| BackgroundIn today’s society,with the continuous advancement of the medical and health system reform process,people have put forward new requirements for the quality of medical services.In medical activities,medical disputes have arisen because the patients and their families are not satisfied with the medical services provided by medical personnel or medical institutions.This has become a hot issue.Medical disputes have brought serious negative impacts on all aspects of society and are not conducive to the healthy development of China’s medical and health undertakings and the construction of a harmonious medical environment.With the deepening of the reform of the medical and health system in China,how to reasonably prevent and solve medical disputes in a fair,time-and labor-saving,and low-cost way,optimize the environment for medical personnel to practice,eliminate the negative impact on medical personnel,promote the physical and mental health of medical staff,control the occurrence of defensive medical behaviors,safeguard the legitimate rights and interests of both doctors and patients,and promote the harmonious and healthy development of the medical and health industry have become the common aspirations of patients and their families,medical personnel,medical institutions,health administrative departments and the entire society.ObjectiveTo study the incidence,the department distribution,the treatment methods,the compensation,the influencing factors of both doctors and patients of medical disputes,and its influence on the attitudes,psychology,and medical behaviors of doctors and nurses from 2005 to 2016 in a grade-A tertiary hospital,and proposed countermeasures.MethodsThis study uses a combination of qualitative analysis and quantitative analysis.Qualitative analysis mainly includes literature learning and semi-structured interviews.Through reading literature,we will understand the research status of medical disputes at home and abroad and their impact on medical personnel.In addition,qualitative interviews were conducted with the management staff of the Institute’s Regulatory Affairs Office to understand the causes of changes in medical disputes and to supplement other materials.Quantitative analysis selected from January 2005 to December 2016 a total of 1832 cases of medical dispute registration form information,the incidence,department distribution,processing routes,compensation of medical disputes for descriptive analysis;and stratified sampling selected medical disputes the demographic information,medical insurance,disease-related information,and the basic information of the medical parties in the non-medical dispute group were analyzed by Chi-square analysis and logistic regression analysis,focusing on the factors affecting both doctors and patients in medical disputes.In addition,a questionnaire survey was conducted among the medical staff who are in the departments of top 10 number of medical disputes to study the impact of medical disputes on their attitudes,psychology,and behavior.They were analyzed using Chi-square test,Mann-Whitney U,Kruskal-Wallis H test,and other statistical methods.After that,a multiple linear regression model was constructed to analyze the influencing factors of medical disputes on defensive medical behaviors of medical staff.The above analysis was mainly implemented using Excel 2010 and SPSS 21.0 statistical software.Research Results(1)The overall status of medical disputes:The incidence of medical disputes in the past 12 years was the first to rise and then decline.The incidence of medical disputes rose from 0.14%in 2005 to 0.37%in 2008 and 2009,and then dropped to 0.13%in 2016.There were 955 cases of medical disputes in the surgical departments,accounting for 52.13%of the total eases ranked first;there were 271 cases in internal departments,accounting for 14.79%of the total cases,ranking second;there were 209 cases in obstetrics and gynecology,accounting for 11.41%of the total cases,ranking third,indicating that surgery,internal medicine,obstetrics and gynecology are high number of medical disputes department,especially the highest proportion of medical disputes occurred in surgery department.The top three reasons of medical disputes are patients is not satisfied with the treatment effect(70.41%),the medical service attitude is not good(8.24%)and medical expenses(7.64%).About the treatment of medical disputes,doctor-patient consultation(70.03%)is the most important way to resolve medical disputes.The number of disputes handled by administrative mediation is decreasing year by year and the proportion of court litigation in the handling of medical disputes is very low.The amount of compensation for medical disputes showed an upward trend.The highest average amount of compensation was for the surgical department(86,300 yuan).The average amount of compensation in the surgical department is the highest(86,300yuan).The total amount of compensation(35,487,300yuan)and the average compensation amount(74,400 yuan)of the medical disputes caused by the dissatisfaction of the medical disputes are the highest,and the average amount of the compensation obtained by court proceedings is the highest(126,400yuan).(2)Factors Affecting Medical Disputes:The results of this study show that the occupation,admission status,operation status,discharge status,and length of hospital stay of inpatients are the influencing factors of medical disputes in this hospital(P<0.05).Compared with other practitioners,agricultural production personnel(P=0.011,OR=6.591)and industrial production personnel(P=0.021,OR=6.332)have a higher probability of medical disputes;patients who were admitted to the emergency room have a higher probability of medical disputes(P=0.018,OR=3.456)compared to the general condition of patients admitted to the hospital.Compared with patients without surgery,patients received four operations(P=0.021,OR=5.199)and tertiary surgery(P=0.030,OR=2.903)have a higher probability of medical disputes;patients with cure(P<0.001,OR=0.003)and improvement(P<0.001,OR=0.014)were less likely to have medical disputes than those who died;compared with patients who were hospitalized for more than 10 days,patients with less than 5 days of hospital stay had a lower probability of medical disputes(P = 0.013,OR = 0.320).The working life of medical staff,academic qualifications,knowledge familiarity of medical disputes,and attitudes and behaviors of treating patients are the influencing factors of the medical disputes.Compared with medical personnel whose working lives are less than 5 years,medical workers who have been working for more than 15 years have a higher probability of medical disputes(P=0.024,OR=2.395);compared with medical personnel with bachelor degree or below,Ph.D.Medical staff with higher educational background(P=0.002,OR=3.818)had higher probability of medical disputes;compared with medical personnel who are very familiar with medical disputes,they are not familiar with(P=0.001,OR=13.613)and general familiarity(Medical staff with P<0.001,OR=7.322)had a higher probability of having a medical dispute;compared with medical staff with very good patient behaviors and attitudes,the patients were very poor(P<0.001,OR=18.108)and general(Medical personnel with P=0.006,OR=8.705)are more likely to have medical disputes.(3)Impact of medical disputes on medical staff:Medical disputes have a significant influence on the attitudes and psychological of medical staff.The proportion of medical staff who have experienced disputes believes that the relationship between doctors and patients is tense significantly more than the proportion of medical personnel who have not experienced disputes,and the willingness of children to engage in medical work is far lower than those of untried ones.The proportion of doctors and nurses who have experienced disputes is more likely to feel nervous,fearful,depressed and stressed in their daily work.In addition,medical staff who have experienced medical disputes take defensive medical behavior more often than medical personnel who have not experienced medical disputes.The impact factors on the scores of defensive medical behaviors were their experience of medical disputes,age,working years,education,occupations,and departments of medical personnel which were statistically significant(P<0.05).Further analysis showed that medical behavior scores have a significant positive correlation with the medical dispute experience,and a negative correlation with the working years and education.Conclusions and SuggestionsAt present,the overall situation of medical disputes in this hospital in Shandong Province has shown a tendency of rising first and then declining,mainly occurred in the surgical departments.The main causes of medical disputes are related to the quality of medical personnel and the high expectations of patients for medical treatment.The solution is based on doctor-patient consultation.Patient’s occupation,admission status,operation status,discharge status,length of stay in hospital,medical staff working time,education,familiarity with medical disputes,and attitudes and behaviors of treating patients are factors influencing the occurrence of medical disputes.Medical disputes have a certain negative impact on the attitudes,psychological and medical behaviors of medical staff.The medical staffs disputes,age,working years,academic qualifications,occupations and departments are the influencing factors for whether or not the medical staff takes defensive medical behaviors.In order to effectively relieve the stress of the stressful relationship between doctors and patients and reduce the occurrence of medical disputes,the following recommendations are proposed based on the research results:(1)Implement various rules and regulations in department where there is many medical disputes;(2)Improve the medical personnel skills;(3)Popularize basic medical knowledge for citizens;(4)Pay attention to the psychological problems of medical personnel;(5)Control defensive medical behavior. |
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