Posting slogans at the annual meeting of doctors caused controversy.

This is really a serial explosion! In fact, the "hysteroscopy" incident and the "non-surgeon" incident in Taiwan Province Chang Gung Hospital are both 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 couldn't help it, so he had to bravely go up and ask, "Hey! Aren't you operating on my father? Guess, how did the famous doctors respond? The doctor asked coldly, "who is your father?" My son became anxious and said, "My father's name is xxx. The famous doctor actually replied: "Oh! I'll go in and have a look. . . . . 。” I quickly walked into the operating room, leaving my son puzzled and anxiously waiting.

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

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

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 higher success rate for patients among various treatment methods in clinical work, based on the interests of patients, including referring uncertain cases to appropriate peers or teaching them in person.

Therefore, the "non-surgeon" doctor violated the principle of doing good in medical ethics, that is, he did not have his own practical teaching colleagues, but let his so-called qualified doctor practice the knife alone, regardless of whether the knife is good or not.

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

4. "Hysteroscopy incident" violated the "no harm principle" of medical ethics. Doctors have learned the principle of "no harm" since they studied medicine, that is, no matter what they do, they can't make the patient worse than before. 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) and hurt the fetus to make it 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 harmlessness? Due to the limited text here, I can only simply give some examples that are 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, which means that 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 (it is ok to have an equally qualified doctor for 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 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, for the sake of performance, Dr. Chang Gung faked his illness and overtreatment, so that patients received unnecessary examinations, 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 according to law if necessary, and even hospitals or doctors should be liable for compensation. The two have different meanings on the ethical level.

Then, someone will surely ask: Why do these big doctor make ethical, moral and conscience mistakes? Didn't anyone immediately notify these big doctor? Let me ask you, if you were a junior doctor, would you tell a famous doctor that he had made a conscience and moral mistake? His students will say, "Teacher, if you don't operate together on the operating table, it will violate the principle of doing good in medical ethics ..."? 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 has long been a habit. Similarly, the doctor in charge of the unit has also expanded the scope of inspection for performance. Otherwise, someone in the hospital will take care of you and pay attention to your business volume. Perhaps this is the case, everything will be acquiesced and continued.

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 and no material and financial communication, but that we "lack 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 tried to change a bunch of processes or systems and continue to do a decent job. Who knows, conscience gradually wears away in this job, and it has worn away very thin. As long as you choose a small introduction, such as bad business and rising pressure, it is easy to wear off the "conscience" of the movie. To make matters worse, many people often don't know this until the incident broke out and found that their "conscience" was riddled with holes!

Ah! Conscience reform is really necessary. We should be able to care together because we still believe that human nature is kind, don't we? How to deal with medical ethics incidents at the same time? Maybe it can be divided into "medical end" and "patient end"

Medical terminal 1. Set the warning light number.

Because the current medical insurance system in Taiwan Province Province is "pay by piece", that is to say, the more times you check, the more money you get. The business volume of the same medical insurance payment project suddenly increases in a hospital or department, which is a warning light! Warning authorities, pay attention, how can only a few medical centers in most countries be able to do business that cannot be done? Is the technology really good? Is the service process too good? Or is it just to rush the performance? You should declare this project. It's computerized now, so you can catch it easily.

2. Medical behavior of people who are not in China

In fact, this happened a few years ago, that is, the doctor continued to declare health insurance premiums when he was clearly not in China. Now it has happened again, which means that even if it has happened, everyone will rationalize their behavior for a long time. The review may not be so strict.

The Immigration Bureau can cooperate with the 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 major event?

3. Random sampling

People go abroad, or non-surgeons wander around, which is an obvious plot for hospital officials to take care of each other. If you are teaching 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 patient's own safety for colleagues to teach well? In fact, everyone can monitor these big doctor by using the closed recording mechanism of computer or TV. 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 inspection and assessment, patients have the right to ask doctors to fully inform and explain their responsibilities for 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 of second opinions for signature before implementation.

The patient must bear part of the burden.

Because the doctor will make subjective judgment, the patient does not have to pay the fee at all, but the doctor will decide to pay the medical insurance premium anyway. In the future, it may be possible to implement a mechanism in which patients bear part of the burden reasonably, that is, various examinations and prescriptions, and patients must bear a small amount of expenses. 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.