Recruitment of famous doctors

This is really a serial explosion! In fact, the "hysteroscopy" incident and the "non-surgeon" incident in Taiwan Province Chang Gung Hospital are thought-provoking medical ethics issues.

A fact really happened before. The patient's family waited outside the operating room, knowing that the patient was lying on the operating table and undergoing surgery. A surgeon should be a famous doctor. The family saw the surgeon go out and walk into the operating room. The patient's son had no choice but to bravely go up and ask, "Hello! Aren't you in there operating on my dad? Guess, how did the famous doctors respond? The doctor asked coldly, "who is your father?" The son began to worry and said, "My father's name is xxx." . The famous doctor actually replied: "Oh! I'll go in and have a look ... "I hurried into the operating room, leaving my son puzzled and waiting anxiously.

1. The incident of "non-surgeon" was also compared with Chang Geng's medical record, and it was found that the operation was not done by big doctor himself, but by a qualified doctor. Therefore, Chang Geng's "non-surgical doctor" incident only thinks that the doctor violated the hospital regulations because he didn't ask for leave, not because he didn't perform surgery himself. Because in teaching hospitals, it is completely legal for senior doctors to operate on qualified doctors with little experience.

"But don't you have to teach together on the operating table? How can I slide my mobile phone and slowly get in and out of the operating room? Isn't that illegal? " My former patient's son once asked me this question in confusion!

To be correct, in fact, these doctors have violated medical ethics!

2. When the "non-surgeon incident" violates the "principle of doing good" in medical ethics, doctors do not operate on the operating table, which actually violates the "principle of doing good" in medical ethics: that is, doctors should choose a treatment method with high success rate for patients in various treatment methods in clinical work, based on the interests of patients, including referring uncertain cases to appropriate peers or teaching themselves.

Therefore, "non-surgeon" doctors violate the principle of doing good in medical ethics, that is, they do not have their own practical teaching colleagues, but let their so-called qualified doctors practice knives alone, whether good or not.

3. Hysteroscopy Event Another "Hysteroscopy Event" reported that Chang Gung Gynecologists were suspected of pursuing performance, forging medical conditions, overtreating patients, using hysteroscopy as a profit-making marketing tool, and some female employees in their own hospitals gave birth prematurely; The doctor has been suspended because he failed to carry out the pregnancy test before hysteroscopy according to the procedure after listening to the patient's chief complaint of taking contraceptive pills, resulting in stillbirth. The doctor did make a mistake.

4. "Hysteroscopy incident" violates the "harmless principle" of medical ethics. Doctors know the principle of "no harm" from the beginning of studying medicine, that is, no matter what they do, they can't make the patient worse than the original situation. For example, examinations, drugs or operations that are obviously unfavorable to patients should not be performed on patients because of the doctor's own preferences, convenience or interests. In other words, doctors must never deliberately expose patients to unnecessary danger.

The mystery of this hysteroscopy is that the doctor exposed the patient to unnecessary danger (hysteroscopy), which hurt the fetus to be premature.

In fact, there are four principles in medical ethics, but why do I only choose the principle of doing good and the principle of not hurting? Due to the limited text here, I can only simply cite an example that is consistent with the obvious violation of ethical principles by doctors in Chang Gung Memorial Hospital. In addition, in fact, the principle of doing good and the principle of not hurting are two sides of an organic whole, that is to say, there are very positive and negative differences between them, which is easier for ordinary people to see:

The principle of doing good is to actively demand the doctor's own behavior and emphasize the initiative (for example, the surgeon must be present), but it may not be fully observed (doctors with the same qualifications can make a diagnosis and treatment), so when the behavior fails to meet expectations, it is rarely punished by law.

You got it? Chang Geng only deals with the problem of doctors' personal "leave" procedures and the wrong declaration of individual doctors' medical insurance information! This is also the reason why Chang Gung Memorial Hospital decided not to publish the name of the doctor, because it believed that the doctor was not malicious and illegal.

Without prejudice to the principle? This is a negative and forbidden behavior, which is negative and must be fully observed and taken seriously, because it is "forbidden to hurt" first. If the doctor deliberately violates this principle of no harm, this behavior will hurt the patient. For example, this time, Dr. Chang Geng faked his illness and overtreated his patients for the sake of performance, which led to abortion. Chang Gung Hospital immediately suspended the doctor and suspended the punishment, which can be seen.

Hysteroscopy is a serious or even illegal act, which should be stopped by law if necessary, and even hospitals or doctors should be liable for compensation. The two have different meanings at the ethical level.

Then, someone will surely ask: Why do these big doctor make ethical, moral and conscience mistakes? Didn't anyone inform these big doctor immediately? Let me ask you, if you were a junior doctor, would you tell a famous doctor that you had made a moral mistake? His student union said, "Teacher, if we don't operate together on the operating table, it will violate the principle of medical ethics and good deeds ..."? The scores and promotion of junior doctors depend on these experienced big doctor for performance appraisal! It is conceivable that the principle of doing good in medical ethics has not always been implemented, and it has become a habit over time. Similarly, for the sake of performance, the doctors in charge of the unit have also expanded their examination. Otherwise, someone in the hospital will take care of you and keep an eye on your business. Maybe that's it. Everything will be acquiesced and go on.

The ethical incident in Chang Gung Memorial Hospital reminds me that we are now in an era of high-tech, rich material and excessive economy. The only thing we lack is not that we don't have a mobile phone, no material and no financial communication, but that we "lack a conscience". Everyone from all walks of life has done a good job in their respective posts according to the system, SOP and hospital evaluation documents, or has changed a bunch of processes or systems and continued to do it decently. Who knows, conscience gradually wears away in this job, and it has been worn very thin. As long as you gently pick a small primer, such as bad business and rising pressure, it is easy to wear out the film of "conscience". To make matters worse, many people often don't know that it was not until the incident broke out that they found that their "conscience" was already riddled with holes!

Ah! I really need to reform my conscience. We should be able to care together because we still believe that human nature is good, don't we? How to deal with medical ethics events together? Maybe it can be divided into "medical end" and "patient end"

Medical terminal 1. Set the warning light number.

Because the current health insurance system in Taiwan Province Province is "piecework", that is to say, the more inspections, the more money you get. The business volume of the same medical insurance payment project in a hospital or department suddenly increases, which is a warning light! Warning authorities, pay attention to the business volume that most medical centers in the country can't do. How can only a few of them do it? Is the technology really good? Is the service process too good? Or is it just to rush the performance? You should declare the project. It's computerized now, and it's easy to catch it.

2. Medical behavior of people who are not in China

In fact, this happened a few years ago, that is, doctors continued to declare health insurance premiums when they were clearly not in China. Now it's happening again, which means that even if it happens, everyone will rationalize their behavior for a long time. The review may not be so strict.

Immigration can cooperate with entry and exit, and you will know whether the doctor is really in China, and the hospital itself has the obligation to supervise the behavior of its employees. If you are not in China, the hospital still declares medical insurance benefits for famous doctors. Is it because of negligence when applying? This is false fraud, and it also damages the reputation of the hospital. Isn't it a big deal?

3. Random sampling

People have gone abroad, or non-surgeons are wandering around, which is an obvious plot of hospital officials caring for each other. If you are a teacher and are not in the same operating table or examination room, you can immediately cancel the qualification of the teaching hospital, because teachers are cheating, how can you give up the safety of patients for the sake of good teaching for your colleagues? In fact, everyone can use the closed recording mechanism of computer or TV to monitor these big doctor. Are they really teaching?

Patient side 4. Patients should seek the advice of a second expert.

Patients themselves should also be alert to the risks of any invasive examination. For similar risk assessment, patients have the right to ask doctors to fully inform and explain the responsibility of their medical behavior, instead of "cooperating with patients according to what doctors say". If necessary, it is best to seek a second medical opinion, or it is best to prepare a book with a second medical opinion for signature before implementation.

The patient has to bear part of the burden.

Because the doctor is subjective, the patient doesn't have to pay at all, but the doctor decides to pay the medical insurance premium anyway. In the future, it may be possible to implement a mechanism that patients should bear a reasonable part of the burden, that is, various examinations and prescriptions, and patients must bear a small amount of money. If it is not confirmed by the opinion of the second expert and scholar, and so on.

Chang Gung emergency storm, tell me five management traps.