Cause Analysis And Strategy For Deficiencies Of Medical Informating Duty In Public Hospital

BackgroundWith the development of biomedical and social progress, medical model and the physician-patient relationship patterns have changed since the 20th century. In the medical process, the rights awareness and sense of participation of patients have gradually enhanced. Medical informing and informing choice have been paid attention to. The current medical malpractice shows a rising trend year by year. Over sixty percent of prosecutions in the national annual medical malpractice cases tend to be the doctors who do not fulfill the informing obligations which violate the informed consent right of patients. Deficiency in Medical informing duty is not conducive to harmonious Physician-patient relationships, which violate the informed consent of patients and reduce patient satisfaction and loyalty.Many foreign countries such as the USA, UK, Netherlands, Finland, Korea, etc as well as Taiwan, Hong Kong in our country have explicit laws for the informing duty recently. But for historical reasons, in our Mainland country, modern health and legal system started later, and the legislation of medical informing duty is still in the early stage. Although legislation has clearly inform medical personnel of medical informing duty, there are many deficiencies which include that most of the provisions are administrative regulations and departmental rules which ranks lower, provisions are too scattered and there were no specific laws, provisions of the subject as well as content and object are not detailed enough which are difficult to be operated.At present, many researches have been conducted for defining the meaning of informed consent, informing subjects, objects, contents, and informing forms, but on the connotation of informed consent, there are still some issues unresolved:informed consent is one right or more? Whether informed consent contains informed right or not? Most descriptions on the exist deficiency in medical informing duty and its causes are scattered, lack of in-depth and systematic analysis; for response, most measures are proposed from the standpoint of legal construction. In the perspective of hospital management, some research was carried out dispersedly from the aspects of continuing education, improving medical ethics, system construction.Clear legal provisions are made in tort Law which is to be implemented for the medical relief of damage created by deficiency in medical informing duty, which impels hospitals and medical staffs paying attention to the deficiency in medical informing duty. At the same time, with the rapid development of medical services and in-depth health care reform, convergences appear between public hospitals and between public and private hospitals in the area of medical technology, department functions, policies, treatments and so on. Competition is fierce in the medical market, service competition has become the main strategy of market competition. Under the new situation, measures should be taken to prevent the deficiency in medical informing duty, improve the level of medical informing and patient satisfaction and loyalty initiatively by hospitals, which is the general trend.Purpose and SignificanceAs much controversy exists on the connotation of informed consent, and analysis on the causes and measures of the deficiency in medical informing duty is not systematic and in-depth enough, this paper focus on the deficiency in medical informing duty in public hospitals at the present stage in our country, makes deep analysis of defining the connotation of medical informing and the causes of deficiency in medical informing duty in public hospitals according to modern hospital management, organizational behavior theory, the comprehensive use of health services methods. Explore to find an effective solution to the problem of deficiency in medical informing duty in public hospitals, under the condition of social environment could not change in short term from the view of Hospital management, in order to provide some theoretical value in perfecting informed consent and improving the realization of medical informing duty, and give some practical value in solving the current problem of the deficiency in medical informing duty in public hospitals, realizing informed consent of patients, improving the satisfaction and loyalty of both patients and medical staff, building a harmonious relationship between doctors and patients, and also give a certain reference value for the other hospitals.Research ideasThe aim of this study is to explore the informing duty in a narrow sense (corresponding to the patient's informed consent). First of all, using qualitative research methods on combination of literature research, field research methods, expert interviews and comparisons to define the meaning of medical informing duty, on which basis 239 cases of complaint in the recent five years in a public Tertiary hospital in Guangzhou were retrospectively analyzed to reveal the deficiency in medical informing duty existed in medical disputes. Secondly, explore the main motives of the deficiency in medical informing duty in public hospitals by Group Discussion Topics, and elaborate from the management system, medicine, patients, law, culture and other aspects respectively. Finally, a discussion is made on the factors affecting medical informing duty, and the operability of the measures is analyzed in hospital level in combination with the essence of medical informing duty and a set of effective solutions are put forward to solve the problem of deficiency in medical informing duty in public hospitals from the point of hospital's cultural management using the knowledge of management and organizational behavior.ConclusionsFirst, informed consent which is the unity of informed and consent is one right. According to the differences of content and purpose, medical informing duty can be divided into the narrow sense and broad. Narrow sense of medical informing duty is in connection with the informed consent of patients, while the broad sense is not only limited to this, including patients'right of informed.Second,239 complaint cases containing 71 cases of deficiency in medical informing duty occurred among January 2005 to December 2009 in a public tertiary hospital in Guangzhou. Deficiency in medical informing duty involves the following aspects:inspecting and opening drugs without informing; not informing the possible complications and precautions; not informing but changing the surgical procedure in the operation; Though signing informed consent, exaggerating the treatment effect; not considering the psychological factors of patients; information such as the costs being not accurate. Only the third situation accounts for small proportion, there is no significant difference in others. Deficiency in medical informing duty in medical disputes is mainly caused by doctors, most through internal consultations to resolve.Third, the top ten causes of deficiency in medical informing duty are as follows: laws and regulations relevant of medical informing do not sound; the impact of Confucian culture on medical ethics, medical demoralization and social credit lost; medical model does not completely change; hospital management system and operation mechanism need to be further improved; medical education system, mechanisms for continuing education are unreasonable; hospital management is weak; Physician-patient information are asymmetry; for some patients, the ability and willingness of informed consent is not strong; the actual level of medical personnel themselves and the specialty of medicine.Fourth, the purpose of medical informing duty is to protect the self-choice right of patients, which is based on the full and effective informing being realized. Since there are no clear regulations on medical informing in China's laws and regulations and limitations in the adjustment filed exist in the law itself and patients are lack of awareness of informed consent and relevant laws, an adequate and true information provided by the clinics can only depend on the hospital management and the health ethics that medical staff really respect for the autonomy and health right of patients. The concept of medical personnel, the behavior of organizations and individuals are deeply influenced by the hospital culture. Therefore, under the condition of current social environment could not be changed in a short time, this research puts forward a set of effective measures to solve the problem of deficiency in medical informing from the perspective of the hospital cultural management, merging the respecting of patient's health and informed consent into the hospital's material culture, behavior culture, institutional culture and spiritual culture through the function of hospital culture. Firstly, to establish a scientific concept and outlook of development and profit, and to change concepts of business and management; Secondly, to perfect the system of medical informing, and to standardize medical informing behavior; Thirdly, to strengthen continuing education and to increase informing capacity; Fourthly, to increase hardware construction and to improve the environment for medical informing.