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1、What can be trust?The combined survey of medical accidents and medical errors,Li Benfu, Cong Yali, Sun Fuchuan, Chen Xiaoyang, Chen Pei, Zhu Kangmei, Fan Mingsheng 2002, Statues,The reality that patients face,Medical accidents are very few; most are medical errors “The experience of foreign courtier
2、s to deal with medical errors”，Management Magazine of Chinese PLA Hospital. No.6, 2002：In U.S.A medical errors rank 8th in the death reasons. In China, major factors for medical error are: skills, incompetence, faultiness of the basic regulations and imperfect supervision,The attitude of physicians
3、to medical errorsthe combined survey in Harbin, Beijing, Jinan, and Shanghai,Sharing results,sample （396）,beijing：140（眼科、产科等） shanghai：58（内科和外伤） jinan：100（妇儿、外科、内总、五官、，门诊各20） harbin：98,5.According to your observation, the rate of medical error around you?,A. 05% B.510% C.1015% D.其他：如 % 90%以上选择A. One
4、 special point, beijing baby delivery：38.8% select B，or C。 Harbin pediatrics: 37.5%,6.After medical error happened, you found how your colleagues to deal with,A.dont let leader knows B dont let colleague knows C.dont tell patient first, but observe and check carefully D.Tell department, but keep sec
5、ret to outside E.others： 选择C：33.3% 【132（396）】 选择D： 36.4% 【144（396）】,7.Do you once make medical error?,if yes, who you once tell： A.colleague； B leader. C.lower colleague； D. family； E.patient； F.others 选择A和B居多，其中B要多于A。 B A,8.IF happened by yourself, how much percent you should take responsibility? %
6、，other factors, please fill at least three items,Most: 10-20%。One eldest，73 yrs, he answered 50-60%。 Other factors：patient not cooperation, work pressure, too tired, complicated disease, not developed system of rule and regulation, and the work exchange time. eg. Some patients not polite, and rude,
7、so physicians very worried, and usually esay to make something wrong,9.If dont want to tell colleage and leader, what is the main reasons,A. afraid leader think uncompetent； B. afraid colleague think lower level; C. afraid affect the promote of position D. afraid punishment on bonus Eothers 明显地，选择A
8、C和D 疑问：现实中的医生差错发生，与相继的医院、科室对其的经济处罚，到底是否进行了客观的区分和考虑,10. If dont want to tell patient, the reasons：,A.sue, court； B.tell the media C.not necessary to tell pt D.others： reason：pt will not understand physicians, dont trust physician, quarrel, hit doctor, sue doctors.（nothing is impossible）,Special point
9、,Hard to answer, some not serious, or one take several questionnaires But still there exist many true response. Something like communicate with them Different depts, and hospitals, sometimes can show the obvious differences. If sample large enough, can find some factors related to hospital education
10、 environment, and different hospital rules and its relationship with medical error,医疗差错对待，医师职业精神的核心问题之一谁的利益至上？,新型的利益冲突患者生命安全利益 Vs 医生的经济利益和名誉等其他利益 目前不利的表现： 观念上的扭曲都清楚这是客观存在的事实，但又认为不能“承认”； 行政管理措施：报告则意味着处罚经济和名誉（如美国的高额赔付的风险赔偿机制也在一定程度上制约着医疗事故的自愿报告；我国的“面子”方面、“被歧视”等心理； 有空子可钻：不报告有可能对自己没有负面的影响。 客观上，不信任的医患关系，更
11、加阻碍了医疗差错的报告，也因此丧失了医生从差错中学习的机会。 我国，仍然缺乏认错、反省、互相理解等机制和传统。患者对差错也缺乏客观的认识。,Share experience,Shouldnt inform the patients. Otherwise it will lead such results: misunderstanding by patients, mistrust by patients, quarreling with doctors, prosecution, battery, etc. （nothing is impossible） Dont report to the
12、 hospital administrators. Otherwise you will be punished.,Whose interests are first?,New model of interests conflicts: patients safety vs. doctors interests Some adverse phenomena： Distortion of ideasit is objective, but some do not accept it. Administrative measures: report means punishment Exploit
13、 an advantage. There are some bad effects with no report. Objectively, the mistrust between doctors and patients hinders the report of medical errors. So doctors lose the chance to learn from the errors. There is no tradition of misknow, reflection and mutual understanding. Patients have no objectiv
14、e knowledge of medical errors.,What can be trust for patient safety？,Foreseeable：dealing with accidents, compensation, report of medical errors, building the safety system, the team work, etc. Unforeseeable ：the attitude to medical errors, the psychological stats after errors, etc.,The construction
15、of Error report systemvisible,任仲杰，the report system of medical error and medical accident in U.S ，中华医院管理杂志，2006年06期 In U.S, there are more and more evidences that the report system of medical error and medical accident would promote the medical quality and security. It is adopted in mostly hospitals
16、.,Peter Singer etc，The ethical dilemma medical error and medical culture，An ethical dilemma-Medical errors and medical culture- 2002年03期 Commentary: Learning to love mistakes Doctors are obliged to be honest with their patients,the atmosphere of trust, understanding invisible,What can be done for me
17、dical professionalism on medical error,Take more objective education on medical error to medical students Educated differently -for physicians, for hospitals, for patients, for doctor-patient understanding etc. Constitute for the long term doctor-patient relationship with understanding and trust, so we can create medical humanity idea Changing the culture of blamewhether a culture, in which there is more trust and security between doctor and patients, can be constructed? Changing the culture of blaming doctors only (excluding the subjective factors like responsibility ) ?,