Author: Guo Xiaobing, Sun Li
Unit: Department of Laboratory Medicine, The First Affiliated Hospital of Zhengzhou University
Health care workers, patients and their health, saving lives family’s goals. Between doctors and patients, there should be a unity of life and death.
However, in reality, disputes between doctors and patients occur from time to time, and vicious incidents caused by disputes between doctors and patients are constantly reported. Doctor-patient disputes have become a negative existence that seriously plagues the work and life of medical staff.
Although clinical tests do not face patients directly, disputes between tests and patients are not uncommon in recent years. Actively exploring the links that are prone to disputes and formulating and implementing corresponding solutions are the key to preventing disputes before they occur.
So, what are the factors that are hidden in daily work and are prone to disputes?
01 Inappropriate service attitude
attitude Problems are perhaps one of the most common causes of doctor-patient disputes.
Looking at the vicious medical injury incidents around me, most of them are caused by bad attitude. His face is indifferent, he likes to ignore him, he has a bad attitude, and he speaks rudely.
“Solutions”: Correcting service awareness, improving service level, and always holding the concept of high-quality service for patients are the keys to effectively solving problems. Facing patients or their family members, it is necessary to be patient, enthusiastic, and sincere, giving them confidence and reassuring them, which can not only avoid disputes, but also help to achieve a harmonious doctor-patient relationship.
02 The assay process is complicated
Patients need to complete several steps for laboratory examinations: appointment registration, doctor billing, outpatient payment, barcode generation, specimen collection, and some specimens need to be transported to specialized laboratories.
Based on the fact that most of the hospital’s patients are from other places, they are not familiar with the hospital layout and laboratory procedures, and the departments involved are often not in the same region. The complicated process causes patients or their family members to frequently run to various buildings or floors, or to wait in line repeatedly, which will cause the patients or their family members to feel anxious. This is also one of the sources of disputes.
“Solution”< /strong>: Starting from the convenience of the patient, optimize the workflow and adjust the layout of the department; give full play to the network function, implement online appointment, online billing, online payment, online guidance, and give patients laboratory guidance online , making it more convenient for patients.
03 Bad Message ID
Information errors can appear in name, gender, age, diagnosis, specimen type, test item name, etc. In medical institutions that have used manual test applications in the past or currently, due to unclear doctor’s handwriting, poor patient description, The reasons such as incorrect identification and input of information by the inspection colleagues will cause the patient information on the laboratory report to be inconsistent with the actual situation. This is also the reason why patients are most likely to go to the laboratory to question and discuss.
Currently, the collection and entry of patient information is basically networked and informatized, and the probability of errors in patients’ personal information/identification is significantly reduced. The content is still manually input, especially the specimen type or item name, and there are many errors.
But erroneous findings are often made when the laboratory report is printed and received, so patients will often go to the laboratory for investigation and accountability.
“Actions”: Move the problem forward, strengthen the training of medical staff information entry to minimize the risk of disputes; the inspection department strictly implements the inspection system , solve the problem before the release of the laboratory report; appropriately expand the information modification authority of the laboratory, and solve some problems on the spot in the laboratory.
04 Specimen Rejection Challenge
The rejection of specimens is the key to reducing the quality error of specimens before analysis in order to ensure the accuracy of test results and the disposal of unqualified specimens.
However, in the actual operation of this initiative, not only patients, but even medical staff will be puzzled or rejected. Specimens of infants and young children, specimens of critically ill patients, difficult-to-collect specimens (various puncture specimens, bronchoalveolar lavage fluid, etc.), specimens for arterial blood gas analysis, or specimens for mass testing after centralized storage For specimens that need to be re-collected, disputes between doctors and patients and medical technology are most likely to occur when specimens are rejected.
“Resolution“: Strengthen the publicity to medical care and patients, not only to explain the standardized process of specimen collection, but also to explain the reasons for specimen rejection and its pros and cons, in order to improve the qualified rate of specimens and to obtain medical care, patients’ understanding and understanding of specimen rejection. Understand; for very special or difficult-to-obtain specimens, even if they are unqualified, tests and result reports should be carried out after full communication with the clinic and detailed remarks in the results.
05 The results are reported delay < /strong>
The development of medical testing has brought the testing level to a new height, and the value of the testing results in clinical diagnosis and treatment has become more and more significant . Based on this, the expectations of clinicians and patients for test results can be imagined.
However, in the actual testing process, there are many reporting delays. For example, when batch testing is performed due to cost reasons, the patients who collected samples earlier waited, and the testing results were abnormal< /span>(especially important items)It is unexpectedly time-consuming to re-examine and re-examine, the failure of equipment and equipment leads to the delay of testing or re-examination of results, the amount of specimens increases sharply, and the personnel and equipment are relatively insufficient There is a lag in the reporting of test results.
Of course, there are still some unintentional human-caused inappropriate tests, such as missing items, missing items or item errors in the test, the specimens are covered and worn, and the storage location of the capital preservation is improper, resulting in loss and omission of testing. Wait. When these problems arise, it means that the occurrence of disputes is not far away.
“Actions”: Optimize the testing process to minimize the waiting time of patients; Strictly implement regular and real-time equipment maintenance, and have emergency backup measures >; estimates developed and implemented test results and emergency programs; strengthen the sense of responsibility, to avoid man-made accident.
06 Assay “Difference”
< p>The process of human disease is dynamic, and its test indicators will also change dynamically, so the test results will be different in different courses of disease. In addition, due to factors such as cost, sensitivity, specificity, etc., the assay methods and equipment of the project are diversified.
The methods and equipment used in different medical institutions and even between different laboratories in the hospital will also vary. The test results of various methods and equipment will be different, and even the reference intervals of different methods are very different.
Based on this, when patients are tested in different hospital laboratories, or in different laboratories in the same hospital, the results will be different. Because the patient does not understand the root cause of the difference in the result, he will go to the laboratory to question the difference in the result.
The resulting conflicts have occurred even intensify the doctor-patient paradox.
“Actions”: Improve the professional quality of inspection colleagues and improve the ability to reasonably explain the reasons for differences for patients or medical care; try to use the same equipment and methods between laboratories in the hospital to avoid differences in results within the hospital; standardize The timing of specimen collection, and the frequency of testing should be set reasonably to reduce the probability of differences in the results of different disease courses; ensure the consistency of testing methods in each ward, and avoid differences in results caused by mixing different equipment and methods in the same ward to test the same item.
07 extreme test results
Due to the different levels of professional quality or the lack of responsibility of employees, the unqualified specimens were not rejected, and the examination of the test results was not strict, so that the laboratory often released some extreme results.
If the coagulation specimens report the four results of coagulation, the poorly anticoagulated specimens report the platelets, the hemolyzed specimens report the electrolyte results, or the yin and yang results of the specimens are reversed after wearing a crown, etc., causing clinical symptoms. Misdiagnosis and mistreatment result in a certain degree of economic and mental loss to patients, which is one of the most common reasons for doctor-patient disputes.
“Actions“: formulate and implement a reward and punishment system, manage people with the system, and continuously improve employees’ sense of responsibility; formulate and implement a professional assessment system to promote people through assessment, and continuously improve professional quality.
08 INTERPRETATION less accurate
interpretation of test results is extremely important in today’s inspection department services, one of the work content. And with the establishment of laboratory physician clinic, this work will become increasingly able to promote universal. In the process of interpretation of results, we must be objective and scientific.
If the hepatitis B viral load result is 5.0×10^2 IU/L, two points are indicated, one is true negative and no virus; the other is the viral load in the patient’s body. The amount is lower than the sensitivity of the method and cannot be detected effectively. Based on patients with clinical often believe that this result is negative, we must interpret it in place. Otherwise, if the patient is tested positive by a high-sensitivity method, or if there are serious consequences in the follow-up(such as the infection of the fetus due to the failure of the pregnant woman to take antagonistic measures), we will definitely face extreme consequences. Tricky medical disputes.
“Actions”: Improve laboratory business capabilities and accumulate experience in laboratory diagnosis.
General, There should be mutual understanding and mutual support!
asMedical staff, we need to constantly remind ourselves that every individual responsibilities and obligations as a healer. And improve professionalism, constantly enhance service concept, the real patients do, “often to help, to comfort always, sometimes to heal,” Over time, the doctor-patient disputes will be solved.
End ◥
source | Dean laboratory diagnosis
edit | Luobing Han
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