Chapter 9 Clinical Risk and Brief Psychodynamic Therapy

Abstract

This article explores the risk environment confronting practitioners of brief psychodynamic treatment, and describes strategies that can help clinicians practice effective risk management. I argue that clinicians can reap only limited benefits from a focus on profiles of high-risk clients and litigation “hot spots.” The optimal approach is attention to the contextual dynamics shaping clinical practice. Among the most important are the relational processes driving the clinician-client dyad, the clinician-client-third party payer triangle, and the interface between the mental health and legal systems. I close with a discussion of the ambiguity and uncertainty that characterize clinical decision making and risk management.     

论我国药品不良反应救济制度的构建

药品不良反应是正常使用合格药品产生的有害或意外反应.药品不良反应责任不同于产品责任、国家赔偿责任、侵权责任和医疗事故责任.我国应及早建立药品不良反应救济基金制度,对受害者进行补偿.     

医疗风险、责任与对策

医疗风险是医疗实践中客观存在的一种具有不确定性、损害性事件,对患者、医院和医学的发展有着不利的影响。医疗风险的存在有着复杂的原因,因此,对医疗风险管理与防范也应该采取包括提高医疗技术水平、加强风险教育、实行医疗责任保险等多种手段。     

药物不良反应侵权诉讼问题研究

药物不良反应侵权诉讼是一种特殊的民事侵权诉讼。药品的生产者、药品经营者以及医疗机构都可能成为诉讼中的被告。药物不良反应侵权诉讼中的许多案件事实实行举证倒置。主要举证倒置事实有:药品缺陷、因果关系、免责事由、医疗过错等。     

无过错输血感染法律责任的承担

现行法律、法规规定,无过错输血感染的法律责任采取过错责任归责原则,意味着当医患双方均无过错而又造成输血感染的损害后果时,完全由患者承担损害后果,这种规定无法体现公平、公正的法律精神。无过错输血感染法律责任应当规定为公平责任,这样才能更好地既保护医方利益又保护患方利益。     

La responsabilité médicale des accidents de la circoncision en Tunisie : à propos de trois affaires judiciaires

Circumcision is the most frequently performed surgical procedure worldwide, mainly as part of religious rituals. It may lead to serious complications. Although there is no specific law relative to circumcision accidents in Tunisia, the occurrence of complications of this act is likely to engage the penal, civil and disciplinary liability of the doctor. Prevention involves respecting the principles of the Medical Deontology Code, raising awareness about the need to practice circumcision in a medical environment and the promulgation of specific legislation regulating this act. The new Tunisian law on medical liability seems to offer a solution to solve the legal complaints concerning circumcision accidents by providing more opportunities for amicable settlement and at the same time guaranteeing adequate and rapid compensation of the prejudice. In this article, we discuss the medical liability of circumcision accidents through three medicolegal cases carried out at the Department of Legal Medicine of Ibn El Jazzar University Hospital, Kairouan, Tunisia.     

中美医疗损害责任制度改革之比较研究

医疗损害责任已成为现代社会普遍的医疗法律问题。中美两国医疗损害责任制度改革正朝着相反的方向发展。诉讼机制在美国医疗损害责任中的作用由强变弱，医疗诉讼起诉由易变难，医疗损害赔偿由不限制到相对限制，行政管理式的医疗过错责任制度由无到逐渐提议。我国医疗损害责任制度改革恰恰相反，即诉讼制度的作用由弱变强、医疗损害起诉由难到易，医疗损害赔偿由相对限制到不限制、行政管理式的医疗过错责任制度从有到无。我国医疗损害责任制度的改革趋势值得反思。建议借鉴美国医疗损害责任制度改革的经验。     

Le risque médico-judiciaire des infections nosocomiales

These last years in France, the term ‘nosocomial infection’ has been replaced by ‘health-care associated infection’, which has a much broader definition. In all cases, the plausibility of the association between infection and the care provided deserved to be rigorously analyzed. To qualify an infection as nosocomial, the expert witness must at the judge's request determine that infection actually occurred within the health facility and is linked to health care. French Public Health Code as well the most recent jurisprudence give currently a rather close definition of nosocomial infection. The principle of faultness liability in the field of nosocomial infection has been enshrined in the law of March 4^th 2002, the most severe situations (death; permanent functional deficit > 25 percent) being compensated by ONIAM, the French national office of compensation for nosocomial infection.     

论医疗事故的法律责任

随着我国医疗卫生体制的改革、法制建设的发展,特别是新《刑法》的施行、《执业医师法》的颁布,关于医疗事故中医方行政、民事和刑事法律责任的法律规定正逐步健全。为了引起医方的高度重视、提高医疗质量、减少医疗事故的发生、有效地避免触犯法律,故对医疗事故概念的界定、构成、免责情形及三种具体法律责任作了较为系统的阐述。     

The CAMS Approach to Working with Suicidal Patients

The Collaborative Assessment and Management of Suicidality (CAMS) is a novel clinical protocol designed to quickly identify and effectively engage suicidal outpatients in their own clinical care. The CAMS approach emphasizes a thorough and collaborative assessment of the patient's suicidality that then leads to problem-solving treatment planning that is coauthored by the clinician and the patient. This approach is specifically designed to launch a strong therapeutic alliance creating an effective treatment trajectory. The CAMS approach is designed to modify and change clinician behaviors in terms of how they initially identify, engage, conceptualize, assess, treatment plan, and manage suicidal outpatients. Critically, however, CAMS does not usurp clinical judgment or dictate treatment modality. Preliminary research has shown that CAMS leads to faster resolution of suicidality and may decrease nonmental health medical utilization. Given the challenges of clinical work with suicidality, increased concerns about malpractice liability, and the decreased use of inpatient hospitalization, CAMS provides a potentially important new approach to working with suicidal individuals on an outpatient basis.