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 & Zh

ou Hongzhu

Outline

• The current situation of medical accidents in China

• The survey of medical errors in 2008

• What can medical professionalism do for patient safety?

Medical accidents medical errors

• Medical accidents are 医疗事故是指在诊疗护理过成中，因医务人员诊疗护理过失，直接造成人员死亡、残废、组织器官损伤导致功能障碍的。

• Be classified into 4 grades

• Subjective and objective reasons

• Errors, disobey rules, cause harm

• Medical errors is dereliction of duty and technological negligence in the process of 医疗差错是指在诊疗护理过成中，医务人员虽有失职行为或技术过失，但未给病员造成死亡、残废、组织器官损伤导致功能障碍的不良后果。

The reasons of medical accidents——26 cases of a hospital in 2003

Item cases percentage（ % ）

misdiagnosis 、 missed diagnosis & delayed treatment

6 23.1

Operative indication choice, operation method and mishandling the observation after operation

16 61.5

Improper use of drugs and adverse reaction

2 7.7

Carelessness, disobey the concerned rules

2 7.7

The current states of medical accidents

• 47.8% happens on holiday and in the evening• Most statistics shows that accidents happen often in

the orthopedics, obstetrics and gynecology .• Mainly elders and youth

• Some statistics shows that there less accidents in the first level hospital than the second level, less in the second than the third level. But some survey shows the contrary results.

The history of medical accidents in China

• Period of exploration——1949-1956. over punishment, limited compensation for patients. administrative mediation.

• Period of improvement——1956-1965. Treat the medical errors more reasonably, but the radical phenomena does exist.

• Period of anarchy——1966-1976. Culture Revolution.

• Period of legalization——1978 to now 。 1987, Measures ; 2002, Statues

The reality that patients face

• Medical accidents are very few; most are medical errors

• “The experience of foreign courtiers 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 to medical errors—

the 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. 0 ～ 5% B.5 ～ 10% C.10 ～ 15% D. 其他：如 < % 或 > %

90%以上选择 A.

One 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.don’t let leader knowsB don’t let colleague knows C.don’t tell patient first, but observe and check

carefully D.Tell department, but keep secret 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? % ，

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, so physicians very worried, and usually esay to make something wrong

9.If don’t 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 E ． others

明显地，选择 A 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 don’t 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, don’t trust physician, quarrel, hit doctor, sue doctors. （ nothing is impossible ）

Special point

• 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 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

• Shouldn’t inform the patients. Otherwise it will lead such results: misunderstanding by patients, mistrust by patients, quarreling with doctors, prosecution, battery, etc. （ nothing is impossible ）

• Don’t report to the 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 ideas——it is objective, but some do not accept it.– Administrative measures: report means punishment– Exploit 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 objective 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 of Error report system——visible

• 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.

• Peter Singer etc， The ethical dilemma –medical error and medical culture， An ethical dilemma--Medical errors and medical culture-- <<英国医学杂志中文版 >>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 medical 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 blame——whether 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 ) ?