legislation, establish the overall framework in many specific cases and cases, with obvious regional characteristic shoulds not be too specific provisions, for judicial interpretation to retain a certain space." According to ding, local legislation, based on the detailed rules of the law, will be more suitable for local features, which will be refined in areas where it is not perfect.
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