بررسی علل انجام پزشکی تدافعی و ارائه راهکار کاهش آن از دیدگاه دست‌یاران تخصصی دانشگاه علوم پزشکی مشهد در سال 1394
محورهای موضوعی : -مدارک پزشکیعلی وفایی نجار 1 , علی اصغر رضایی 2 , حبیب الله اسماعیلی 3 , میترا دوگونچی 4 , الهه هوشمند 5
1 - دکترای تخصصی مدیریت خدمات بهداشتی و درمانی، مرکز تحقیقات مدیریت و عوامل اجتماعی موثر بر سلامت,دانشگاه علوم پزشکی مشهد، مشهد، ایران
2 - دانشجوی کارشناسی‌ارشد مدیریت خدمات بهداشتی درمانی، دانشکده بهداشت، دانشگاه علوم پزشکی مشهد، مشهد، ایران
3 - دکترای تخصصی آمار زیستی و اپیدمیولوژی، مرکز تحقیقات مدیریت و عوامل اجتماعی موثر بر سلامت، دانشگاه علوم پزشکی مشهد، مشهد، ایران
4 - دانشجوی دکترای آموزش بهداشت و ارتقاء سلامت، گروه آموزش بهداشت و ارتقای سلامت، دانشکده بهداشت، دانشگاه علوم پزشکی همدان، همدان، ایران
5 - دکترای تخصصی مدیریت خدمات بهداشتی و درمانی، مرکز تحقیقات مدیریت و عوامل اجتماعی موثر بر سلامت، دانشگاه علوم پزشکی مشهد، مشهد، ایران
کلید واژه: خطاهای پزشکی, دست‌یاران تخصصی, ﭘﺰﺷﻜﻲ تدافعی,
چکیده مقاله :
مقدمه: پزشکی تدافعی، تصمیم‌گیری‌های درمان پزشکان است به منظور محدود کردن خطاهای پزشکی که می‌تواند عواقبی را به لحاظ کیفیت مراقبت افراد و بهره‌وری از منابع محدود سلامت در پی داشته باشد. هدف از این مطالعه بررسی علل بروز این پدیده و ارائه راهکارهایی برای کاهش آن از دیدگاه دست‌یاران تخصصی دانشگاه علوم پزشکی مشهد می‌باشد. روش: این مطالعه توصیفی - تحلیلی است که در بین تمام دست‌یاران تخصصی دانشگاه علوم پزشکی مشهد در سال 93 انجام شده است. ابزار جمع‌آوری اطلاعات پرسشنامه محقق ساخته بود. داده‌های پرسشنامه در نرم‌افزار spss20 جمع‌آوری گردید و با استفاده از آمارهای توصیفی و تحلیلی شامل آزمون‌های کروسکال والیس و من ویتنی در سطح معنی‌داری 0.05 و در قسمت سوالات باز با استفاده از تحلیل محتوا آنالیز شد. یافته‌ها: بیشترین علت بروز پزشکی تدافعی "برای جلوگیری از مورد دادخواهی قرار گرفتن و اقدام قضایی از طرف بیماران "(2/87%) و کمترین علت انجام دادن پزشکی تدافعی نداشتن بیمه مسئولیت و جلوگیری ریسک از دست رفتن سرمایه پزشک، آموزش تدافعی عمل کردن پزشک در اقدامات درمانی تشخیصی برای بیمار (7/43%) گزارش شده است. شرکت‌کنندگان در این پژوهش 6 راهکار کلی برای کاهش پزشکی تدافعی ارائه دادند که شامل: اعمال حمایت‌های قانونی از پزشکان (46.2 درصد)، طب مبتنی بر شواهد (19.8 درصد)، ایجاد پایگاه اطلاعاتی داده‌های بیمار (19.8 درصد)، آشناسازی جامعه با مفهوم پزشکی تدافعی (16.5درصد)، تقویت کار گروهی (13.2 درصد) و اصلاح شیوه برخورد با شکایات (9.9 درصد) است. نتیجه‌گیری: نتایج حاکی است پزشکی تدافعی در دست‌یاران تخصصی دانشگاه علوم پزشکی مشهد بالا و رایج است، در این راستا ﻟﺬا ﭘﻴﺸﻨﻬﺎد ﻣﻲﺷﻮد آﻣﻮزشﻫﺎی ﻣﺮﺗﺒﻂ ﺑﺎ رﻓﻊ اﻳﻦ ﭘﺪﻳﺪه و هدایت ﺑﻪ سمت ابعاد مثبت آن به ﭘﺰﺷﻜﺎن داده ﺷﻮد. هم‌چنین رفتارهای پزشکی تدافعی به طور قابل توجهی با اقدامات کاملا ساده کاهش می‌یابند.
Introduction: Defensive medicine is concerned with decisions made to avoid errors that could result in serious consequences in terms of quality of care and efficient use of scarce health resources. This study aimed to investigate the causes of this phenomenon and provide solutions to reduce it from the perspective of residents in Mashhad University of Medical Sciences. Method: This descriptive analytical study was conducted with all residents in Mashhad University of Medical Sciences in 2015. Data were collected using a researcher-made questionnaire, and analyzed in SPSS-20 using descriptive and analytical statistics including Kruskal-Wallis and Mann-Whitney tests at significance level PResults: Defensive medicine was mostly adopted to avoid being sued by patients (87.2%) and least due to lack of liability insurance, to prevent loss of capital, to teach defensive medicine in treatment-diagnostic procedures (43.7%). Furthermore 6 overall strategies to reduce defensive medicine were proposed by residents, which included: applying legal protections for physicians, evidence-based medicine, create a database of patient data, Familiarizing with the concept of community defensive medicine, reinforcing teamwork and improving the treatment of complaints. Conclusion: The results obtained suggest high level of defensive medicine among residents in Mashhad University of Medical Sciences. Accordingly, it is recommended that training be provided to eliminate this phenomenon, and doctors be steered toward its positive aspects. Furthermore, defensive medicine behaviors can be reduced through simple measures.
1- Mossman D, Defensive medicine: Can it increase your malpractice risk? Current Psychiatry, 2009; 8(12): 86.
2- Summerton N, Positive and negative factors in defensive medicine: a questionnaire study of general practitioners. British Medical Journal, 1998; 310(6971): 9-27.
3- Rx M, Defensive medicine: Can it increase your malpractice risk? Current Psychiatry, 2010; 8(12): 86.
4- Asher E, et al., Unconscious defensive medicine: the case of erythrocyte sedimentation rate. Eur J Intern Med, 2007; 1(8): 35-38.
5- Asher E, et al. Defensive Medicine in Israel-a nationwide survey. Plos One; 2012: 7(8).
6- Catino M, Why do Doctors practice defensive medicine? The side-effects of medical litigation. Safety Science Monitor, 2011; 15(1): 1-12.
7- Moosazadeh M, et al. Determining the frequency of defensive medicine among general practitioners in Southeast Iran. Ijhpm, 2014; 2(3): 119–123. [Article in Persian]
8- Haghshenas MR, et al. Study the frequency of malpractice lawsuits referred to forensic medicine department and medical council, Sari, 2006-2011. J Mazandaran Univ Med Sci, 2012; 21(86): 244-51. [Article in Persian]
9- Rafizadeh Tabai Zavareh SM, Haj Manoochehri R, and Nasaji Zavareh M. Study of General physicians negligence frequency among complaints referred to tehran’s forensic medicine commission from 2003 to2005 SJFM, 2007; 13(3): 152-7. [Article in Persian]
10- Sloan FA and Shadle JH. Is there empirical evidence for Defensive Medicine? A reassessment. Journal of Health Economics, 2009; 2 (28): 91-481.
11- Amiresmaili M, et al. A Survey On Frequency Of Defensive Medicine Among General Practitioners Of Kerman City. payavard salamt, 2013; 7(5): 399-409.
12- Robinson A., et al. Physician and public opinions on quality of health care and the problem of medical errors. Arch Intern Med, 2002; 162: 2186-2190.
13- Shojania K, et al. Safe but sound: patient safety meets evidence-based medicine [Editorial]. JAMA, 2002; 288: 508-513.
14- Seyabani S, et al. The survey of Complaints against physcians in Medical Council of Kermanshah from 2001 to 2005, 2009; 1: 74-83. [Article in Persian]
15- Rubin RJ, Mendelson DN. How much does defensive medicine cost? J Am Health Policy, 2008; 4(4): 7-15.
16- Kessler DP, Sage WM, and Becker DJ. Impact of malpractice reforms on the supply of physician services. JAMA, 2009; 293(21): 2618-25.
17- Afessa B, Gajic O, and Keegan M.T, Impact of introducing multiple evidence-based clinical practice protocols in a medical intensive care unit: A retrospective cohort study BMC Emergency Medicine; 2007: 7(10).
18- Trenti T, Canali C, and scognamiglio A, Clinical Governance and Evidance Baseb Labratory Medicine. clin Chem Lab Med, 2006; 44(6): 726-732.
19- Brilla R, et al. Are Neurology residents in the United States being taught defensive medicine? Clinical Neurology and Neurosurgery, 2012; 108(4): 374-7.
20- Robinson AR, et al., Physician and public opinions on quality of health care and the problem of medical errors. Arch Intern Med, 2006; 162: 2186-90.
21- Ghalandarpoorattar SM, Kaviani A, and Asghari F, Medical error disclosure: the gap between attitude and practice. Postgraduate medical journal, 2012; 88(1037): 130-3.
22- Hartnell N, et al. Identifying, understanding and overcoming barriers to medication error reporting in hospitals: a focus group study. BMJ quality & safety, 2012; 215(5): 361-8.
23- Etchegaray JM, et al., Error disclosure: a new domain for safety culture assessment. BMJ quality & safety, 2012. bmjqs-2011-000530.
_||_
1- Mossman D, Defensive medicine: Can it increase your malpractice risk? Current Psychiatry, 2009; 8(12): 86.
2- Summerton N, Positive and negative factors in defensive medicine: a questionnaire study of general practitioners. British Medical Journal, 1998; 310(6971): 9-27.
3- Rx M, Defensive medicine: Can it increase your malpractice risk? Current Psychiatry, 2010; 8(12): 86.
4- Asher E, et al., Unconscious defensive medicine: the case of erythrocyte sedimentation rate. Eur J Intern Med, 2007; 1(8): 35-38.
5- Asher E, et al. Defensive Medicine in Israel-a nationwide survey. Plos One; 2012: 7(8).
6- Catino M, Why do Doctors practice defensive medicine? The side-effects of medical litigation. Safety Science Monitor, 2011; 15(1): 1-12.
7- Moosazadeh M, et al. Determining the frequency of defensive medicine among general practitioners in Southeast Iran. Ijhpm, 2014; 2(3): 119–123. [Article in Persian]
8- Haghshenas MR, et al. Study the frequency of malpractice lawsuits referred to forensic medicine department and medical council, Sari, 2006-2011. J Mazandaran Univ Med Sci, 2012; 21(86): 244-51. [Article in Persian]
9- Rafizadeh Tabai Zavareh SM, Haj Manoochehri R, and Nasaji Zavareh M. Study of General physicians negligence frequency among complaints referred to tehran’s forensic medicine commission from 2003 to2005 SJFM, 2007; 13(3): 152-7. [Article in Persian]
10- Sloan FA and Shadle JH. Is there empirical evidence for Defensive Medicine? A reassessment. Journal of Health Economics, 2009; 2 (28): 91-481.
11- Amiresmaili M, et al. A Survey On Frequency Of Defensive Medicine Among General Practitioners Of Kerman City. payavard salamt, 2013; 7(5): 399-409.
12- Robinson A., et al. Physician and public opinions on quality of health care and the problem of medical errors. Arch Intern Med, 2002; 162: 2186-2190.
13- Shojania K, et al. Safe but sound: patient safety meets evidence-based medicine [Editorial]. JAMA, 2002; 288: 508-513.
14- Seyabani S, et al. The survey of Complaints against physcians in Medical Council of Kermanshah from 2001 to 2005, 2009; 1: 74-83. [Article in Persian]
15- Rubin RJ, Mendelson DN. How much does defensive medicine cost? J Am Health Policy, 2008; 4(4): 7-15.
16- Kessler DP, Sage WM, and Becker DJ. Impact of malpractice reforms on the supply of physician services. JAMA, 2009; 293(21): 2618-25.
17- Afessa B, Gajic O, and Keegan M.T, Impact of introducing multiple evidence-based clinical practice protocols in a medical intensive care unit: A retrospective cohort study BMC Emergency Medicine; 2007: 7(10).
18- Trenti T, Canali C, and scognamiglio A, Clinical Governance and Evidance Baseb Labratory Medicine. clin Chem Lab Med, 2006; 44(6): 726-732.
19- Brilla R, et al. Are Neurology residents in the United States being taught defensive medicine? Clinical Neurology and Neurosurgery, 2012; 108(4): 374-7.
20- Robinson AR, et al., Physician and public opinions on quality of health care and the problem of medical errors. Arch Intern Med, 2006; 162: 2186-90.
21- Ghalandarpoorattar SM, Kaviani A, and Asghari F, Medical error disclosure: the gap between attitude and practice. Postgraduate medical journal, 2012; 88(1037): 130-3.
22- Hartnell N, et al. Identifying, understanding and overcoming barriers to medication error reporting in hospitals: a focus group study. BMJ quality & safety, 2012; 215(5): 361-8.
23- Etchegaray JM, et al., Error disclosure: a new domain for safety culture assessment. BMJ quality & safety, 2012. bmjqs-2011-000530.