Improve the effectiveness of doctor-patient communication and improve the third-party witness mechanism for preoperative conversations
The problem of doctor-patient communication has always been an important cause of doctor-patient disputes. Studies by scholars have shown that more than 60% of doctor-patient disputes are caused by defects in medical notification. The survey found that the current medical notification issues in practice are extremely complex, mainly manifested in the complexity of medical notification objects, the difficulty in comprehensive medical notification content, unclear medical notification methods, vague medical notification standards, and the resolution of conflicts between the patient's right to informed consent and the doctor's right to medical intervention. The rules are unclear and so on. Disputes often arise between doctors and patients over notification issues.
For example, in a medical notification dispute case, the patient's condition was serious and the operation was extremely difficult and risky. The doctor fully informed the patient of the risk of death before the operation, and the patient finally decided to accept the risk of death and give it a try. The operation was successful and the patient survived, but postoperative complications caused the patient to become paraplegic. The patient believed that the doctor's failure to provide medical information about the risk of paraplegia before surgery violated his right to informed consent, and he had a dispute with the hospital. After investigation, it was found that the risk of paraplegia was not stated in the informed consent form signed by the patient before surgery. In the end, the hospital assumed corresponding compensation liability to the patient due to insufficient notification.
This case is very typical. It can be seen that the current main focus of dispute between doctors and patients is the effectiveness of medical notification. After a dispute occurs, patients and their families generally believe that they lack medical expertise, and the medical staff's information is just a formality, making it difficult for them to understand the content of the information and make correct medical choices. To this end, we have been exploring and improving medical notification methods in practice, hoping to allow patients and family members to better understand the content of medical notifications, especially medical measures and risks, and achieve better medical notification effects. Among them, the establishment of a “third-party witness mechanism for preoperative interviews” has received attention and recognition from the People’s Court and the health administrative department.
There have also been some success stories in recent years. For example, Meishan City, Sichuan Province proposed the establishment of a preoperative witnessing system, which mainly refers to the third-party witnessing of preoperative conversations for "high-risk, difficult, and complex" third- and fourth-level surgeries. The medical commission will intervene and witness the preoperative doctor-patient interviews for major surgeries. , explain relevant medical risks, let patients fully understand surgical risks, complications, sequelae and other issues, and avoid doctor-patient disputes afterwards. The medical commission signed as a witness the relevant interview materials; Henan Hebi requires all medical institutions to establish and improve medical risk sharing mechanisms, conduct third-party witnessing of preoperative interviews, and encourage patients to participate in medical accident insurance and purchase surgical accident insurance. If the above work is done well, it will help prevent doctor-patient disputes by "moving the gateway forward", improve the effectiveness of doctor-patient communication, and promote mutual respect and trust between doctors and patients.
The author suggests that the applicable situations for third-party witnessing of preoperative conversations can be limited to: patients with complex and critical conditions and high surgical risks; new technologies, new projects, and clinical trials; family members who have inconsistent opinions, excessive medical expectations, poor medical compliance, and refusal or non-cooperation Diagnosis and treatment; medical disputes have occurred or doctor-patient communication is poor; immediate family members are not around, which may affect medical decisions, etc.
In specific operations, it may be considered to have hospital administrative department personnel, lawyers, volunteers, or insurance institutions underwriting the hospital's medical liability insurance as third parties to participate in the preoperative conversation witness. Medical staff will explain the patient's condition, preferred medical plan, alternative plans, possible medical risks and other relevant content to the patient and family in detail, and answer questions for the patient. The third party is responsible for urging doctors to fully inform medical risks and other statutory notification matters, reminding patients to pay attention to medical risks, and informing patients of the medical risk sharing mechanism and ways to protect their rights according to law. In addition to being signed by the doctor, patient, and witness, the entire conversation is audio-recorded. This can solve the problem that the content of the doctor's notification cannot be fully reflected in the written notification due to space limitations in conventional written notifications, and strengthen the evidence fixation of the content of the medical notification. , improve the effect of medical notification and avoid disputes between doctors and patients due to the content of the notification afterwards.
