MEDICAL ERRORS — the mistakes of the doctor at execution of the professional duties which are a consequence of a conscientious delusion and free of corpus delicti or signs of offense.
Unlike offense and from a medical crime, V. the lake cannot be provided and prevented by this doctor, it is not result of negligent attitude of the doctor to the duties, ignorance or malicious action. Therefore for V. of the lake, regardless of their effects, the doctor cannot be punishable neither in disciplinary, nor in a criminal order. The term «medical error» does not belong to legal concepts; UK and the comment to it do not contain the term «mistake». It is used usually in the daily analysis of diagnostic and to lay down. works, and also at identification of the reasons of the adverse next and remote result of medical interventions, to-rye in some cases can become also a subject court. medical researches.
Prof. of a mistake at the doctor occur, as well as at the representative of any other profession, however owing to features of a profession of the doctor V. of the lake can gain great public value. Dealing with health and life of the patients, the doctor bears moral responsibility before them and before society. The public and individuals sometimes very sharply react to the unexpected, unusual or seeming such outcomes of a disease which are especially connected with active intervention of the doctor in process of treatment of a disease.
The concept «medical errors» and measures of medical responsibility for them of the course of history of mankind were turned. In times when doctoring was equated to action of supernatural force, imperfection of knowledge was identified intentionally. At various failures of a disease put out of the attending physician eyes, chopped off hands etc., for the death of the patient, regardless of its reason, the doctor quite often had to answer with the life (laws of the Babylon tsar Hammurappi). The Roman right entered broad use of the concept «mistakes», having carried it and to profession of a physician (Akviliya's law). Referred both inexperience, and imprudence, and non-rendering of medical aid to mistakes. The bourgeois right enters the concept «medical errors» into a bed of the capitalist relations. In the legislation of the capitalist countries usually the mistake is delimited from intention. As the relations «the doctor — the patient» are under construction on a contract basis, the doctor at the favorable result of treatment receives the royalties if the patient through his fault died, the civil suit can be made to the doctor.
Progressive doctors of both Russia, and foreign countries saw a real and efficient way to improvement of medical aid in the analysis and V.'s studying by the lake. N. I. Pirogov wrote that each conscientious person, especially the teacher, shall have some kind of internal need rather to publish the mistakes to warn against them the people less expert. However at the time of Pirogov this belief was shared only by certain progressive doctors. Presently such requirement at each Soviet doctor forms all way of life of the Soviet society and reflects the nature of socialist public consciousness.
In the USSR legitimacy of medical actions is regulated by the adopted laws, and in particular Bases of the legislation of USSR and federal republics on health care. Century of the lake in the USSR draw constant unrelenting attention of bodies and healthcare institutions, to-rye not only analyze V.'s reasons for the lake, but also take effective measures according to their prevention. A number of monographic and dissertation works is devoted to the analysis and studying of character of V. of the lake.
Century of the lake meet in work of doctors of all specialties. V.'s most the lake it is possible to subdivide with the known share of convention on that to-tichesky and technical mistakes. Besides, depending on a stage, on Krom they are allowed, it is possible to allocate V. to the lake diagnostic, medical and mistakes in prevention, to-rye are quite often interconnected. Sometimes in the course of treatment of the patient concerning one disease several V. is allowed by the lake. To tactical mistakes refer the wrong choice of methods of a research for establishment of the diagnosis, the wrong assessment of results of a research, a mistake in establishment of indications or contraindications to this or that method of treatment, prevention, a mistake in the organization to lay down. process, etc. Can be technical V.' examples of the lake the wrong performance of diagnostic or lay down. manipulations, wrong execution of medical documentation, etc.
V.'s reasons for the lake can be objective and subjective. From the major objective reasons it should be noted inconstancy of separate postulates and the principles in the field of theoretical and applied medicine in this connection views of an etiology, a pathogeny, treatment of diseases change. History of medicine, in particular surgeries, knows many examples of basic change for rather short interval of time of views of treatment of a peptic ulcer, cholecystitis, pancreatitis, etc. The complex to lay down. actions, to-ry was considered as the most rational quite recently, it can be qualified as wrong from positions of the latest decisions of forums of scientists or on discrepancy to the new instructions of bodies of health care which did not reach timely the doctor.
Every year the volume of researches of the patient increases. The most experienced doctors can be fooled the wrong results of a research, napr, due to indistinctly adjusted metrological support exploited medical technicians. Though the objective reasons of V. of the lake are rather studied, they can not always be warned. Nek-rye from them treat insufficiently accurate organization of work in most to lay down. establishment (V. the lakes allowed by doctors — organizers of health care). Efforts of bodies and healthcare institutions are also directed to elimination of these shortcomings first of all. It is one of effective measures of the prevention of V. of the lake.
Among the subjective reasons of V. of the lake the most numerous group is made by mistakes, to-rye are caused by absence at the doctor of sufficient experience and cannot be qualified as ignorance. Has value and discrepancy of improvement of knowledge of the young specialist with the rate of continuous development of medical science and practice demanding regular acquaintance with periodic medical literature, visit scientific medical about-in, participations in medical and kliniko-anatomic conferences, increases in the general culture etc. Sometimes doctors make mistakes in the process of the address them with patients owing to non-compliance with philosophy of a medical deontology (see. Deontology medical ).
Among V.'s reasons for the lake it is impossible to ignore negative influence of the narrow specialization of doctors which is a little limiting a medical outlook, resulting in lack of complete understanding of a disease. It leads sometimes to underestimation by doctors of the anamnesis, to fetishization of tool and laboratory researches, to emergence in nek-ry narrow specialists of revaluation of the diagnostic opportunities, to lack of due succession between the growing number of various medical institutions.
The question of diagnostic mistakes is most in detail developed. M. V. Cherporutsky (1938) Carries an insufficient, bad or wrong research or observation, insufficient knowledge, the wrong judgment (the wrong assessment of data or the wrong conclusions) to their main reasons.
As most of patients begins and finishes treatment out of hospitals, it is necessary to analyze and study first of all V. the lake in policlinics. Most often mistakes in history taking take place, at physics flax a research, in to lay down. - professional, recommendations. In the capitalist countries mistakes during the rendering the extra hospital help are especially high. Takker (W. R. Tucker, 1965) with soavt, would give analysis findings of quality of ambulatory medical aid by the patient at St Luke un-that Illinois (Chicago). The diagnosis, according to experts, was defective in 58% of cases.
The indicator of discrepancy of the diagnosis at the direction in-tsu and put in a hospital at an extract, according to various authors, fluctuates within 10 — 25%.
Mistakes or shortcomings of rendering medical aid take place and in hospitals. According to E. A. Loginova et al., to 21% of the patients who are in a hospital it is inspected not completely and to 6% — it is untimely. Especially does not satisfy inspection concerning the accompanying diseases. In hospitals take place and the wrong treatment, very often revealed polypragmasy, unsatisfactory use of physical therapy, to lay down. physical culture and massage. On F. J. Cook's materials reflecting quality of medical aid in-tsakh New York, 43% of patients received the wrong therapy because of incorrectly established diagnosis, treatment of therapeutic patients was satisfactory only in 31% of cases.
The indicator of discrepancy between a wedge, and section diagnoses in-tsakh the mixed type for adults makes apprx. 11% (D. I. Golovin). Not recognizable rare diseases are not reflected significantly in this indicator. The majority of discrepancies of diagnoses are the share of malignant tumors (most often a carcinoma of the stomach and a lung), tuberculosis, pneumonia, atherosclerosis and its complications. Also pathologists can make the wrong diagnosis, especially at treatment morfol, researches (M. V. Voyno-Yasenetsky and Yu. M. Zhabotinsky, 1970).
Shveyts. therapist Hegglin (R. Hegglin, sort. 1907) notes that at the heart of V. lakes can be: insufficiently constructive thinking, installations on a faultlessness of the diagnosis, bias of opinion, vanity and vanity, an illogicality, indecision of character, aspiration to make «interesting diagnoses», pessimism or excessive optimism. Certainly, at diagnosis of feature of character of the doctor play not a smaller role, than his prof. preparation.
Mistakes in treatment are much better studied in surgery as at surgical interventions they it is more obvious. Mistakes in treatment of therapeutic patients are analyzed a little. Most often at the same time the wrong appointments, lack of recommendations about the mode and a diet, not appointment in the presence of indications of physical therapy take place, to lay down. physical culture and massage. Wrong tactics of treatment by at the same time many drugs — a medicamentous polypragmasy is especially extended (see Treatment). In some cases it is caused by existence in the patient of several diseases. Also insufficient development of many sections of clinical pharmacology matters that demands care in use of a number of the medicines especially new. Therefore in the resolution XVI of the All-Union congress of therapists it is specified that «in connection with all the accruing phenomena of medicinal allergization it is necessary to limit considerably use of medicamentous drugs, especially when during the carrying out the correct mode, corresponding dietotherapy and normalization of working conditions it is possible to achieve similar results». Principle wedge. pharmacology shall be: «only what is absolutely necessary» there are less drugs, but not «still to give to the patient» (B. E. V otchat). H. M. Rudnitsky considers that the polypragmasy is a sign of undisciplined medical thinking. It is also necessary to refer to errors of drug treatment use of drugs in the wrong dosages (both in raised, and in underestimated), incompatible mixes of drugs, underestimation of possible side reactions.
Mistakes are deontological, being followed by quite often mental traumatization of the patient, eventually come down most often to mistakes in his treatment.
Mistakes in prevention are least of all studied. They can treat not only incorrectly carried out inoculations, vaccination, etc., but also mistakes in carrying out medical examination.
Mistakes in execution of medical documentation can conduct to nepravil to ny diagnostic inferences, to mistakes in treatment and to the wrong organizational conclusions. This question is well developed by pathologists (M. K. Dahl, S. S. Vail, etc.), and also court. - medical experts. Quite often at the heart of the wrong registration .med. documentation the wrong medical thinking or wrong organizational and methodical installations lies.
Mistakes in the organization of medical aid require special attention and the fastest elimination because they can be reflected on health of a large number of sick and healthy people.
In practice V. is frequent lakes mix with negligence or negligence. The same action of the doctor with identical effects can be qualified differently depending on motives and various specific conditions. So, e.g., if the doctor made perforation of a uterus with patholologically the changed wall at operation of a scraping of a uterus, doing this transaction of indications in a hospital situation after careful inspection of the patient, then perforation could be only a technical mistake or accident. If he made it in the same conditions, but without pilot careful survey of the patient, then it should be regarded as negligence, office offense. And if perforation happened during the carrying out operation obviously without indications or out of hospital, then it is a crime. Negligence or negligence — the most frequent qualification of the wrong actions of the doctor. Quite often negligence is defined as a mistake that, of course, it is incorrect. Introduction of one medicine instead of another and some other medical actions is explained by negligence. Different manifestations of negligence and its effects force to recognize in one cases negligence as offense, and in others — a crime. If the doctor in directly or indirectly joins the prof. of activity the conflict with the law, it is about a crime.
E. I. Chazov (1975) writes that analyzing the reasons of diagnostic mistakes, it is necessary to proceed from specific conditions, in to-rykh they arose. It is accurate to differentiate V. of the lake from a medical crime (see. Medical offenses ) in some cases extremely difficult; it can sometimes become the reason of wrong excitement against the doctor of criminal case.
In such not clear and disputable cases it is necessary highly skilled court. - medical examination (see. Examination , medicolegal) with participation of authoritative specialists in the specific question which was a reason for excitement against the doctor of criminal case. The final decision on such affairs is passed by competent legal instances.
Ways of fight against V. of the lake follow from their sources. First of all the speech shall go about systematic professional development of doctors, especially in the course of daily work. The systematic analysis of mistakes on medical-control and in particular is of great importance on kliniko-anatomic conferences (see). These conferences aim at the comprehensive and objective analysis a wedge, and section materials with the address of special attention to identification of the reasons and sources of mistakes in terms of hospitalization, in diagnosis, treatment, and also defects of organizational character in medical service. Conferences shall promote increase in the general prof. of level of doctors to lay down. institutions, in to-rykh the patient it was treated (policlinic, a medical medical unit, hospital). The same aims are pursued by city problem kliniko-anatomic conferences, on to-rykh V. are analyzed by the lake of this or that medical establishment.
Special value in the conditions of a scientific and technological revolution, the developing specialization of medical aid and implementation in medical practice of achievements of science gets education of the keeping an open mind, comprehensively educated specialist capable it is reasonable, rational to use escalating opportunities of medicine.
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I. V. Davydovsky, N. K. Permyakov; M. I. Avdeev (court. medical).