" L Practise medicine illegally " R Charge: The big stick-means of intimidation or show alertly?
PLA Bethune International Peace Hospital quality control department
Li XiaoPing
CCTV reported recently exhaustively husband and lawyer of a medical professor of Peking University query to the dead in the rescue situation of hospital treatment of BJ Univ Hospital, its core is directed at " L BJ Univ Hospital practises medicine illegally " R And " L Borne out by ironclad evidence " . This formulation should exceed a lot of accidents of medical unit and relevant administrative department, because in the industry generally think the intern participates in the thing that the clinical practice is more normal. However, lawyer and media provide this incident " L Practise medicine illegally " R Determine the nature. As being engaged in writing and managing and standardizing the medical worker who studies in medical quality, medical security, case history for a long time, I want to discuss several viewpoints briefly.
The intern writes that is burying the medical potential safety hazard in case history
Mention to practise medicine illegally, everybody will think that refer to the black clinic that interlope in the society. The public hospital will not obviously employ the medical worker who has qualification. I think, this report " L BJ Univ Hospital practises medicine illegally " Formulation touch in fact system, norm, management,etc. to be getting darker issue of level, also a sensitive problem related to medical safety assurance.
Relatives of the dead and the lawyer point out : " Practise issues of medical worker, practise medicine qualification, give patient treat disease and write the case history in hospital. " L If the fact was established, it has really violated operation medicine while imitating " R Not been registered and obtain the practising certificate by the doctor, can't be engaged in the operation activity of a doctor " L Regulation. But," Practise a medical worker and make a diagnosis and give treatment to write the work with the case history clinically " But there are trade files that are supported!
In 2002, Ministry of Public Health, State Administration of Traditional Chinese Medicine issued >7th regulation : " Practise medical worker, probationary period case history that medical worker write, should check, revise and sign in this medical organization legal medical worker of operation. " January 1 of 2009 was issued by Ministry of Public Health, Ministry of Education>Stipulate: " R The intern can contact and observe a patient to teach in the tape under the teacher's supervision guidance, inquire the medical history, check patient's physical sign, consult patient's relevant materials, participate in analyzing and discussing patient's condition, write the case history and patient's course of disease in hospital to record, fill in all kinds of and check and handle single, doctor's order and prescription, have something to do with and make a diagnosis and operate the patient, participate in relevant operations,etc.. " The public hospital unifies and works under the leadership of Ministry of Public Health, because there are the above-mentioned two files, practise issues of medical worker, practise medicine qualification, go on clinical medical treatment practise the activity and is always preceded by in hospital " Legal" L Identity. And the medical potential safety hazard is buried among them exactly .
Emphasize excessively the necessity that the intern practises will injure a patient
All hospitals which undertake the teaching task at home, a large number of interns and nurses are engaged in medical treatment clinically. The intern is not originally a doctor, their identity remains students, the traditional formulation will practise a medical worker the clinical job will be called " The clinical practice activity that medical science grows " . However, emphasize excessively the practicality when students practise has a lot of drawbacks.
The first, interns do not possess basic working ability. The students whom the intern just educated after accepting the basic theory, had not made a comprehensive study and a thorough master of all theory study yet, mastered, no matter diagnose, treating, operating or surgery, need studying from scratch. They do not possess and can give the patient a level and ability to make a diagnosis and give treatment safely. In 3 patients' case history of BJ Univ Hospital, the mistaken diagnosis of complication is managed by mistake after the operation which lawyer and patient relatives mentioned, heart press rescue tactics, the intersection of patient and handling etc. take place irritated, under infusion outside the very rude chest when patient die suddenly, prove intern make the intersection of work and the intersection of treatment and security in patient the guarantee.
The case history quality that the intern writes is unable to guarantee the second. Case history write it is the intersection of doctor and work in patient that record, have no ability, do well, and what can write well? Domestic some the intersection of quality and managerial expert part 7 correctly Make every year ' Master) Student, undergraduate and medical science that has already graduated grow the case history written to check, find all respects generally have more problems. There are statistics, students write the disqualification rate of the case history and is up to 19%. Such a case history can't reflect the clinical true medical level, should not keep as patient's medical file either.
The third, it is restricted effectively that the intern's work safety is scarce. According to two gists of a document of Ministry of Public Health, require the intern to teach a teacher how to guide and responsible for from taking the place of the clinical work. Generally speaking, the question commitments responsibility of intern's incorrect course China of making a diagnosis and giving treatment, so between intern and patient, there is no clear responsibility relation. The high flowability while practising makes them very difficult to observe the whole course of patient's hospital treatment completely, newborn calf wonder depth can cause a lot of medical emergence of problem.
Fourth, the ones that work to the intern in the hospital take the place of teaching and management can't be guaranteed. Two files of Ministry of Public Health have certain requirements on work of the intern's clinical practice, but because clinical medical worker insufficient allocation ratio have and the intersection of hospital and global medical treatment manage issues such as quality,etc., whom intern work take the place of teach and management, in place, appear intern become routine phenomenon of subject impossible. So, in a situation that the management system of medical quality at present has more problems, cross and open to the intern more " L The green light " ,It is very old to endanger the patient.
Standardize medical science and grow the clinical practice activity imperatively
I especially propose discussing to the question of intern's job file this, because the regulations of the above-mentioned two files violate the regulation that operation medicine imitated. Operation medicine imitates the regulation : " The country implements the registered system of doctor's operation; Not been registered and make the operation certificate by the doctor, can't be engaged in the operation activity of a doctor; The doctor implements medical treatment, preventing, health care measure, sign relevant medical science to prove the file, fill in the medical file according to the regulation . " The intern has not obtained the practising certificate yet, so can't be engaged in any concrete clinic work, including recording the course of disease and writing the case history. The ones that should especially emphasized are, can become the legal case history materials if after the medical worker of the legal operation of this medical organization examine, revise, sign, not a professional engaged in working in some clinical medical treatment under the guidance of professional on meaning allowing. This is incorrect, have violated the law of medical practitioner.
Make involved in medical management any standardize file, should consider patient seek medical advice safe problem at first. About this, we have advised the related departments to consider and improve many times. Because the mentioning of consciousness as the public and patient safeguard the rights
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