Guangzhou, three hospital doctors: The main causes of the patient disputes and expensive medical treatment is difficult

of May Day, International Nurses’ Day the advent of The occasion, organized by the Women’s Children’s Hospital of Ningbo City, a police medical hand in hand with, and build a safety line activities. The picture shows a medical staff to learn self-defense skills. CFP for map

the beginning of May, the Ministry of Health issued an urgent notice, the health administrative departments at all levels to coordinate the public security organs established in two or more hospitals and other key medical institutions Policing.

occurred in recent years more than “kill Medical Records” malignant cases not only impact on the psychology of the public, forcing health authorities continue to carry out the defense upgrade. This notice, there are hospitals asked to defend the room is equipped with helmets, shields, anti-stab vest, the length of the stick. On April 30 this year, the Ministry of Health, Ministry of Public Security jointly issued the “Notice” on the maintenance of medical institutions in order to require the burning of paper money in medical institutions, furnishings hall violations morgue, mob, or insult, intimidation of medical personnel and other acts of law and order punished or even investigated for criminal liability.

May 8th, the former dean of the Tsinghua University Law School Professor Wang Chenguang, Beijing Union Medical College, Education Director of Wang, professor at Peking University’s China Center for Economic Research, Chinese Ministry of Health Policy and Management experts member the Li Lingdeng Hospital Road, where lectures held at Tsinghua University.

the above notice, Wang Zhong said: “This is a deterioration of the doctor-patient relationship the most concentrated and most serious performance. But he believes the hospital is not can not set up a police station in 1998, I went to the University of Southern California Hospital in Los Angeles, USA, into the door through security, 1993, the doctor-patient conflict in which three doctors were killed. “Li Ling believes that solve the fundamental problem, set up a police office in two or more hospitals, as long as the antagonism exists no confidence in the relationship to continue, the doctor-patient conflict will continue to occur.

why

doctor-patient relationship deteriorated to such a degree? Where is the root of the contradiction? How to return to a harmonious doctor-patient relationship?

the

“your doctor” and “difficult” is the main reason

patient disputes in the end the reasons arising from? Faced with this outstanding contradictions, some hospitals itself is also summarized.

Traditional Chinese Academy of Sciences, Beijing Xiyuan Hospital, an information display to the hospital in 2007 and 2009 a total of 333 cases of medical disputes, which:

work responsibility and quality of medical care 139 cases, accounting for 41.7%. This regard, disputes often reflected in the medical staff is not a strong sense of responsibility, the work is not detailed medical records in a timely manner, is not complete, inform the full or a mere formality;

service attitude and communication 109 cases, accounting for 32.7 %. Mainly backward sense of service, lack of compassion for patients, and a lukewarm attitude on the patients, blunt, or work with a bad mood;

hospital management of 42 cases (12.6%). Mainly reflecting the examination environment, processes, unreasonable layout, resulting in patients waiting for a long time. Encounter problems the lack of a rapid settlement mechanism, the prevarication of the various departments, small problems become big disputes;

hospital management in place, clinics link divorced, poor communication and other disputes. The irrational use of drugs and check the 28 cases, accounting for 8.4%, the dispute is mainly manifested in the prescription of the medical staff, multi-drug use, dose of ultra-super package insert label use, and not timely communication with patients.

other 15 cases, accounting for 4.5%. Mainly reflects the lack of understanding of the patient for some health insurance policies, regulations.

However, in Guangzhou, a top three hospital doctors Yun’s view, and there’s some reason is just skin deep, she believes that the patient disputes the main reason is “expensive” and “difficult”.

a little cold to spend a thousand dollars, and doctors over-prescribing drugs and false high-priced drugs are very common. Yun opinion, “your doctor” The reason is the lack of financial investment, leading to the hospital became a revenue-generating units, the public interest side of the expression of very obvious. “The reason why doctors to prescribe medication and drugs to support medical is the root cause, the doctor there is no way.”

Fellow of the Institute of Industrial Economics, Chinese Academy of Social Sciences, the China Economic System Reform Research Association for Public Policy Research Center Director afterglow believe that drugs to support medical, excessive use of checks and medication of benign constraints and incentives of the doctor’s yet to be established. Doctors in public hospitals of the nominal wage is very low, forcing doctors medication.

than 10 years has tirelessly and medical corruption struggle famous counterfeiting of medical devices Chen Xiaolan told the China Youth Daily reporter, hospital check-ups abuse, abuse of a drugs really common. “Excessive for fees, charges with the medical staff to open a single commission rebate is closely related to many hospitals encourage billing, doctors prescribe more drugs, but also to get the drug rebate doctor legitimate income is not high, but the gray income much higher than the legal income. ”

lectures in Tsinghua University, Professor Li Ling also believes that the physician-patient relationship tension is the mechanism of health care in the design of the system, the state did not assume the responsibilities of health staff to get a decent wage . Some hospitals are public, but to make money, this is a distortion of the situation.

Wang Yun said, all these years, it has been said to improve the income of doctors, to improve the medical fees, change the status of drug dependent doctors, but in her view, no change. A top three hospital doctors Lee also believes that “I feel not put into us, the thunder, little rain.

Yun seems “expensive” problems caused by the suffering from the medical side as the service industry, spent the money necessary to have results. Coupled with the “hidden rules” the doctor received a red envelope, open the high-priced drugs, the risk of side prone to distrust, unhappy place in the treatment process, there may be medical disputes.

she said, as long as no cure, patients and their families can not understand, always felt that the people sent to the hospital, sent money, cure is the responsibility of the hospital. “The idea is a deviation, each individual distinction, a conventional treatment methods are not all patients the effect of some common disease in some patients who need special treatment, health care itself, there are many unpredictable, and some disease is not the rule of law in the present surgery, there are some unforeseen circumstances, there is a risk of unpredictable. “

Lee also believes that, save will have two consequences, one is saved, is to save the dead. Some people may think, spent so much money, both of the final wealth is indeed difficult to accept.

“expensive” at the same time, “see” a lot of fresh cases. In 2009, the president of the 19 tertiary hospitals in Beijing disguised as ordinary patients to experience the treatment process as a result, the shortest time-consuming three hours, the longest took seven hours, but really to see a doctor for only a few minutes to ten minutes .

“see” highlights the status of the medical imbalance in the allocation of resources, large hospitals focus on too many patients and some community hospitals are deserted. Patients flocked to large hospitals, often resulting in a large hospital overload operation. Wang Yun said, a patient doctor one morning we should see seven or ten more throat will say dumb to the last, then do not want to say, even the toilets are not the attitude of how can get up ? Patients such as a few hours, a few minutes to a few words sent, I of course will not be comfortable.

Wang Yun said, she met the patients, almost half can be treated in two hospitals or community hospitals do not have the top three hospitals, but people do not trust, that level is not high in those places may also have patients in small hospitals had suffered, and do not want to go. “I also have students in community hospitals, their patients less and less medical, less income, level of experience would not increase, so a vicious circle, the patients do not want to go.”

afterglow also mention to the grass-roots hospitals hardware does have greatly improved, but the years, the comprehensive reform of the medical institutions not only failed to improve the capacity of grass-roots hospital service, but reduced. Statistics found that the township health centers and hospital outpatient downward trend in recent years, a basic drug system, resulting in drug varieties less, slow delivery, township hospitals with the original secondary treatment services have stopped, the second or incentives, many places to engage in two lines of income and expenditure, the actual decline in revenue.

the

how to rebuild a harmonious doctor-patient relationship

want to create a harmonious doctor-patient relationship, is pinning its hopes in resolving these issues. Hospital stationed in the practice of police officers, maritime law firm in Shanghai, Liu Ye, medical lawyers, police officers stationed in the hospital can not solve the fundamental problem of medical disputes need to be sparse and not blocking.

Chen Xiaolan: Ministry of Health and the Ministry of Public Security provisions of the the dimethyl hospitals and the Hong Kong Police Force A of hospitals and primary hospitals regardless of the? This approach is a palliative, not desirable.

afterglow also believe that the police assigned to solve the root cause of tension not doctor-patient relationship.

ease the doctor-patient conflicts afterglow think, to give the doctor paid to solve the doctor seeks profit It is unrealistic, financial barely. feasible path is first to further improve the national health insurance, especially investment in low-income people health insurance, and then ask the health care agencies with the hospital negotiations, to carry out more health insurance to pay fee reform of the mechanism, through the health insurance package pay constraint hospital behavior, the good doctor to the hospital management.

twilight at the same time, public hospitals to speed up the reform, the real “tube do separate hospital independent health sector need to do is medical dispute prevention and management of industry affairs, such as strengthening the supervision of doctors, to ensure the safety and quality of medical services.

Liu Ye then that, doctors rely on technology rather than rely on open more drugs, more examinations to eat, should raise the value of medical technology, such as surgery of the registration fee to be reasonable to raise prices, “the doctor’s service price the state can not interfere too much, to be determined by the market. The biggest problem now is that the doctor is not free to practice, attached to the hospital, especially state-owned hospitals, doctors medical technology without pricing. The doctors can not practice freedom, which does not match with the nature of the doctor’s, but also greatly limits the doctor’s ability to practice. If doctors have been liberated, the doctor’s ability to be released, medical care has greatly eased.

afterglow also believe that if doctors can flow more freely, the price of services is more market-oriented doctors get kickbacks phenomenon would be greatly reduced.

In addition, to alleviate the doctor-patient contradiction, many places are built on people’s mediation mechanism, the data show that in April 2009, Nanjing launched a medical dispute people’s mediation work, as of the end of August 2010, received a total mass of 2589 batch, more than 7000 people. 1350 accepted disputes, mediation has been successful 1304, involving compensation of about 42.79 million yuan, by persuasion and persuasion, to clear up doubts, so that patients expressly waived by the demands of the 495.

in January 2010. Ministry of Justice, Ministry of Health, the CIRC issued opinions on strengthening the work of people’s mediation of medical disputes across the country are starting to set up a people’s mediation organizations of the medical dispute.

For the mediation mechanism, the Tsinghua University Professor Wang Chenguang lecture, “There is a basic principle, encounter patient disputes, a neutral third party should be freed from the opposite, doctors and patients, there is a misunderstanding of the rule of law is going to court proceedings, We should vigorously promote arbitration and third-party mediation to avoid the doctors to the muzzle of the medical disputes.

but twilight does not agree with this way, be seen as more advanced compounding method “I think to solve doctor-patient conflicts at this stage, or go the judicial procedures, so many medical disputes through the full judicial process and the mechanism of the accident and hazards through case summed up. Litigation process can be open, the Medical Malpractice Committee proceedings are open to the public, including a list of experts to open, I think the neutral will be greatly reduced.

Liu Ye also believes that the medical dispute Mediation Committee can only play a buffer role can play a mainstay role in the medical dispute, or a fair and impartial judicial channels, including the identification system of rules of evidence must not be mediation, mediation and conciliation for the maintenance of stability.

He said the present situation is that the medical expert conclusions, the court is often difficult to fully and effectively cross-examine or cross-examine a mere formality, basically the court on the Identification, according to a single adoption of the assessment process to the parties publicly, conclusions both sides open to cross-examine expert witnesses to appear in court, to accept both doctors and patients question should judge the adoption of the conclusion some initiative.

Liu Ye also believe that, from a national perspective, the ability of judges to hear the medical dispute is necessary to strengthen our country is not the formation of independent groups of judges of the Trial of medical disputes, and other countries and regions, such as medical law clearly defined trial of medical disputes, judges have a medical background or a senior judge. “China in Beijing, Shanghai and Guangdong and other places of the court judge long-term trial of medical disputes, lack of medical trial but more local judges experiences.

Chen Xiaolan said patient conflict is largely a conflict between patients and hospitals, doctor-patient relationship opposing the other side, hospitals, medical institutions, health care laws and regulations, the administrative department of health, medical Institute of Medicine industry, the price department. “These doctor-patient relationship is the real antithesis, these do not make any changes, the doctor-patient relationship status quo is unlikely to change.

(Wen Wang Yun and Lee, and upon request pseudonym)

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