"medical errors" at the cost of life. Typical mistakes of ENT doctors
A medical error in medical practice is a non-malicious act. However, this definition often refers to the negligent and dishonest actions of a doctor in the performance of professional duties. And in such circumstances, a medical error becomes a criminal offense, and the doctor is responsible.
The concept and statistics of medical errors in Russia
First of all, the victim should understand that the law will be on his side, since a medical error is a criminal offense. However, it has a number of features, many of which you need to know:- Since this error often occurs by accident and involves an act without bad intentions, the responsibility on the part of the doctor is mitigated. In order for the punishment to be serious, it will be necessary to prove that the error was malicious.
- The objective causes of medical error are negligence, inattention and lack of experience. They count towards the mitigation of the sentence.
- The subjective causes of a medical error are negligence in the examination and conduct of medical actions, neglect of modern medical means, etc. Subjective reasons are used in legal practice to aggravate the sentence.
- In 2015, 712 people, including 317 children, suffered from medical errors and poor-quality medical care.
- In 2016, 352 patients died due to medical errors, of which 142 were children. At the same time, the UK received more than 2,500 reports of crimes related to medical negligence. On their basis, more than 400 criminal cases were opened.
There is no precise definition of medical error established to date. That is why the situation is quite difficult during the proceedings, because it is required to prove the very fact of a medical error.
Classification of medical errors
To date, medical errors are classified according to different principles, the main among which is at what stage of the implementation of medical care and in what field of activity the medical error occurred. Let's look at it further:- Diagnostic. These types of errors occur at the diagnostic stage and are the most common.
- Organizational. Occur with insufficient or illiterate organization of medical care, as well as with insufficient provision of medical services.
- Therapeutic-tactical. As a rule, occur after diagnostic. That is, the specialist makes a mistake in the diagnosis and begins to treat the patient in accordance with a specific diagnosis.
- Deontological. They relate to the psychological nature and behavior of the doctor when communicating with employees, patients and relatives of patients.
- Technical. Often related to paperwork. This may be an incorrectly completed patient card, an extract, any medical documentation, etc.
- pharmaceutical. They take place in situations where the pharmacist has incorrectly determined the indications or contraindications, as well as compatibility with other drugs.
Errors that cannot be classified in any way are classified as "other". The responsibility for it will depend on what type the error will be assigned to.
Medical errors in dentistry
Mistakes made in dentistry are today considered a serious topic of controversy. The fact is that the services of dentists are quite expensive, so patients have a selfish goal in filing claims. According to statistics, now about 30% of claims against dentists do not have a really good reason. Nevertheless, dentists make mistakes in treatment - this may be an incorrect diagnosis, an inappropriate agent for anesthesia, the preservation of a tooth to be removed, etc.In order to avoid problems in the future in proceedings with the client, the specialist should clearly and clearly explain the treatment regimen in advance, consult with the patient, clarify any details with him. Sometimes in dental clinics, especially for serious treatment, a contract is concluded, which states that the patient is aware of the prescribed treatment and has nothing against it.
Types of liability for medical error
If a medical error is found on the internal line, the punishment will be presented in the form of reprimands, deprivation of the category, sending to advanced training courses, and so on. Perhaps a mistake will lead to a transfer from one job to another, for example, from the position of a resident in the surgical department to the position of a surgeon in a polyclinic.If an error is discovered during an external investigation, liability in this case can be conditionally divided into two types, which we will consider below:
- Civil Liability. As a rule, it implies monetary compensation for damage, which includes non-pecuniary damage, the patient's money spent on the service, the cost of the required care, the price for additional services, etc. Note that there is no clear algorithm for determining the amount of money that the plaintiff may require. Therefore, he has the right to present the amount he needs, but within reasonable limits.
- Criminal liability. It is established for harm caused to life and death due to medical error. In the event that the patient received poor-quality medical care, but his health was not significantly harmed, criminal liability is impossible. To determine the extent of damage, a forensic medical examination is carried out.
Often, victims have to make some efforts to obtain moral harm, because usually doctors do not agree to admit the fact of an error and prove their own innocence by all means.
Articles of the Criminal Code of the Russian Federation on medical errors and criminal liability
The Criminal Code of the Russian Federation does not have a separate article that provides for liability for medical errors, however, a special part provides for punishment for certain elements of a crime, as a result of which irreparable harm was caused to a person’s health or a patient died.So, if as a result of the examination it is established that the patient died due to a medical error, in accordance with Part 2 of Art. 109 of the Criminal Code, a doctor can be imprisoned for up to 3 years. If severe bodily harm was caused, the perpetrator is sentenced to a term of up to 1 year. It is worth noting that both in the first case and in the second, deprivation of the right to engage in medical activities may also be provided.
Criminal liability will follow the following offenses:
- Illegally performed abortion, and the patient died or received serious harm to health. Part 3 of Art. 123 of the Criminal Code.
- The patient contracted HIV due to the negligence of a doctor. Ch. 4 Art. 122 of the Criminal Code provides for imprisonment of up to 5 years.
- If, as a result of illegally conducted medical or pharmaceutical activities, the patient has received severe harm to health, the perpetrator is punished by Part 1 of Art. 235 of the Criminal Code. Cases with a fatal outcome are considered part 2 of Art. 235 of the Criminal Code.
- If the patient was not provided with assistance, as a result of which he received harm of moderate or light severity, the punishment is established by Art. 124 of the Criminal Code. If the harm is more significant or irreparable, then Part 2 of Art. 124 of the Criminal Code.
- If the fact of medical negligence is established, the result of which is the infliction of serious harm to human health or the death of the patient, then Part 2 of Art. 293 of the Criminal Code.
After a criminal case has been opened before a trial is held, the victim can file a civil claim to receive monetary compensation for the damage caused. This right is enshrined in Art. 44 Code of Criminal Procedure.
Where to go in case of medical error?
Consider the options where you can contact in case of a medical error:- Managers of a medical institution. This may be the head of the department/polyclinic/hospital or the head physician. He needs to tell in detail the current situation and provide evidence that the fact of treatment and medical error really was. Sometimes issues can be resolved already at this stage. The responsibility of a doctor who makes a mistake can be in the form of deprivation of bonus, deduction from salary, reprimand or fine.
- The insurance company from which you received the insurance policy. Here the patient will need to provide all the evidence that he has, as well as explain in detail the situation. Insurance officers will have to review your case and conduct a detailed examination of the actions committed by the doctor. According to the results of the examination, a fine will be imposed on the medical institution where the medical error was made.
- Judiciary. You will need to bring to the court not only all paper evidence, but also a lawsuit in which you write in detail your requirements for the defendant. The case will be carefully considered in court. This will most likely involve attending a number of legal proceedings, which will most likely result in obtaining the required compensation.
- Prosecutor's office. You can apply here if you want to initiate a criminal case against a person who has committed a medical error. Be prepared for lengthy proceedings and serious consequences if the evidence provided turns out to be false.
How to prove medical error?
To prove a medical error, first of all, it is necessary to save all documents confirming the fact that a medical institution provides medical services. These documents may include:- medical card with relevant records;
- documents with test results;
- copies of papers with the results of examinations;
- checks and receipts for payment for services rendered;
- checks and receipts for the purchase of prescribed drugs for treatment.
July 8 marks the 11th anniversary of the unprecedented medical error in the UK. As a result of the negligence of doctors, dark-skinned twins were born to a white couple in an artificial insemination clinic.
Kremneva Yana
Parents believe that the laboratory staff mixed up the test tubes. The negligence of doctors often leads to the most fatal mistakes. We decided to recall the 5 most monstrous medical errors.
Forgot a napkin in the stomach
In 2007, Indian woman Sabnam Praveen gave birth to a son by caesarean section. For several weeks, the woman in labor felt great, but then she began to experience pain in her stomach. The young mother decided to see a doctor, and after a while she ended up on the operating table at the Chattisgarh Institute of Medical Sciences. The unlucky surgeon who performed the operation to remove the fetus forgot the medical napkin in the patient's abdomen, so the woman had to be operated on again. Whether the patient received compensation and went to court is unknown. When a similar incident happened to Donald Church (in 2000, a 31-centimeter instrument was left in his stomach), the man received compensation in the amount of 97 thousand dollars.
Inserted a tube to deliver food to the lungs
Eugene Riggs from San Francisco, who suffered from diverticular disease, was admitted to a military hospital for treatment. The bowel disease did not allow the patient to get enough food, so the doctors decided to additionally feed the body by supplying a special tube to the patient's stomach. As a result of the error, however, food began to enter not the stomach, but the lungs of the sick man. True, the doctors managed to notice the error in time. The wife of Eugene Riggs sued the US government because, according to the laws of the country, it is impossible to sue military doctors and hospitals.
Injected tool disinfectant
Another case of negligent treatment of medicines, and even patients, took place in Seattle, Washington. Virginia Mason, a nurse at the medical center, ignored the packaging of the "medicine" and injected 69-year-old Mary McClinton with an instrument disinfectant instead of medicine.
Irradiated the wrong organs
Another case of medical error led to terrible consequences. Jerome-Parks, an American patient with tongue cancer, was irradiated to the wrong organ. More precisely, they even irradiated several segments of his body. The computer system was wrong, and the doctors did not check the information on the medical record, and as a result, Jerome-Parks was irradiated to a healthy brain stem and neck. The irradiation lasted for three days, and as a result of this "treatment" the patient became deaf and blind.
Amputated the wrong leg
The classic of the genre was the case of the American Willie King. In 1995, the man had a difficult operation to amputate his right leg. A Tampa, Florida surgeon amputated 52-year-old Willie King's wrong leg. It is difficult to imagine the feelings of a patient who, waking up from anesthesia, saw that his left leg had been amputated instead of his right. Later, the doctor tried to prove that the left leg was also unhealthy and would most likely also have been amputated after some time had passed. True, this fact did not please King, and he sued. As a result, the man received compensation in the amount of 900 thousand dollars from the medical institution and 250 thousand dollars from the surgeon, who was deprived of his license for 6 months.
medical errors
An unfavorable outcome of treatment associated with a conscientious delusion of a doctor is usually referred to as medical errors. The term "medical error" is used only in medical practice.
The variety of medical errors, their causes and conditions of occurrence has led to the fact that so far there is no single concept of medical error, which naturally makes it difficult for medical and legal assessment of the erroneous actions of medical workers. The main criterion for medical error is the conscientious error of a doctor arising from certain objective conditions without elements of negligence, negligence and professional ignorance.
Medical errors are divided into three groups:
1) diagnostic errors - non-recognition or erroneous recognition of a disease;
2) tactical errors - incorrect definition of indications for surgery, erroneous choice of the time of the operation, its volume, etc.;
3) technical errors - incorrect use of medical equipment, use of inappropriate medicines and diagnostic tools, etc.
Medical errors are due to both objective and subjective reasons.
Objective difficulties in diagnosing a number of diseases arise due to the latent atypical course of the disease, which can often be combined with other ailments or manifest itself in the form of other diseases, and sometimes difficulties in diagnosing diseases and injuries are associated with the patient's state of alcoholic intoxication.
Timely diagnosis of pneumonia in children aged 1-3 years also causes great difficulties, especially against the background of catarrh of the upper respiratory tract.
Example.
Klava B., aged 1 year 3 months, died during her daytime sleep in a nursery on January 29, 1998. From January 5 to 17, she suffered from an acute respiratory infection, for which she did not attend the nursery. The nursery doctor admitted the child on January 18 with residual effects after suffering a catarrh of the upper respiratory tract (abundant mucous discharge from the nose, single dry rales in the lungs were heard), subsequently the child was examined by a doctor only on January 26. The diagnosis of pneumonia was not established, but it was noted that the symptoms of catarrh of the upper respiratory tract persist, but the child's temperature was normal. The treatment continued in the manger (potion - for coughing, drops in the nose - for the common cold). The child looked unwell, was lethargic, drowsy, ate without appetite, coughed.
On January 29, 1998, at 1 pm Klava B., together with other children, was put to bed in the bedroom. The child slept peacefully, did not cry. When the children were raised at 3 pm, Klava B. showed no signs of life, but was still warm. The older nurse of the nursery immediately began to give her artificial respiration, gave her two injections of caffeine, the child's body was warmed by heating pads. Arriving ambulance doctor performed mouth-to-mouth artificial respiration and chest compressions. However, the child could not be revived.
During the forensic medical examination of the corpse of Klava B., the following were found: catarrhal bronchitis, widespread serous-catarrhal pneumonia, interstitial pneumonia, multiple foci of hemorrhages in the lung tissue, which caused the death of the child.
According to the expert commission, the mistake of the doctors' actions in this case was that the child was discharged to the nursery not recovered, with residual symptoms of a respiratory infection. The nursery doctor had to ensure active monitoring of the child, conduct additional studies (radioscopy, blood tests). This would make it possible to more correctly assess the condition of a sick child and more actively carry out therapeutic measures. It would be more correct to treat a child not in the conditions of a healthy group of children in a nursery, but in a medical institution.
Answering the questions of the investigating authorities, the expert commission pointed out that the defects in the management of a sick child were largely due to the difficulty in diagnosing interstitial pneumonia, which proceeded with an undisturbed general condition of the child and normal body temperature. Pneumonia could develop in the last days of the child's life. The death of children with pneumonia can also occur in a dream without any pronounced signs of the disease.
Practice shows that the majority of medical errors are associated with an insufficient level of knowledge and little experience of the doctor. At the same time, errors, such as diagnostic ones, occur not only among beginners, but also among experienced doctors.
Less often, errors are due to the imperfection of the applied research methods, the lack of the necessary equipment or technical shortcomings in the process of its use.
Example.
Patient P., aged 59, was admitted to the hospital on February 10, 1998 № 131 with a diagnosis of hypochromic anemia. During clinical examination, a hernia of the esophageal opening of the diaphragm was established, and a niche in the lower esophagus was detected radiographically.
To clarify the nature of the niche and exclude a malignant neoplasm for medical reasons, the patient underwent esophagoscopy on February 12, 1998, during which it was found that the mucous membrane of the esophagus was so thickened that the tube could not even be passed into the upper third of the esophagus. Due to the ambiguity of the esophagoscopy picture, repeated X-ray examination and esophagoscopy under anesthesia were recommended.
The next day, the condition of the patient P. deteriorated sharply, the temperature rose to 38.3°C, pain appeared when swallowing. An x-ray examination on February 15 revealed a defect in the left wall of the esophagus and a blackout in the region of the upper mediastinum. Diagnosis: rupture of the esophagus, mediastinitis. On the same day, an urgent operation was performed - opening the paraesophageal tissue on the left, emptying the abscess, draining the mediastinum. The postoperative course was difficult, against the background of anemia.
On March 2, 1998, patient P. suddenly developed massive bleeding from a wound on his neck, from which he died 10 minutes later.
During the forensic medical examination of P.'s corpse, it was established: instrumental rupture of the anterior and posterior walls of the cervical esophagus, purulent mediastinitis and encysted left-sided pleurisy; condition after surgery - drainage of an abscess of the paraesophageal tissue on the left; slight erosion of the left common carotid artery; a large number of dark red blood clots in the cavity of the drainage channel, anemia of the skin, myocardium, liver, kidneys, moderate atherosclerosis of the aorta and coronary arteries of the heart, disseminated small-focal cardiosclerosis, reticular pneumosclerosis and emphysema.
In this case, a technical error in the process of esophagoscopy led to a serious illness, complicated by fatal bleeding.
The modern form of medical errors are iatrogenic diseases, usually arising from a careless word or incorrect behavior of a doctor or nursing staff. The incorrect behavior of a medical worker can have a strong adverse effect on the patient's psyche, as a result of which he develops a number of new painful sensations and manifestations that can even turn into an independent form of the disease.
The vast majority of iatrogenic diseases depend not so much on the inexperience and ignorance of the doctor, but on his inattention, tactlessness, lack of a sufficient general culture. For some reason, such a doctor forgets that he is dealing not only with a disease, but also with a thinking, feeling and suffering sick person.
More often, iatrogenic diseases develop in two forms: the course of the patient's organic disease worsens significantly or psychogenic, functional neurotic reactions appear. In order to avoid iatrogenic diseases, information to the patient about the disease must be given in a clear, simple and non-intimidating form.
To prevent any erroneous actions of a doctor, each case of medical error must be carefully studied and discussed at medical conferences.
When evaluating medical errors with the help of forensic medical expert commissions, it is necessary to reveal the essence and nature of the doctor’s wrong actions and, as a result, get a basis for qualifying these actions as conscientious and, therefore, permissible, or, conversely, unfair and unacceptable. Objective difficulties in identifying certain diseases arise as a result of the characteristics of the pathological process itself. The disease can be latent or take an atypical course, be combined with other diseases, which, of course, cannot but affect the diagnosis. For example, a strong degree of alcohol intoxication of persons who have received skull injuries makes it difficult to perform a neurological examination and recognize a traumatic brain injury. Misdiagnosis is sometimes due to the behavior of patients who may actively oppose research, refuse biopsies, hospitalization, etc.
Accidents in medical practice
Sometimes the unfavorable outcome of an operation or other medical intervention is accidental, and the doctor was not able to foresee the misfortune. Such outcomes in the medical literature are called accidents in medical practice. Until now, there is no single concept of "accident". Some doctors and lawyers try to misinterpret the term broadly, including in accidents careless actions of medical workers, medical errors, and even individual cases of negligent attitude of medical personnel to their duties.
Accidents include all deaths that were unexpected for the doctor. Examples of such outcomes include: 1) activation of a chronic infection after surgery; 2) postoperative complications - cases of peritonitis and bleeding after simple appendectomies, rupture of the surgical scar or thrombosis many days after the operation, air embolism of the heart, and many others; 3) suffocation with vomit during anesthesia; 4) death after encephalography, esophagoscopy, etc.
Professor A.P. Gromov proposes to understand an accident in medical practice as an unfavorable outcome of medical intervention associated with random circumstances that a doctor cannot foresee and prevent. To prove an accident in medical practice, it is necessary to completely exclude the possibility of professional ignorance, negligence, negligence, as well as medical error. Such outcomes are sometimes associated with intolerance and allergy to certain medicinal preparations, which was not known during the life of the patient. To date, the literature has accumulated significant material on the side effects of various drugs, including allergic and toxic reactions after parenteral administration of antibiotics. One of the measures to prevent adverse outcomes from anaphylactic shock with the introduction of antibiotics is a preliminary determination of the sensitivity of patients to them.
Random adverse outcomes can be observed when examining patients at the time of various diagnostic manipulations. Forensic practice shows that such outcomes are sometimes observed during diagnostic angiography using iodine preparations.
Sometimes accidental deaths are observed when transfusing blood that matches the blood type of patients, or when transfusing blood substitutes.
Accidental death during surgical interventions is the most difficult to recognize, since it is not always possible to fully elucidate the causes and mechanism of its onset.
Thus, only such unsuccessful outcomes can be attributed to accidents in medical practice, in which it is impossible to foresee the consequences of medical actions, when failures in treatment do not depend on medical errors and other omissions, but are associated with an atypical course of the disease, individual characteristics of the organism, and sometimes with the lack of elementary conditions for the provision of emergency medical care.
Lawyers should be aware that all this must be taken into account by forensic medical expert commissions when assessing lethal outcomes in medical practice. Before coming to the conclusion about the occurrence of a fatal outcome as a result of an accident or linking it to the negligent actions of a doctor, such commissions must study in detail all the circumstances related to this incident.
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Figure from an article by Yu.T. Sharabchieva
"It is human to err, but God is to forgive"
Alexander Pope (1688-1744)
“The process of making medical decisions may seem simple to some.
All doctors have to do is to collect the facts correctly, prescribe
appropriate tests, accurately diagnose, choose the best treatment
and follow its progress. If all this was easy, doctors would soon be replaced
computers and robots. However, every practitioner knows that in fact
in fact, this is not a trivial situation.” Richard K. Riegelman
“The doctor is a public person. And society has the right to know how he
works, what mistakes it makes and for what reason, than it
can help him not to make mistakes. society, at least
face of the media, should change their attitude towards the doctor. Behind the fact
you need to see the cause of its occurrence and the mechanism of development”
Rudolf ARTAMONOV, professor
“In case histories, doctors more often record symptoms,
confirming their diagnosis than the symptoms that
"do not fit" and therefore seem to be superfluous,
random. This feature is a common source
medical errors" Prof. E. R. Guglin
“Irreversible complications as a result of drug therapy
develop in millions of people. The number of deaths
associated with the use of drugs, hundreds of thousands.
In the United States alone, between 3.5 and 8.8 million patients are hospitalized annually.
sick and 100-200 thousand patients die due to the development
adverse drug-related adverse reactions
VC. Lepakhin and others.
"Some medicines are more dangerous than the diseases themselves"
Seneca the Elder
"The main problems faced by parents of children
with rare diseases (mucopolysaccharidosis, Fabry disease,
Williams syndrome, etc.), - poor diagnosis, inexperience
doctors and lack of real treatment. most doctors
do not think about the fact that a small patient may have
some rare disease. And many see no symptoms
because they just don't know about them.
"Many physicians (76%) in the US believe they are giving patients unnecessary
attention. Their excessive zeal is caused by fears about
lawsuits for medical malpractice and professional
incompetence" (from the report of the American Medical Association)
"Dr Murray is charged with involuntary manslaughter.
According to the prosecution, he gave Michael Jackson
potent anesthetic "Propofol", without following
at the same time for the condition of the patient"
"The qualities of special medical care are the means,
through which hospitals can be punished financially,
rather than a means by which doctors and hospitals could
improve your work"
"You must always be careful and remember that a person
several acute events can occur at the same time
diseases, the symptoms of one disease can be veiled
symptoms of another." Doctor Andrey Borisov
"The public is not yet ready to talk about medical errors
and therefore the system is not ready to publicly report them"
"For 6 years now, the Tallinn Advisory Service has been operating in Estonia.
Center "Family Doctor's Advice". For free
24-hour family doctor telephone number 1220 is received
about 600 calls daily. It is supposed to supplement
skype project. Caller on the phone 1220 people
can not only tell, for example, about trauma,
cut finger, but also show the problem area"
"According to world experts, out of a huge number
only 5-7% of medicines have a proven
efficiency. Everything else is business. In addition, by
global data, in 75% of cases the appointment
antibiotics unreasonably"
"5 - 7% of all medicines sold
all over the world, were found to be falsified"
"The ability to predict the risk of developing diseases
- not far away. A new era is dawning in medicine
individual genomics. DNA-reading machines have become
compact and easy to use so that
some of them can be used without any
special training"
"More than 100,000 Americans die every year due to
medical errors that could have been prevented.
In France, cleanup costs
misuse of medicines account for more than 5
billion euros per year. And in the Netherlands, according to unofficial
data, erroneous actions of doctors lead to death
from 1.5 to 6 thousand patients per year"
"In the United States, about 98,000 people annually
are dying from preventable medical errors.
An additional 106,000 die every year from
side effects of medications. In total
this is about 200,000, which makes
medical error is the third leading cause of death
in the United States, after heart disease and cancer"
"There is no state in the world where doctors would not allow
mistakes"
Medical (medical) (Medical mistake, Medical malpractice, Medical error, Physician error) errors are global. Due to a number of objective and subjective reasons, the problem of medical errors (MD) is becoming more and more urgent all over the world. The Executive Committee of the World Health Organization (WHO) in January 2002 considered a special resolution "Health Quality and Patient Safety" and approved the Strategy for Improving Patient Safety, which outlined the main measures to improve the quality of medical care for the population. Every country needs a government program aimed at significantly reducing the death rate due to medical errors. In the United States, recommendations aimed at improving patient safety were issued by the White House in February 2000. The first works devoted to the description and study of the problem of medical errors began to appear in the 1990s. One of the first significant studies of this issue was organized in the United States by the Agency for Research and Quality in Health Care and conducted by the Institute of Medicine.
1. Definition of VO
2. Signs of VO
3. Types of VO and their frequency
4. Accidents in medical practice
5. Causes of VO and responsibility
6. VO prevention
7. Frequency of VO by country
8. Examples of VO
9. Operator errors
10. History of VO
Literature
1. DEFINITION OF IN
There are a number of definitions of medical errors. Here are some of them:
* Unintentional misrepresentation of a doctor (or any other medical worker) in his professional activity, if negligence and dishonesty are excluded.
* Incorrect actions or inaction of a doctor in the performance of his professional duties, which are not the result of his bad faith and do not contain corpus delicti or signs of misconduct.
*Conscientious delusion of a doctor, based on the imperfection of the current state of medical science and its research methods, either caused by the peculiarities of the course of the disease of a particular patient, or explained by a lack of knowledge and experience of the doctor.
*Conscientious delusion of a doctor based on an unusual, atypical course of the disease, on a lack of diagnostic or therapeutic means and methods, or sometimes on a lack of experience and knowledge of a particular doctor
* Incorrect actions or inaction of a doctor in the performance of his professional duties, which are not the result of his bad faith and do not contain corpus delicti or signs of misconduct (formulated by academician Davydovsky)
2. SIGNS IN
1) a medical error is an incorrect, improper professional action (inaction) of a medical worker;
2) if the doctor acts intentionally, then there can be no question of any error, he deliberately causes harm, therefore the unintentionality of the doctor's actions is a necessary sign of a medical error;
3) the difference between medical errors and objectively insurmountable adverse outcomes lies in the fact that with medical errors there is an unscrupulous error of the doctor, the causes of which are different - ignorance, inability, arrogance, inattention, hindsight;
4) another fundamental feature is that in case of a medical error, the subject has a real opportunity to avoid negative consequences for the patient, i.e. harm to the life or health of the patient. In other words, medical errors are due to the personal and psychological qualities of the medical corps and entirely depend only on the medical worker.
3. VO TYPES AND THEIR FREQUENCY
Errors are divided into deontological, diagnostic and therapeutic.
Option I
Deontological errors - a violation of the principles of proper behavior of a doctor in relation to the patient, i.e. non-compliance by the doctor with the ethics of medical practice.
Diagnostic errors - ignoring or inept use of anamnesis; incomplete examination of the patient; erroneous interpretation of clinical data; erroneous assessment of x-ray and laboratory research; negligence and haste in the examination; misdiagnosis.
Treatment errors are associated with incorrect clinical diagnoses. As a result of such diagnoses, the patient is prescribed treatment that does not correspond to the true nature of the disease, and at the same time, the indicated and necessary therapy is not carried out.
Option II
1. Diagnostic, i.e. associated with the diagnosis.
2. Therapeutic-tactical, this includes errors in the choice of research methods and in the evaluation of their results.
3. Medical and technical, this is an incomplete examination of the patient and errors in diagnostic or therapeutic manipulations.
4. Organizational, this includes the incorrect organization of the workplace and the treatment process.
5. Mistakes in maintaining medical records.
6. Mistakes in the behavior of medical personnel.
Medical errors also include:
The leading ones are errors in the doctor's choice of the drug and its dose - 56%.
The second place was occupied by errors associated with incorrect changes in the dose and duration of drug use - 34%. Many patients die in hospitals from improper drug distribution. In medical institutions in the United States, for example, from 6 to 9 thousand people per year die for this reason. The Israelis have invented a fully computerized, error-free drug distribution system.
V.O. frequency by types:
Mistakes in diagnosis (40%);
Wrong treatment with correct diagnosis (28%);
Errors in performing procedures and manipulations (22%);
Administrative errors (4%);
Errors in the interaction of doctors and the transfer of information (2%);
Laboratory errors (2%);
Faulty medical equipment (1%);
Others (1%);
"A modern form of medical errors are IATROGENIC DISEASES, usually arising from a careless word or incorrect behavior of a doctor or nursing staff. The incorrect behavior of a medical worker can have a strong adverse effect on the patient's psyche, as a result of which he develops a number of new painful sensations and manifestations that can go even into an independent form of the disease"
4. ACCIDENTS IN MEDICAL PRACTICE
Sometimes an unfavorable outcome of an operation or other medical intervention is accidental. The doctor is unable to foresee misfortune. Such outcomes are called accidents in medical practice.
Accidents include all deaths that were unexpected for the doctor.
Examples:
1) activation of chronic infection after surgery; 2) postoperative complications - cases of peritonitis and bleeding after simple appendectomies, rupture of the surgical scar or thrombosis many days after the operation, air embolism of the heart, and many others; 3) suffocation with vomit during anesthesia; 4) death after encephalography, esophagoscopy, etc.
Thus, only such unsuccessful outcomes can be attributed to accidents in medical practice, in which it is impossible to foresee the consequences of medical actions, when failures in treatment do not depend on medical errors and other omissions, but are associated with an atypical course of the disease, individual characteristics of the organism, and sometimes with the lack of elementary conditions for the provision of emergency medical care.
5. REASONS FOR AND RESPONSIBILITY
Associated with the following factors: a) the workplace of the staff (the organization of the information model and management bodies); b) the mode of work and rest; c) vocational training; d) functional state; e) work motivation, f) relationships in the team.
Physician's responsibility
Responsibility of the institution (clinic)
Based on: the obligation of the clinic to provide medical care to patients; the obligation of the clinic to be jointly and severally liable for the negligence of its employees.
6. PREVENTION IN
* Transition to nanomedicine and nanodrugs;
* Use of an electronic health passport based on a computer model of the body;
* The use of lean medicine (lean medicine, lean healthcare) (English lean healthcare);
* Use of natural medicine;
* Transition to NBIC convergence in medicine;
* Application of modern technologies;
* The active role of the patient in avoiding medical errors;
* Simulators in training programs. The concept of simulation education;
* Application of medical robots.
7. COUNTRY FREQUENCY
Here are the data for 10 countries. More complete data (for 25 countries) and for the world are contained in article 21 (see References).
Australia
In 1995, adverse side effects occurred in 16.6% of hospitalized patients.
Great Britain
In 2000, the adverse effects of medical interventions amounted to 850 thousand cases and were the cause of 10% of all hospitalizations.
Germany
Adverse reactions accounted for 5.8% of hospitalizations.
Italy
Due to incorrect diagnosis, incorrect treatment and due to poor organization of medical care in general, according to various estimates, from 14 to 50 thousand patients die every year (2003 data).
Canada
Medical errors cost Canadian authorities $750 million each year. In terms of the total number of patients treated annually, these figures mean that an average of 187,000 people experience medical errors, and from 9250 to 23750 of them die (i.e., the proportion of fatal errors is 4.9-12.7%).
Netherlands
In 2003, 2642 thousand medical errors were registered. Of these, 164 cases resulted in the death of the patient. According to unofficial data, the erroneous actions of Dutch doctors over the same period led to the death of 1.5 to 6 thousand patients.
Russia
There are no official statistics. Every year in Russia, 50,000 people die from medical errors, more than from traffic accidents. "The percentage of medical errors in Russia is very high, over 30%." acad. Alexander Chuchalin (chief pulmonologist).
USA
According to the Institute of Medicine of the US National Academy of Sciences (1999), medical errors are the fifth leading cause of death, ahead of such common diseases as diabetes mellitus, pneumonia, Alzheimer's disease and kidney failure. In 1999, 98,000 deaths were registered as a result of medical errors. The economic costs associated with drug complications in the United States are about $76.6 billion per year. According to other sources, up to 195 thousand people die every year from mistakes made by medical personnel. In 2000-2002, there were an average of 1.14 million medical errors per 37 million hospital admissions each year. Of these, 15-20% led to the death of patients. Most often, the cause of death was infectious complications of invasive procedures, fatal errors of surgeons were in second place, and incorrect prescription of medications was in third place. In the US, between 44,000 and 98,000 people die in hospitals every year due to medical errors - mostly due to the wrong choice or dosage of drugs, for example, Michael Jackson. Mortality due to medical errors is much higher than from car accidents, cancer, pneumonia and AIDS. Every year, from 3.5 to 8.8 million patients are hospitalized and 100-200 thousand patients die due to the development of adverse drug-related adverse reactions .
Ukraine
About 3,000 deaths per year and about 7,000 cases of disability due to the negligence or unprofessionalism of medical workers.
France
In 1997, about 10% of all hospitalized patients were patients with adverse reactions. Complications of drug therapy occurred in 1,317,650 patients, of which 33% were serious and 1.4% were fatal.
Estonia
Medical errors lead to the death of 1500 people a year in Estonia, 12 thousand people experience treatment errors.
(according to the level of European statistics, since there is no analysis of medical errors in Estonia yet).
In 593 gastroenterological patients, it was found that errors in diagnosis and treatment were made in 46% of patients, incl. when taking an anamnesis - 18.5%, physical examination - 12.1%, laboratory and instrumental appointments - 12.5%, diagnosis - 8.1%. Journalist Mikk Salu raised the issue of the quality of medical care and shortcomings in this area.
8. EXAMPLES IN
* The book of prof. E.R. Guglin gives a detailed description of 77 medical errors. An analysis is made of the complex, multicomponent, contradictory process of medical thinking - the main function of medical practice - thinking about the patient and his illness.
Guglin E. N. Clinical studies (http://www.guglin.ru/book/) (text on the Internet)
* Doctors' mistakes in pharmacotherapy are detailed in the article "Medical errors as a cause of drug therapy complications" (J. Qualitative Clinical Practice - see http://medi.ru/DOC/9920111.htm)
* The death of Michael Jackson received a wide public outcry due to the fact that his personal doctor Murray gave the musician an excessive dose of propofol, which, in combination with sedatives, caused the death of the singer.
* In a detailed article by V.K. Lepakhina et al., three cases (with abbreviations) associated with errors in the use of drugs are given:
Case 2. Patient S., aged 57, underwent endoscopic cholecystectomy in a planned manner. In the postoperative period, combined drug therapy was prescribed. Two days later, the patient's condition was complicated by bleeding from the gallbladder bed (platelets - 68 x 109/l, whole blood clotting time - 44 min). A relaparotomy was performed. Death occurred 15 days after the planned operation. Over the past 6 years, the patient has been constantly receiving therapy with an indirect anticoagulant - phenylin (phenindoin) at a dose of 0.03 2 times a day.
The child was admitted to the hospital to rule out congenital hepatitis. The diagnosis of congenital hepatitis was rejected.
* The ambulance team and the family doctor treated the patient for sciatica, and he almost died from pneumonia.
The patient suddenly developed a sharp pain in the shoulder, which then spread to the entire back. The pain did not subside, there was a slight cough. A week later, during which the pain did not subside, but only intensified and spread. The temperature rose to 38 degrees. He visited the family doctor and twice called an ambulance to the house, and all the doctors unanimously treated him for back pain. Pneumonia was found in the regional hospital. The situation was already critical. He needed urgent lung surgery. According to the doctor Andrei Borisov, in this situation it all started not at all with lung pathology, but with ordinary myalgia or neuralgia, in parallel with which a second, completely independent disease developed - pneumonia. "You always have to be careful and remember that a person can have several acute diseases at the same time, the symptoms of one disease can be veiled by the symptoms of another." Doctor Andrey Borisov
* Zhenya M., a resident of the city of Karakol, at the age of 1.5 years, died in a nursery while sleeping on January 29, 1998. The diagnosis of pneumonia was not revealed, the child took cough syrup, nasal drops. The medical mistake was: the discharge of an unhealthy child, the active management of the child's illness was not ensured, the failure to conduct additional examinations (X-ray, blood test). The child needed medical treatment.
* Victim Shch., 37 years old, was taken to the hospital with an open comminuted fracture of the middle third of the leg bones. Primary surgical treatment of the wound was completed by open reposition of fragments with their fixation with a metal rod. . After almost a year and a half, the nail was not removed and, despite a well healed fracture, the function of the ankle joint was completely lost.
* A woman in the eighth week of pregnancy was rushed to the hospital due to small bleeding. The gynecologist, having examined the patient, indicated to the latter that the gestational age was only 4-5 weeks and suggested that the woman had a miscarriage. The woman was scheduled for an abortion. The patient ran away from the hospital and did an ultrasound in a paid clinic. As a result, the woman gave birth to a healthy baby.
* A 53-year-old woman consulted a radiologist 3 months after cholecystectomy for calculous cholecystitis. He complains that after the operation he cannot bend down to lace up his shoes: "Something is in the way ...". The radiologist found in the abdominal cavity the shadow of a metal "sole", which surgeons use to push back the viscera when suturing the wound of the abdominal wall.
* Patient P. suddenly developed massive bleeding from a wound on his neck, from which he died 10 minutes later. During the forensic medical examination of P.'s corpse, it was established that there was an instrumental rupture of the anterior and posterior walls of the cervical esophagus. A technical error in the process of esophagoscopy led to a serious illness, complicated by fatal bleeding.
* A 16-year-old teenager died of a ruptured abdominal aortic aneurysm. The doctors misdiagnosed him as stomach flu. The disease that led to death is very rare. Because of the rupture of the abdominal aorta, children die extremely rarely. - "This is a disease of older people" (survival rate up to 10% if the gap occurs at home).
* The patient's small intestine was damaged during gallbladder surgery. The measures taken were insufficient. The patient's life was saved by treatment in another hospital, to which her relatives transported themselves.
* An 81-year-old woman died in Sweden after doctors mistakenly removed a healthy kidney instead of a diseased one during an operation.
The doctors made a mistake because the diseased kidney was labeled incorrectly in the case history.
* In St. Petersburg, in the Children's City Clinical Hospital No. 5, an emergency occurred - a one-year-old child was transfused with the blood of an HIV-positive donor. According to the preliminary version, the human factor is to blame.
The child was delivered to the Children's City Clinical Hospital No. 5 by ambulance in St. Petersburg on February 27, 2013. The girl swallowed six magnets in a child's toy. The child was diagnosed with developing peritonitis of the abdominal cavity. An urgent operation and transfusion of red blood cells were required. The doctor of the children's city hospital No. 5 did not notice the "danger signal" against the name of the HIV-infected donor and decided to start the transfusion procedure. The child has already managed to transfuse 50 milliliters of infected blood. The girl was urgently given antiretroviral therapy, thanks to which the probability of contracting HIV infection is 50/50.
* Numerous examples of medical errors are given on the portal IA REGNUM "Plots"
9. OPERATOR ERRORS
Engineering psychology deals with the problems of human operator errors. It is useful to give some provisions that can be used to study medical errors. An error is the result of an action done inaccurately or incorrectly. This is a deviation from the intended goal, a discrepancy between what was received and what was planned, a discrepancy between the achieved result and the intended goal, the task set.
A set of five criteria is proposed for the analysis and classification of operator errors:
1) place the error in. the structure of the ergatic system; 2) external manifestation of the error; 3) the consequences of the error; 4) the nature of the display of the error in the mind of the operator; 5) reasons for the error.
Detailed analysis methods have been developed for each of the criteria. For example, when analyzing the causes of operator errors (criterion 5), their place in the activity structure is determined.
Errors can be localized:
1) in perception - visual, auditory, etc.; 2) in memory - memorization, preservation, reproduction; 3) in decision-making - in logical operations, calculations, in creative thinking; 4) in executive action - in motion, speech response.
The causes of the error can be associated with the following factors: 1) with the operator's workplace - with the organization of the model of information and controls; 2) with the regime of work and rest; 3) with vocational training; 4) with a functional state; 5) with work motivation; 6) with relationships in the team.
This set of criteria for the analysis and classification of operator errors sets the sequence for their psychological analysis and allows you to combine many heterogeneous factors into a system that lead to errors, errors and operator failures.
By place in the structure of activity, the following types of errors can be distinguished:
- errors of perception;
- memory errors;
- errors of thinking and decision making;
- feedback errors.
According to the type of broken patterns:
- inconsistency of the information processing process;
- inconsistency of skill (transfer of skill to conditions where it is not applicable, insufficient skill);
- lack of attention.
The main causes of operator errors:
- operator's workplace (disadvantages of the distribution of functions between a person;
- organization of work and rest;
- preparation of the operator and the system to perform this task;
- the physical and mental state of the operator;
- setting the operator to perform the task.
The causes of errors stem from fundamental personality traits:
- Emotional condition;
- The requirement of absolute infallibility leads to an increase in anxiety, an increase in the intensity of operator work;
- The control of the subject himself over the execution of his action is one of the important functions of consciousness.
- Motor automatism is a distinctive feature of professional work;
- Establishing the causes of the error is carried out by moving back along the chain of operations performed to the point at which the deviation occurred.
If an error is an accident, then no one is to blame for it, and nothing follows from it, no measures in any area. If the error is the result of someone else's oversight, the culprit should be punished and measures should be taken to prevent the occurrence of such errors in the future.
In order for a mistake to become the property of experience, it must be carefully and comprehensively considered.
There are many cases when the fault for errors often lies not with the operator, but with the designer who created the technical link of the system.
Mistakes can be punished only in cases where the performance of tasks does not require going beyond the natural limits of perception, memory, thinking, and attention.
Errors caused by mental processes and functions that take place against the will of the subject and his consciousness should not be punished.
The path to professional excellence lies through overcoming mistakes. Experience cannot arise from knowledge of the rules alone.
Mistakes are indispensable - they are the source of the experience of any person.
Why don't people learn from mistakes?
The mistake made must be accepted by the person. He must admit his mistake and accept the blame. People tend not to admit they are wrong.
Increasing the resistance to errors is associated with the implementation of a set of engineering and psychological measures that provide for three levels of problem solving:
1. Automatisms of behavior;
2. Purposeful behavior determined by rules;
3. Behavior driven by purpose and based on knowledge.
10. HISTORY IN
In the Code of Laws (lawyer) of Hammurabi, carved on stone, who ruled Babylon and united Mesopotamia (Babylonia) in 1792-1750. BC e., in which three paragraphs are assigned to liability for medical error.
In Roman law, the concept of “error” was widely used, incl. and in relation to medical practice (Law of Aquilia). Medical errors included inexperience, negligence, and failure to provide assistance. Roman law provided for the punishment of a doctor for gross errors, and the concept of "medical errors" was very broad. Although Roman law allowed the legitimacy of the death of the patient due to the severity of the disease.
In ancient Greece, physicians were exempted from liability for mistakes if the patient died "against the will of the doctor."
in England in the 15th century. a surgeon who harmed a patient was brought before the court of the mayor of the city and, by the verdict of the latter, was fined, imprisoned, or deprived of medical practice for a certain period.
In ancient Rus', healing was equated with sorcery and sorcery. Therefore, for medical errors, the doctor was liable as for an intentional crime. An example is the killing of the doctor Leon, who treated the sick son of Grand Duke John III, but could not save him from death.
In the 19th century progressive doctors saw in the analysis and V.'s studying of the lake. an effective way to improve medicine. N.I. Pirogov wrote that every conscientious person, especially a teacher, should have an inner need to make his mistakes public as soon as possible in order to warn people who are less knowledgeable from them.
x x x
Apparently, it is necessary to radically reduce the number of medical errors. This is possible not by increasing costs, but by using modern management methods: Don Tapscott's wikinomics and Lean management (more precisely, lean healthcare), medical logistics, electronic health passport, stimulants in training programs, etc. In the future, personalized medicine , nanomedicine and nanodrugs, NBIC-convergence (NBIC-convergence) of medicine with other sciences, as well as within medicine itself, will significantly reduce the number of medical errors, as well as reduce the mortality rate from drugs. Under conditions of network (collective) medical intelligence, the efficiency of the medical network will immeasurably increase. The psychological factor is also becoming increasingly important, as a result of which a certain percentage of medical errors arise. For example, a lot depends on the ability of a doctor to communicate with a patient and a patient with a doctor. At the stage of diagnosis, communication provides important information. After the appointment of treatment, it is necessary for the patient to follow the doctor's instructions, and also adapt his lifestyle to the conditions of the disease. Unfortunately, e-medicine also does not facilitate doctor-patient communication. At the University of Tartu, medical students will be taught the psychology of doctor-patient communication and conflict resolution. The biological factor also has a significant impact on social and psychological behavior. Improving the quality of medical care and preventing errors can be helped by public commissions for monitoring the quality of medicine.
Note:
1. The concept of medical errors is described in full in the well-known book by Richard K. Riegelman "How to avoid medical errors. The Book of Practitioners" (http://lib.rus.ec/b/217050/read).
2. Guglin E. N. Clinical studies (http://www.guglin.ru/book/)
3. Visit the first site about medical errors (http://vra4i.proizvoly.net/o_nas.html).
Literature
1. Operator errors (http://psychology.net.ru/dictionaries/psy.html?word=625)
2. How to protect yourself from medical errors (http://www.moscowuniversityclub.ru/home.asp?artId=7426)
Studies by the US Institute of Medicine show that out of 98,000 people, approximately 44,000 become victims of medical errors. These results unmercifully indicate that the percentage of deaths due to medical errors is much higher than from car accidents, cancer, pneumonia and AIDS.
3. Ermanok A.E. Medical errors: the current state of the problem 4. Medical error
5. Medical errors kill 1500 people a year?
There is no analysis of medical errors in Estonia
6. Models do not hurt SPb Vedomosti Issue No. 018 dated 02.02.2011
Petersburg scientists figured out how to prevent medical errors
7. Richard K. Rigelman. How to avoid medical errors. Book of practitioners (http://lib.rus.ec/b/217050/read)
8. Yu.T. Sharabchiev. Medical errors and defects in the provision of medical care: socio-economic aspects and losses of public health
(http://www.mednovosti.by/journal.aspx?article=301)
9. Nanodrugs ()
10. Nanosociety ()
11. Nanomedicine (ru.VIKI)
12. Medical error (ru.VIKI)
Doctor; bnaya mistakes; bka - an unintentional misconception of a doctor (or any other medical worker) in the course of his professional activities, if negligence and dishonesty are excluded.
The forensic medical expert and scientist Israel Gamsheevich Vermel named three conditions under which (all at the same time), from his point of view, medical workers should be criminally liable for improper treatment:
1. The actions of a medical worker in a particular case were objectively wrong, in conflict with the generally recognized and generally accepted rules of medicine.
2. A medical worker, by virtue of his education and his position, should have been aware that his actions are wrong and therefore can harm the patient.
3. These objectively incorrect actions contributed to the onset of adverse consequences - the death of the patient or causing significant harm to his health.
There is no state in the world where doctors do not make mistakes.
12a. Medical error en.WIKI
12b. Medical malpractice en.WIKI
13. Natural medicine ()
14. NBIC Convergence Phenomenon: Reality and Expectations
(http://www.transhumanism-russia.ru/content/view/498/116/)
15. ERRORS OF DOCTORS (HTTP://WWW.MEDOCENKA.RU/CONTENT/SECTION/4/64/)
16. Medical errors (http://rudiplom.ru/lecture/sudebnaya-medicina/1829.html
17. Medical errors (http://www.nedug.ru/library//-)
18. E.O. Kostikova. On the concept of medical error. (http://medoshibka.ru/statya/23-ponyatie-medoshibki.html)
19. Medical errors (http://mediblog.ru/?p=135)
In Slavic countries (including Hungary), medical errors are rarely covered. Most of the medical errors in the diagnosis or choice of treatment are the lack of experience and skill among doctors, as well as their lack of opportunity sometimes to improve their skills.
20. Anna Voevodina. Medical errors" in Ukraine: there are enough "articles", but there are still few "imprisonments"
(http://cripo.com.ua/index.php?sect_id=3&aid=110879)
21. Comparative data on cases of inadequate medical care abroad
(http://pravo-med.ru/articles/medical_mistake/2753/)
Australia, Belarus, Bulgaria, Great Britain, Hungary, Germany, Greece, Ireland, Spain, Italy, Israel, Kazakhstan, Canada (new), Cyprus, Portugal (new), Latvia, Poland, USA, Ukraine, France, Switzerland, Sweden ( new), Scotland, Estonia (new), Japan, Groups of countries, General data on the countries of the world.
22. The first site about medical errors (http://vra4i.proizvoly.net/o_nas.html)
23. Every year in Russia, 50 thousand people die from medical errors.
Every year in Russia, 50,000 people die from medical errors, more than from traffic accidents.
24. Medical error (http://www.dislife.ru/flow/theme/1348/)
For Ukraine, the following figures are given: about 3,000 deaths per year and about 7,000 cases of disability due to the negligence or unprofessionalism of medical workers.
25. Medical errors as a cause of drug therapy complications
(http://medi.ru/DOC/9920111.htm)
26. Guglin E. N. Clinical studies (http://www.guglin.ru/book/) (text on the Internet)
The book is about medical errors. Specific examples are used to analyze the complex, multicomponent, contradictory process of medical thinking - the main function of medical practice - thinking about the patient and his illness.
27. Medical errors (http://medgazeta.rusmedserv.com/2003/91/article_670.html)
28. Statistics of medical errors in the West...
(http://www.mosmedicina.ru/news/11/)
In the analysis carried out by 37 heads of therapeutic departments in cities and a number of regions of Estonia at the appointments of 593 gastroenterological patients by district therapists, it was found that errors in diagnosis and treatment were made in 46% of patients, incl. when taking an anamnesis - 18.5%, physical examination - 12.1%, laboratory and instrumental appointments - 12.5%, diagnosis - 8.1%
29. Don Tapscott, Anthony D. Williams. Wikinomics. How Mass Collaboration Changes Everything: BestBusinessBooks, 2009 ISBN 978-5-91171-016-3
30. Livshits V. Age of lean manufacturing ()
30a. Livshits V. Mirror neurons ()
31. V.K. Stepanov. The Age of Networked Intelligence: About Don Tapscott's Digital Society
Twelve key features of the new society, among which the key position is occupied by knowledge orientation, digital representation of objects, virtualization of production, innovative nature, integration, convergence, elimination of intermediaries, transformation of producer-consumer relations, dynamism, globalization and a number of others.
Tapscott, Don. Electronic-digital society: Pros and cons of the era of network intelligence / Translated from eng. Igor Dubinsky. Ed. Sergei Pisarev. //Kyiv. – INT Press; Moscow. - Relph book.-1999.-432 s
Don Tapscott. Digital Economy: Promise and Peril In The Age of Networked Intelligence, published in 1995.
32. Future doctors will be taught how to communicate with patients
Communication courses have become popular in hospitals in recent years. Little is taught during psychology studies. The Faculty of Medicine of the University of Tartu is going to introduce a compulsory subject, during which communication with the patient and conflict resolution will be taught.
33. Frequent problems of rare diseases SPbVedomosti Issue No. 167 of 09/07/2011
The main problems faced by parents of children with rare diseases (mucopolysaccharidosis, Fabry disease, Williams syndrome, etc.) are poor diagnosis, inexperienced doctors and the lack of real treatment. It is very important to detect such a disease in time. If you do not start treatment at an early stage, the child's condition will imperceptibly worsen and it will be much more difficult to treat him. But, alas, most doctors do not think that a small patient may have some rare disease. And many do not see the symptoms because they simply do not know about them.
34. NBIC convergence NBIC convergence
()
35. The success of the operation depends on the communication skills of the staff
36. III International Conference on Coaching "Coaching for the health of organizations and people"
(http://kdelo.ru/press-reliz/01-06-2007)
37. Models do not hurt SPb Vedomosti Issue No. 018 dated 02/02/2011
To prevent medical errors, an electronic health passport based on a computer model of the body is needed. Insurance companies in the US have been able, on this basis, to significantly reduce physician errors and realize significant savings.
38. Logistics of the healthcare system in the context of health insurance
(http://planetadisser.com/see/dis_60607.html)
39. Purpose of logistics
(http://biznestoday.ru/log/231-cellogistiki.html)
40. Myths about medicine and doctors
(http://www.krestianin.ru/articles/5716.php)
41. Applying Lean Principles to Healthcare
(http://www.leanforum.ru/library/5/87.html)
42. American doctors treat patients too hard
Physician appointments are often driven by fear of being accused of incompetence
In the United States, medical expenses per capita are higher than in any other developed country: they amount to 5.475 dollars (for comparison, Switzerland occupies the second place, where 3.581 dollars are spent on medical care per person). These data were published in the journal Health Affairs.
“Our survey showed that many physicians feel they are giving their patients too much attention. 76% of respondents say that their overzealousness is caused by fears of lawsuits for accusations of medical errors and professional incompetence, ”(from a report by the American Medical Association).
43. Billion Dollar Healthcare Industry
The United States government is providing almost a billion dollars in new grants to the healthcare industry. The money will be used to provide more than 100,000 hospitals and primary care physicians with information technology by 2014. The money will also be used to train thousands of specialists in the field of technical means of communication and healthcare.
44. Michael Jackson's death - murder or accident?
Dr. Murray is charged with involuntary manslaughter. According to the prosecution, he gave Michael Jackson the potent anesthetic Propofol, without monitoring the patient's condition.
45. Age of Lean Manufacturing
The Michael Jackson case shocked the world. However, from mistakes with medicines (mistakes of medical staff and patients), many people die without publicity. Even in the US, this is the reason why most people die. The reason is the outdated system of medical management. It's time to switch to lean medicine, elements of which are already used most in oncology.
46.. Mikk Salu No quality control in health care The quality of special care is a means by which hospitals can be punished financially, not a means by which doctors and hospitals can improve their performance.
47. Mikk Salu: a response - silence http://rus.postimees.ee/439666/mikk-salu-a-v-answer-tishina/
The Estonian public is not yet ready to talk about medical errors and therefore the system is not ready to report them publicly
Vice Chancellor of the Estonian Ministry of Social Affairs Iivi Normet
48. A court in the United States sentenced ex-doctor Michael Jackson to 4 years in prison
http://news.yandex.ru/yandsearch?cl4url=news.bcm.ru
Michael Jackson's personal physician Conrad Murray has been sentenced to four years in prison. Murray gave the musician an overdose of propofol (sleeping pills), which, in combination with sedatives, caused the singer's death. The doctor injected the singer with an overdose of sleeping pills. A significant number of deaths from unauthorized intravenous infusion of this drug is due to the lack of necessary support for the respiratory and cardiovascular systems; for example, Michael Jackson, the famous pop singer, died in 2009 from acute propofol intoxication. A short-acting intravenous hypnotic. It is used to induce or maintain anesthesia (anesthetic - analgesic), as a sedative for mechanical ventilation in adult patients and for procedural sedation (sedative and (with increasing dose) hypnotic effect)
49. V.K. Lepakhin, A.V. Astakhova, E.A. Ovchinnikova, L.K. Ovchinnikov. Medical errors as a cause of drug therapy complications
(http://medi.ru/doc/9920111.htm)
In the USA alone, from 3.5 to 8.8 million patients are hospitalized annually and 100-200 thousand patients die due to the development of adverse drug-related adverse reactions. In France in 1997, about 10% of all hospitalizations were patients with adverse reactions. Complications of drug therapy occurred in 1,317,650 patients, of which 33% were serious and 1.4% were fatal. Adverse reactions accounted for 5.8% of hospitalizations in Germany.
The first works devoted to the description and study of the problem of medical errors began to appear in the 90s. . One of the first significant studies of this issue was organized in the United States by the Agency for Research and Quality in Health Care and conducted by the Institute of Medicine
Medical errors also include:
misdiagnosis leading to the wrong choice of drug for treatment
failure to use the prescribed diagnostic test;
misinterpretation of survey results;
not taking action after receiving results that deviate from the norm;
use of faulty medical equipment;
complications in blood transfusion;
non-compliance with other medical prescriptions.
Case 1. Patient Sh., 71 years old, being in the hospital with a diagnosis of pneumonia, received combined drug therapy, including gentamicin in a single dose of 80 mg 3 times a day for pneumonia, eufillin 200 mg three times a day, furosemide 40 mg per day to correct blood pressure (suffers from hypertension). 10 days after the start of therapy, acute renal failure developed with a fatal outcome.
Case 2. Patient S., aged 57, underwent endoscopic cholecystectomy in a planned manner. In the postoperative period, combined drug therapy was prescribed, including: heparin 5000 IU 4 times a day, fraxiparin (nadroparin calcium) 300 IU subcutaneously once a day, ciprofloxacin 200 mg twice a day, cefantral (cefotaxime) 1 g 2 times per day, riboxin (inosine) 10 mg 3 times a day intravenously. Two days later, the patient's condition was complicated by bleeding from the gallbladder bed (platelets - 68 x 109/l, whole blood clotting time - 44 min). A relaparotomy was performed. Death occurred 15 days after the planned operation. From the anamnesis it is known that 6 years ago the patient underwent surgery for a complex heart disease and over the past 6 years he has constantly received therapy with an indirect anticoagulant - phenylin (phenindoin) at 0.03 2 times a day.
Case 3. A 2-month-old child was prescribed furazolidone (1/4 tablet - dose not indicated - 3 times a day) for the treatment of dysbacteriosis, which, as noted by the pediatrician, was manifested by loose stools (without pathological impurities). After 5 days from the start of treatment with the drug, the child showed yellowness of the skin, an increase in the level of liver enzymes.
The child was admitted to the hospital to rule out congenital hepatitis.
As a result of discontinuation of the drug and treatment with lipoic acid, vitamin E, sorbitol, diphenhydramine, the child's condition returned to normal, and liver function indicators returned to normal. The diagnosis of congenital hepatitis was rejected.
50. The showman almost died due to a misdiagnosis
An ambulance team and a family doctor treated the showman for sciatica, and he almost died from pneumonia.
The patient suddenly developed a sharp pain in the shoulder, which then spread to the entire back. The pain did not subside, there was a slight cough. A week later, the pain did not subside, but only intensified and spread. The temperature rose to 38 degrees.
He visited the family doctor and twice called an ambulance to the house, and all the doctors treated him for back pain. Pneumonia was found in the regional hospital. The situation was already critical. He needed urgent lung surgery. According to the doctor’s conclusion, in this situation, it all started not at all with lung pathology, but with ordinary myalgia or neuralgia, in parallel with which a second, completely independent disease developed - pneumonia. Doctor Andrey Borisov:
"You always have to be careful and remember that a person can have several acute diseases at the same time, the symptoms of one disease can be veiled by the symptoms of another."
51. By calling 1220 you can find out about Russian medicines
(http://sp.pohjarannik.ee/archives/8179)
For 6 years now, the Tallinn Consulting Center "Family Doctor's Advice" has been operating in Estonia. About 600 calls are received daily on the free 24-hour telephone line of family doctors 1220. It is planned to supplement the project with Skype. A caller of 1220 people will be able not only to tell, for example, about an injury, a cut finger, but also to show a problem area. Call 1220 to find out about Russian medicines.
52. Greed for pills. SPbVedomosti Issue No. 237 dated 12/15/2011
According to world experts, out of a huge number of drugs, only 5-7% have proven effectiveness. Everything else is business. In addition, according to global data, in 75% of cases, the prescription of antibiotics is unreasonable.
53. Equipment that changes thinking St. Petersburg Vedomosti Issue No. 071 of 04/20/2012
The hospital (Mariinsky Hospital) purchased an integrated EndoALPHA operating room.
This is the integration of systems and complexes, documentation and telemedicine, which ensures maximum efficiency and safety of work. Allows you to perform all the most complex (including combined) manipulations in low-traumatic technologies and in the future will be extended not only to abdominal surgery, that is, to the treatment of diseases and injuries of the organs and walls of the abdominal cavity, but also to gynecology and urology.
54. V.K. Lepakhin, A.V. Astakhova, E.A. Ovchinnikova, L.K. Ovchinnikov. Medical errors as a cause of drug therapy complications//Quality Clinical Practice 1 / 2002
in the United States between 1966 and 1996 showed that serious adverse reactions occurred on average in 6.7% of cases, and fatal complications occurred in 0.32% of all hospitalized patients.
In France in 1997, about 10% of all hospitalizations were patients with adverse reactions. Complications of drug therapy occurred in 1,317,650 patients, of which 33% were serious and 1.4% were fatal. Adverse reactions accounted for 5.8% of hospitalizations in Germany.
The economic costs associated with drug complications in the United States are about $76.6 billion per year. The total annual cost of treating preventable complications of pharmacotherapy alone in the United States ranges from $17 million to $29 million.
In the UK, about $4 billion is spent each year to increase the length of stay in hospitals due to the adverse side effects of drugs.
The most common irrational drug combinations were:
the use of two or more non-steroidal anti-inflammatory drugs against the background of gastritis and peptic ulcer, which led to an exacerbation of chronic pathology and / or the development of gastrointestinal bleeding;
combinations of antibiotics of the aminoglycoside group and other nephrotoxic agents (eg, cephalosporins) with the development of acute renal failure;
the appointment of a combination of drugs that have an irritating effect on the mucosa of the gastrointestinal tract (for example, aspirin, agapurine and aescusan);
55. How patients can avoid medical errors
1. Accuracy in filling out documents
2. Read your medical record
3. Be examined by another doctor
4. Discussion about possible diagnosis and treatment
5. The presence of a friend.
56. Will the drugs get better? SPb Vedomosti Issue No. 090 dated May 23, 2012
In 2011, Roszdravnadzor withdrew from circulation about 2 million packages of substandard, falsified, counterfeit and unregistered medicines for a total amount of 450 million rubles. In the same year, 5-7% of all medicines sold worldwide were found to be counterfeit.
57. Age of Genomics
The ability to predict the risk of developing diseases is not far off.
A new era is dawning before our very eyes. The price of reading individual genomes has fallen to thousands of dollars or less, DNA-reading machines have become so compact and easy to use that some of them can be used without any special training - all these are harbingers of the era of individual genomics.
The genome analysis package will cost hospitals just a few thousand dollars. Human genomes are different from each other. Doctors have the ability to accumulate information about diseases and - now - to compare it with the data of individual genomes. Only a few probable diseases can now be identified from individual genomes. Many factors influence health, and genetics is just one of them.
58. Miraculous cure for cancer
There is a very serious problem in the world, which not everyone knows about - many patients die in hospitals from improper distribution of medicines.
In medical institutions in the United States, for example, from 6 to 9 thousand people per year die for this reason.
The Israelis have invented a fully computerized, error-free drug distribution system.
59. Medical errors, an example from medical practice (http://www.medgreen.ru/pop/274.html)
Zhenya M., a resident of the city of Karakol, at the age of 1.5 years, died in a nursery while sleeping on January 29, 1998. The diagnosis of pneumonia was not revealed, the child took cough syrup, nose drops. The medical mistake was: the discharge of an unhealthy child, the active management of the child's illness was not ensured, the failure to conduct additional examinations (X-ray, blood test). The child needed medical treatment.
60. An example of errors in the treatment of open fractures. (http://medicalplanet.su/traumatology/235.html)
The victim Sh., 37 years old, was taken to the hospital with an open comminuted fracture of the middle third of the leg bones. Primary surgical treatment of the wound was completed by open reposition of fragments with their fixation with a metal rod. . After almost a year and a half, the nail was not removed and, despite a well healed fracture, the function of the ankle joint was completely lost.
61. Medical errors in gynecology
A woman in the eighth week of pregnancy was rushed to the hospital due to small bleeding. The gynecologist, having examined the patient, indicated to the latter that the gestational age was only 4-5 weeks and suggested that the woman had a miscarriage. The woman was scheduled for an abortion. The patient ran away from the hospital and did an ultrasound in a paid clinic. As a result, the woman gave birth to a healthy baby.
62. "Forgotten" foreign bodies
A 53-year-old woman consulted a radiologist 3 months after cholecystectomy for calculous cholecystitis. He complains that after the operation he cannot bend down to lace up his shoes: "Something is in the way ...". The radiologist found in the abdominal cavity the shadow of a metal "sole", which surgeons use to push back the viscera when suturing the wound of the abdominal wall.
63.Volkov V.N., Datiy A.V. - Forensic medicine (http://medbookaide.ru/books/fold1002/book1617/p62.php)
Patient P. suddenly developed massive bleeding from a wound on his neck, from which he died 10 minutes later. During the forensic medical examination of P.'s corpse, it was established that there was an instrumental rupture of the anterior and posterior walls of the cervical esophagus. A technical error in the process of esophagoscopy led to a serious illness, complicated by fatal bleeding.
64. A 16-year-old teenager died after being knocked around the thresholds of the hospital for a week with severe abdominal pain.
A 16-year-old teenager died after a ruptured abdominal aortic aneurysm. The doctors misdiagnosed him as stomach flu. The disease that led to the tragic denouement is very rare. Because of the rupture of the abdominal aorta, children die extremely rarely. - "This is a disease of older people" (survival rate up to 10% if the gap occurs at home).
65. Calda Eric. The patient accuses the Ida-Viru Central Hospital of improper treatment. Newspaper North Coast. March 16, 2013. The patient's small intestine was damaged during gallbladder surgery. The measures taken were insufficient.
66. Physicians under popular control? SPb Vedomosti Issue No. 064 of 04/08/2013
Public commissions for quality control of medicine. Special civilian inspectors will begin to monitor how services are provided to patients in healthcare facilities.
Complaints from citizens, visit hospitals and clinics with inspections, sound the alarm in society if it finds significant shortcomings.
during medical rounds, controllers will look to see if hospitals are provided with medicines and equipment, to monitor how doctors treat patients.
“In some cities, patients with serious chronic diseases: hemophilia, oncological, hematological and rare (orphan) diseases, diabetes, who have undergone transplantation, need constant maintenance therapy.
67. Mistake at the cost of life: doctors cut out a healthy kidney instead of a diseased one
An 81-year-old woman has died in Sweden after doctors mistakenly removed a healthy kidney instead of a diseased one during an operation.
The doctors made a mistake because the diseased kidney was labeled incorrectly in the case history. And although during the operation they noticed that the operated kidney looks healthier than the other. The chief surgeon admitted that it was necessary to suspend the operation and collect additional information.
68. Irina BOTUZOVA. Alien blood SPb Vedomosti Vol. No. 070 dated 04/16/2013
In St. Petersburg, in the Children's City Clinical Hospital No. 5, an emergency occurred - a one-year-old child was transfused with the blood of an HIV-positive donor. According to the preliminary version, the human factor is to blame.
The child was delivered to the Children's City Clinical Hospital No. 5 by ambulance in St. Petersburg on February 27, 2013. The girl swallowed six magnets in a child's toy. The child was diagnosed with developing peritonitis of the abdominal cavity. An urgent operation and transfusion of red blood cells were required. The doctor of the children's city hospital No. 5 did not notice the "danger signal" against the name of the HIV-infected donor and decided to start the transfusion procedure. The child has already managed to transfuse 50 milliliters of infected blood. The girl was urgently given antiretroviral therapy, thanks to which, according to experts, the probability of contracting HIV infection is 50 to 50. According to the results of the first examinations, the girl's HIV tests are negative.
69. BakuToday » Plots » Medical errors
(http://www.regnum.ru/dossier/599.html)
70. Exchange of medical experience and development of competence centers (http://www.infosib.com.ru/doclad31)
More than 100,000 Americans die every year due to preventable medical errors. In France, the costs of eliminating the consequences of the misuse of medicines amount to more than 5 billion euros per year. And in the Netherlands, according to unofficial data, the erroneous actions of doctors lead to the death of 1.5 to 6 thousand patients a year. The most prone to medical errors are children under the age of 1 year, as well as patients who were treated under the state insurance program aimed at helping low-income segments of the population. In the UK, medical error is the third leading cause of death after cancer and cardiovascular disease.
Medical errors in most cases are by no means the result of malicious intent, irresponsibility or low qualification of physicians. Today, there are more than 10,000 diseases, 3,000 drugs, 300 different radiological procedures, and 1,000 laboratory tests, according to research at the Brigham and Women’s Hospital in Boston.
data were given on 4 thousand medicines actively used in the world, among which more than 2 thousand interactions were recorded, significantly affecting the possibility of their use in a particular pathology. It becomes obvious that it is absolutely impossible to keep such a volume of information in mind. “In Europe, the main emphasis is placed on information support for the doctor, on creating a new information environment for his activities, because this is what makes it possible to improve the quality of treatment, its accessibility,” Andrey Stolbov 1 believes. “First of all, we must focus on the doctor.”
To clarify the diagnosis and make a decision, the doctor often needs to refer to reference books or consult with a more experienced colleague. Moreover, all over the world there is a practice of continuous education of doctors, allowing them to constantly keep abreast of the latest developments in the field of medicine and pharmaceuticals. “Computer support systems for medical prescriptions,” Andrey Stolbov commented on the situation, “allow us to significantly, by almost 80%, reduce the number of errors in prescribing drugs and reduce adverse side reactions by 55%.
Another modern tool to support physicians is the Competence Center, such as the IBM-led Biomedical Research Competence Center in Dublin, which focuses on developing cutting-edge analytics applications to help clinicians make better informed decisions based on their findings. This initiative complements IBM's ongoing efforts to create the Clinical Trials Portal, which will provide clinicians and patients with access to clinical trial data in a single resource.
Medical competence centers in Russia are more of a fantasy than a reality.
According to a study by the American Association of Hospitals, in hospitals that actively use information technology, the death rate among patients is significantly lower, Washington ProFile reports. The number of deaths in fully computerized hospitals is on average 7.2% lower than in conventional ones. This conclusion was made on the basis of a study of statistics for more than 1.2 thousand hospitals. Researchers believe that computerization more often avoids medical errors and makes it easier for doctors to work with information.
71. Hospital diagnosis can be double-checked
(http://www.evrika.ru/show/2051)
A Competence Center in Medicine will appear in Moscow, where patients will be able to send their diagnoses for rechecking.
According to academician Chuchalin, a third of diagnoses in our country are made incorrectly. Pathologists annually record 20–25% of discrepancies between intravital and postmortem verdicts of doctors.
In case of serious illnesses, you should always contact several specialists at once, but do not forget that the luminaries of medicine can also make mistakes, and an ordinary doctor in a clinic, on the contrary, can get to the point.
72. Progress in Personalized Medicine: MetaMed & More
In the United States, about 98,000 people die every year from preventable medical errors. An additional 106,000 die each year from drug side effects. That adds up to about 200,000, making medical error the third leading cause of death in the United States, after heart disease and cancer. In contrast, the fourth leading cause of death in the US, respiratory disease, kills about 130,000 a year. Medical errors have cost many lives - doctors don't have the time to keep up with the latest research, which means there's a lot they don't know.
73. Operating room in 3D format SPb Vedomosti Issue No. 175 of 09/12/2013
A pilot or naval officer who has just graduated from training will not be immediately allowed to fly an aircraft or a ship - at first they will study for a long time and hard to manage complex equipment on special simulators.
Throughout the civilized world, before getting up to the operating table, surgeons will work out all the skills to perform the most complex operations on so-called simulators that accurately repeat the operating field in 3D format for more than a month or two. A surgeon will be allowed to see a patient in a Western clinic, where insurance medicine is well developed, only if he has completed a training course on such simulators and has shown good results.
Statistical analysis of treatment results reveals an increase in the number of medical errors associated with the "human factor". Unreasonable use of drugs and their doses, misuse of medical equipment often lead to serious consequences for the patient's life. Studying "on patients" is simply unacceptable when it comes to high medical technologies.
On training complexes, you can hone your skills at any time, both under the supervision of an instructor, and without him. The simulator displays a high-quality 3D image of surgical instruments, which clearly conveys shadows and depth of field. A trained surgeon can practice suturing, hand coordination with more than three instruments, video camera manipulation, etc.
Simulators in educational programs are the standard in the world of medical education, where learning “on patients” is strictly prohibited. As a result of many studies, significant advantages of such training have been revealed: its safety for both the patient and the doctor, an individual approach and the ability to teach people to make decisions in the most difficult situations. These skills are extremely important for our surgeons to master. Especially for those who dream of working using modern technologies.
74. First honey created a virtual clinic for training doctors
http://top.rbc.ru/health/22/10/2012/675580.shtml
The First Moscow State Medical University named after I.M. Sechenov announced the launch of a pilot project "University Virtual Clinic" as part of the implementation of the Federal State Educational Standards of the third generation.
According to the press service of the First Med, the new educational module was demonstrated at the exhibition of the First National Congress of Doctors of the Russian Federation and was highly appreciated by Prime Minister Dmitry Medvedev. The proposed educational model will be extended to the entire system of simulation training in medical education in Russia.
The new concept of simulation education of universities is implemented on the example of endoscopic surgery, provides for multi-stage and multi-level training and certification of specialists: 3D visualization of operations - testing on virtual simulators, on simulators of "live endoscopy" on native tissues - operations on experimental animals - admission to the operating room to the patient .
75. Vlad Livshits. Robotic Medicine
Victims of medical errors, of which there are more in the world than it seems, most often do not know how to defend their case and achieve adequate punishment for a person in a dressing gown who not only deceived expectations, but also demonstrated dishonesty, self-confidence or ignorance.
Punishment for "medical error" as such is not defined by law, there are several articles of the criminal code on this matter. But it's not easy to hold a doctor accountable for ruining someone's life. At a minimum, independent expertise and persevering patience are required.
Fear of visiting a doctor's office is a completely healthy phenomenon. Worse, if this fear is well founded, when patients know from the media about the terrible mistakes that occur in hospitals around the world - even in developed countries with better devices and high incomes for doctors. After all, many have heard stories about medical instruments forgotten by specialists in the bodies of patients. Every year, such embarrassments, and even misfortunes occur with tens of thousands of inhabitants of the Earth who had the bad luck to end up in a hospital, of any level. There are other medical errors in surgery and not only, leading to disability or death of a patient who fell into the hands of a misguided specialist.
Approximately every third medical error causes complications for the health and well-being of the patient. In addition, in Russia at least two patients die every day due to such mistakes, and some social activists claim that up to 50 thousand a year (in America - up to 250 thousand, if that).
Such cases could be spoken of as comical if they were reparable. Not a single decent hospital wants to spoil its reputation with operations performed “in the wrong place”. Nevertheless, even with strict control and recording, here and there, surgeons make mistakes that should never happen. For example, in one of the clinics in the United States, once in the laboratory, biopsy samples of the prostate gland were mixed up, and, therefore, a sick client with a healthy one. As a result, the patient, who lived without any hint of cancer, surgeons removed a healthy prostate, entirely. This is a complex and responsible procedure. Meanwhile, the real cancer patient was sent home without knowing his true diagnosis.
In another overseas case, a patient died from a pathological process in the lung after an intern inserted a breathing tube into a seriously ill patient in the wrong place.
Errors in choosing a patient, according to a number of studies, account for up to 0.5% of all medical oversights in question.
Among the most nightmarish examples of "substitution" of the patient is the story of 41-year-old Colin Burns, who suffered a head injury in a fall and woke up on the operating table a minute before ... the removal of internal organs started by surgeons. Involuntarily, the fanatics not only confused the sick, but confused a living person under sedatives with a lifeless body. Fortunately, the operation was stopped in time, and the doctors remembered the curious incident for life. It happened in 2009 in the state of New York. Doctors were fined $22,000 for dangerous negligence, but could not explain why this happened. Well, Ms. Burns, after 11 months, nevertheless committed suicide by swallowing pills - despite the three daughters.
Errors in blood transfusion
It is believed that every tenth surgical operation in a hospital is accompanied by a blood transfusion, of which millions are performed annually. The procedure, it would seem, is routine, but it also contains a place for medical oversights, and very dangerous ones.
According to statistics, out of 10 thousand packages of donated blood, at least one will contain the wrong blood, which is indicated on the label. Many tens of thousands of errors occur during transfusion every year, and every 500th patient dies. Blood may be incorrectly signed during collection, samples mixed up in the laboratory, data entered incorrectly into the computer, etc. It also happens that the patient's immune system refuses to accept foreign blood components or.
In 2013, in St. Petersburg, Russia, a one-year-old girl, tasting everything, swallowed 6 magnets from a “developing” toy, so the baby needed an urgent operation, during which the patient’s condition became very serious. Due to anemia, the girl was urgently transfused with an erythrocyte mass of blood from ... an HIV-positive donor, dooming the child to a long and expensive treatment. It turned out that the head of the department had received a message that the blood was contagious, but at first he ignored it. By the time the error was discovered, the child had been injected with 50 ml of a dangerous liquid. A similar high-profile case with viruses in donated blood occurred in 2006 in Kostroma. The reason is carelessness.
Air embolism
Atmospheric air, without which a person cannot live, in hospital conditions becomes the cause of death - if it enters the bloodstream. In this case, venous air embolism develops - a special case of gas embolism. Emboli are gas bubbles that can block the circulatory system. In modern surgery, air embolism is a rare phenomenon, but it occurs more often than we would like. A blood gas embolism causes a pulmonary embolism, when the vessels of the lungs suffer from air "plugs". Pulmonary embolism death is one of the most preventable hospital deaths.
Mortality from air bubbles entering the patient's vein through the catheter reaches 30 percent. Even those who survive are often handicapped for life. The consequences include irreversible brain damage. Especially frightening is the fact that air embolism can occur during routine surgical interventions, making them deadly. For example, during prosthetics. In 1987, a certain dentist, "doing teeth" to clients, managed to let air into the blood of five of them. Three victims, turning blue, died right in the office from a heart attack. The problem turned out to be in the hollow drill of the drill, which supplied the bloodstream of patients with a mixture of water and air. Clients had little time to feel, because they were under anesthesia - general or local.
Incorrect surgeries
It happens that victims of medical errors go to court, bringing would-be doctors to justice. In 25%, the case concerns cases where patients do not perform the operations that they are shown. Even in America, the number of such claims exceeds a hundred a year and, if the problem is successfully resolved, the compensation received by the plaintiff averages 232 thousand dollars (reaching 7 million).
Despite all the procedures designed to eliminate the gross errors of surgeons, incorrect operations happen more often than one might think. For example, one woman had her fallopian tube removed instead of her appendix, and another patient had a heart operation that he did not need at all. One of the most horrific cases occurred in 2011, when a 32-year-old resident of England, who was carrying a fourth child in her womb and fell ill with appendicitis, had her right ovary cut out instead of her appendix. The operation was performed by a young surgeon of Pakistani origin, and his senior colleague and mentor chose to go home (early). The inflamed appendix did not go away, after 3 weeks the woman again went to the hospital with abdominal pain. It was then that the doctors from Romford found out about the mistake of an inexperienced doctor. Four days later, the patient gave birth to a dead premature baby, her appendix was removed, but then death on the operating table from multiple organ failure, which led to blood poisoning, followed.
Wrong medications or wrong dosage
People tend to believe that the medicine that the doctor prescribes is the drug they need in the right dosage. At the same time, millions of people are given the wrong prescriptions every day. Let's say Americans sell over three billion prescriptions every year, of which 51.5 million are misspelled. That is, if a pharmacy processes 250 medical prescriptions per day, then four of them will turn out to be incorrect. This phenomenon is doubly dangerous. First, the patient may receive a harmful remedy that he does not need; secondly, he will not get what is really needed.
Prescription drug missteps happen in pharmacies and clinics alike. Once a nurse accidentally poisoned a pair of twins with morphine, who were born prematurely - at 27 weeks of gestation. The boys were injected with lethal doses of the drug - 650-800 micrograms, while only 50-100 micrograms were supposed to be injected. The trouble happened in 2010.
In another case, a 79-year-old pensioner on dialysis was given pancuronium bromide instead of an antacid. Pancuronium is a paralyzing substance used for complex operations or lethal injections, while Grandpa needed an antacid for heartburn. The nurse mixed up the package. After 30 minutes, the patient became non-contact and died from cardiac arrest.
In 2009, in Kazakhstan, an 85-year-old patient who had suffered a myocardial infarction was injected by a nurse with the cardiac drug Corglicon at a dose ten times higher than prescribed by the doctor. She, they say, imagined that the ampoules indicated a lower dosage. The old woman began to suffer and by the time the ambulance arrived, she was already dead. The health worker, who made a fatal mistake, quit the clinic of her own free will - with a diploma and a “clean” work book.
Hospital infections and dirty medical equipment
Usually people go to the hospital to get rid of diseases, not suspecting that the hospitals themselves are a source of ailments and infections. They lurk in non-sterile instruments and appliances, on the unwashed hands of staff. Thus, the rare Creutzfeldt-Jakob disease, fraught with brain destruction (“mad cow disease”), was transferred to dozens of patients of American neurosurgeons in 2012-2014. The reason is the insufficient sterilization of surgical instruments used in the treatment of a carrier of a dangerous disease.
Statistics show that every 25th hospital patient becomes a victim of a hospital infection. Hundreds of thousands of people die from such diseases every year. Having been in a hospital bed, they are primarily at risk of acquiring pneumonia, followed by inflammation of the urethra, contagious diseases of the digestive system, and primary infections of the circulatory system (from dirty catheters).
