误诊误治病例所致医疗纠纷分析——附3例报告

当前医疗科技发展的相对性、疾病规律本身的复杂多变性、医生医疗知识的局限性等,导致了临床误诊误治的不可避免性,而医院发生的医疗纠纷事件中,大多是由于误诊误治所致。通过对3例误诊病例及所致医疗纠纷的分析,指出临床误诊误治的客观性、主观性及不可避免性。同时提示临床医师在疾病诊治过程中,随时更新医疗知识,注意疾病的鉴别诊断,及时完善相关的辅助检查,积极治疗,减少对疾病的延误诊治,减轻病人痛苦,改善医患关系,从而减少医疗纠纷。     

Losing a training analyst for ethical violations: A candidate's perspective

The author presents her experience as the analysand of a training analyst who was investigated and expelled for ethical violations with another patient, including sexual-boundary violations, during her analytic training. While boundary violations by training analysts are not uncommon, the particular trauma experienced by 'bystanders' such as candidates and supervisees is not discussed in the literature, nor the response of institutes to the educational problems that are generated. The author illustrates the complications for candidates that arise from the dual roles of training analyst as educator and analyst when he or she faces investigation or censure, including isolation and secrecy, which promote various splits in the candidate, analytic dyad and group, as well as loyalty conflicts. The discussion covers three phases of the author's experience as a candidate-analysand, namely the period encompassing the institute's ethics investigation, the announcement of findings to her and to the institute as a group, and the ensuing individual and group dynamics generated by her analyst's expulsion from the institute and revocation of his medical license. Theoretical perspectives are utilized to understand the group regression, including contamination and contagion fears, which occurred in the wake of the training analyst's expulsion, and the impact of these processes on the candidate, including the pressure to function as a 'container' for projections of the group. Implications and recommendations for candidates and institutes are made for dealing helpfully with trainees who are affected by the process of dealing with a training analyst's ethical violations. Short-term and longer-term outcomes of the experience are considered.     

"仁"——医德的元德

医德是医学道德的简称,具言之,它是指医务人员在医疗卫生服务的职业活动中应该具备的仁爱、救死扶伤等的品德,是道德德目在医务人员身上的内化,也是对医务人员必须具备的最起码的要求.我们评价一个医生,首先是直面他的医德,医德是医生形象的体现,没有医德的医生即使技艺再高超,也算不上一个完整意义上的医生,"无德不成医".事实上一个医德低下的医生,他的技艺也不会高超的.     

医者不可不慈仁，病者不可猜鄙——构建和谐的医患关系

医患和谐是医学的本质要求。目前医患关系紧张是在市场经济和高科技背景下,价值选择和制度安排失当造成的。要充分利用传统文化的资源,同时适应时代要求,在价值选择和制度安排上促进医患和谐。     

患者医疗高付费的社会文化背景断想

“看病贵”的原因之一即病患者主观方面的医疗高付费的表现形式及文化背景包括在趋祈“神灵”的求医心理支配下崇尚名医名院;受“药须贵,医须贿”观念的影响,在医疗活动中以高付费求取感情踏实;富有阶层追求高于一般社会水平的生活享受和精神享受;至爱亲朋在病人重病期间或弥留之际以高额费用寄托伦理亲情。     

老年下背痛诊断的思考

医患关系是医务人员与患者在医疗过程中产生的特定医治关系,是医疗中人际关系的核心。近年来,我国的医患矛盾有激化趋势。以心理动力学方法来描述普通医患关系中医、患双方的心理互动过程,并对维系正常医患关系所需的医、患双方的心理学特征作出设想。     

未成年患者的同意能力研究

众所周知,医疗机构必须在取得成年患者的有效同意后才能实施医疗行为。而当患者是未成年人时,这种对医疗行为的同意是否有效呢?对此,国内外法学均未形成统一的定论。通过比较国外医事法学领域相对成熟的同意能力理论,初步建立我国未成年患者的同意能力理论体系,其中评估方法是关键。     

个体真实性的心理学研究述评

真实性指个体“做真实的自己”的程度。真实性是一个与自我密切相关的概念,是影响个体心理健康的重要因素。本文介绍了真实性的概念、结构、测量方法及研究焦点,指出今后应对真实性的心理结构、后果变量及其对心理健康的影响机制等方面做进一步的探讨。     

命与天命:儒家天人关系的双重视角

As a pair of important categories in traditional Chinese culture, “ming 命 (destiny or decrees)” and “tian ming 天命 (heavenly ordinances)” mainly refer to the constraints placed on human beings. Both originated from “ling 令 (decrees),” which evolved from “wang ling 王令 (royal decrees)” into “tian ling 天令 (heavenly decrees),” and then became “ming” from a throne because of the decisive role of “heavenly decrees” over a throne. “Ming” and “tian ming” have different definitions: “Ming” represented the limits Heaven placed on the natural lives of human beings and was an objective force that men could not direct, but was embodied in human beings as their “destiny”; “Tian ming” reflected the moral ideals of human beings in their self-identification; It originated in man but had to be verified by Heaven, and it was therefore the true ordinance that Heaven placed on human beings. “Ming” and “tian ming” are two perspectives on the traditional relationship between Heaven and human beings, and at the same time Confucians and Daoists placed different emphasis on them. Translated by Huang Deyuan from Zhongguo zhexueshi 中国哲学史 (History of Chinese Philosophy), 2007, (4): 11–21