Research On Medical Fault And Causative Potency Of Medical Damage From The Clinical Perspective

Background:In the field of medical damage liability disputes,judges who "do not understand medicine",must rely on the "appraisal opinions" of medical experts with specialized knowledge to make "assistant judgments".However,there are still many problems in the identification of medical damage.For example,the standard of medical fault is unknown,the basis for determining the size of the cause is insufficient,and the expression and writing of the expert opinion are not standardized.As a result,both doctors and patients have greater disputes over the appraisal opinions and medical disputes are difficult to properly resolve.Objective:Based on the pivotal status and role of medical damage assessment opinions in medical damage liability dispute cases,especially whether there is any fault in the medical institution,whether there is a causal relationship between the fault and the damage consequence,and the influence of core content such as causative potency on the judgment.This article will start with the standard of medical fault and the influence of fault on causal judgment,with a view to improving the quality of the appraisal opinion,increasing the objectivity of the appraisal opinion,reducing and avoiding the subjectivity of the appraisal,reasonably resolving medical damage liability disputes,and protecting the legality of both doctors and patients rights and interests.Method:A total of 674 cases related to AMI were collected through the China Judgment Document Network.After screening,288 effective cases were finally obtained.From a clinical perspective,medical faults are divided into three parts:medical technical fault,medical record fault and Informing fault.Exploring the criteria for medical fault judgment through empirical research and literature analysis.And use Logistic ordered multi-class regression analysis method to analyze the cause of medical fault.Result:Regarding medical fault,laws and regulations,rules and regulations,technical specifications for diagnosis and treatment,operating procedures,and clinical guidelines can be used as criteria for judging medical technical fault.The clinical path as a criterion for fault is debatable.However,expert consensus and expert opinions,medical textbooks,and drug instructions cannot be used as criteria for judgment of medical technical fault.And it is necessary to combine the judgment of"reasonableness".In the judgment of medical record fault,whether it violates laws and regulations and whether it has a substantial impact on medical behavior is the basis for judgment.If the medical record fault violates the article 1222,paragraphs(2)and(3)of the Civil Code,it is presumed that the medical fault exists.In the judgment of the Informing fault,whether it violates laws and regulations,whether it affects the patient’s understanding of medical behavior and the choice of medical behavior as the basis for judgment.In terms of the causative potency of medical damage,there was no significant difference in the identification of causative potency for improper inspection,improper handling of inspection results,improper condition assessment,improper condition observation,and improper care(P>0.05).Improper diagnosis,improper selection of treatment options,improper treatment measures,treatment of changes in the condition,error of notification,improper use of medical products,error of medical records,improper hospital management and other factors have a significant impact on the judgment of causative potency(P<0.05).The influence of medical record fault on causative potency can be further divided into three situations:causative potency cannot be judged,no causative potency at all,and causative potency to be determined.There are two situations in which the influence of the informing fault on causative potency:no causative potency and causative potency to be determined.Conclusion:Medical technical fault can be judged based on diagnosis and treatment obligations,rules and regulations,diagnosis and treatment technical specifications,operating procedures,and clinical guidelines,combined with"reasonableness".In the judgment of medical record fault,whether it violates laws and regulations and whether it has a substantial impact on medical behavior is the basis for judgment.If the medical record fault violates the article 1222,paragraphs(2)and(3)of the Civil Code,it is presumed that the medical fault exists.In the judgment of the Informing fault,whether it violates laws and regulations,whether it affects the patient’s understanding of medical behavior and the choice of medical behavior as the basis for judgment.Improper diagnosis,improper selection of treatment options,improper treatment measures,improper treatment of changes in the condition,improper use of medical products,and hospital management will make the cause a higher level of identification.Medical record fault affects the causative potency by influencing medical behavior,and its causative potency is judged according to the causative potency of medical behavior.Informing fault affects the patient’s choice,thereby affecting the actual medical behavior and having an impact on the causative potency.The judgment of medical fault and causative potency belongs to the "factual judgment" of the dispute between the doctor and the patient.In this regard,the judges should combine the specific circumstances of the case and a comprehensive inspection of the expert opinion to conduct a "legal judgment" on the "factual judgment".In this way,the mistaken situation of "examination by appraisal" can be prevented.