Characteristics and causes of excessive medical treatment in intensive care units
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摘要:
目的 对ICU中的过度医疗现象进行研究，探讨ICU中过度医疗的特点及表现形式，并分析其产生的原因。从而为避免ICU中过度医疗提出解决建议。 方法 选取蚌埠医学院第一附属医院综合ICU于2019年7月—2019年12月收治患者的住院病历为研究对象，应用案例分析法，由3位资深ICU专家对患者的病案资料进行分析，对3位专家同时判定为过度医疗的病例进行案例分析。 结果 本研究共纳入病例359例，其中由3位专家同时判定存在过度医疗现象的32例，其中无效医疗19例，防御性医疗11例，高新技术的不恰当应用2例，总发生率为8.9%。其特点为：无效医疗、防御性医疗以及高新技术的不恰当应用是主要的表现形式；过度医疗产生的过程中，医生虽然是医疗行为的施予者，但医生的角色有时并非主观故意，而只是被动的实施者；其原因主要与医生规避风险、医疗信息不对称、患者家属的不恰当要求有关。 结论 ICU中存在过度医疗的现象，其特点和成因与社会因素和ICU的诊疗特殊性有关；它的形成因素既有经济、社会、伦理因素，也与医生的医疗水平和对疾病的理解有关。针对这些特点和形成因素，给出的对策和建议包括完善法律法规建设、改善医患关系，努力构建尊医、重医的和谐社会环境、加强高新技术管理，严格执行高新技术准入制度，并加强高新技术应用的监督等。 Abstract:Objective To study the phenomenon of excessive medical treatment in ICU, discuss the characteristics and manifestations of excessive medical treatment in ICU, analyze the causes of its occurrence, and make suggestions to avoid excessive medical treatment in ICU. Methods The inpatient medical records of patients admitted to the comprehensive ICU of a third-grade A hospital the First Affiliated Hospital of Bengbu Medical College, Bengbu from July 2019 to December 2019 were selected as the research objects. The medical records of patients were analyzed by three senior ICU experts using case analysis method, and the cases of patients judged as excessive medical treatment were analyzed at the same time. Results A total of 359 cases were included in this study, among which 32 cases were determined by 3 experts to have excessive medical treatment, including 19 cases of invalid medical treatment, 11 cases of defensive medical treatment and 2 cases of inappropriate application of high and new technology, with a total incidence of 8.9%. Its characteristics were as follows: invalid medical treatment, defensive medical treatment and inappropriate application of high and new technology were the main manifestations. In the process of excessive medical treatment, the doctor was the giver of medical treatment, but the role of the doctor was sometimes not subjective and intentional, just a passive implementor. The reasons were mainly related to doctors' risk aversion, medical information asymmetry and inappropriate requirements of patients' family members. Conclusions Excessive medical treatment exists in ICU, and its characteristics and causes are related to social factors and the special diagnosis and treatment in ICU. Its forming factors include economic, social and ethical factors, as well as the medical level of doctors and the understanding of diseases. In view of these characteristics and forming factors, countermeasures and suggestions include perfecting the construction of laws and regulations, improving the doctor-patient relationship, striving to build a harmonious social environment in which doctors are respected and valued, and strengthening the management of high and new technology, strictly implementing the access system of new and high technologies, and strengthening the supervision of the application of new and high technologies. -
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