Recently, Huzhou Central Hospital launched a system in the city - the medical notary system, by the central and provincial media and provincial health departments and other departments concerned. What kind of system is the medical notary system? Is the hospital shirk responsibility or ease the conflict between doctors and patients?
Treatment plan before the determination of the first notary
On September 23, the family of Zhang Shu (a pseudonym) took a few pieces of paper from the staff of the South Taihu Notary Public Office. The above records are the contents of the surgery and risks that Zhang Shu will accept and the corresponding statement.
After listening to a detailed description of Zhang Shu’s possible risks in the hospital in the city center, the Zhang family signed their own names and printed them by hand.
Zhang Shu, 49, has been treated for five months because of injuries, fractures and dislocations of the cervical spine, and skull injuries. However, she is still unclear.
Surgery is the best treatment. However, Zhang Shu’s “anterior cervical decompression and internal fixation†and “cervical posterior decompression internal fixation†are not simple operations. In front of his eyes, Zhang Shu is unconscious and weak. He is confined to hospital conditions. If he is operated on, he may cause cardiovascular and cerebrovascular accidents, heart and lung function, kidney failure, and even death.
The doctor-in-charge suggested that Zhang Shu should be transferred to a provincial hospital with better medical conditions. Perhaps the operation will be even greater. However, due to various considerations, the Zhang family did not accept this proposal.
On the one hand, critically ill patients need surgical treatment. It is inevitable that there will be various risks on the one hand when the surgery is performed. Both the doctor and the patient are hesitant, but the patient can't afford to wait. What should I do?
In order to avoid disputes in the future, before determining the next treatment plan, the hospital proposed to invite third parties to notarize the entire informed notification process and clarify the rights and obligations of both parties.
On the morning of September 23, under the auspices of the staff of the Southern Taihu Notary Office, Zhang Shu’s management doctors, anesthesiologists, and medical management officials explained to the Zhang family the necessity of surgery, the current risks, and possible Adverse consequences, targeted measures that the hospital will take, etc.
Finally, the hospital also said that Shanghai experts will be invited to perform surgery for Zhang Shu and do his best to treat him before and after surgery. An hour later, the Zhang family signed the statement after fully understanding the operation and possible consequences.
On the same day that the Zhang family signed the declaration, Shen's mother, who lives in Daochang Township, Wuxing District, signed the name on the public certificate.
Shen Mama’s daughter, Shen Li (a pseudonym), is 13 years old and suffers from congenital atrial septal defect, moderate mitral and tricuspid valve regurgitation, and mild pulmonary hypertension. Shen Li, who suffers from heart disease, is in urgent need of surgery. But like Zhang Shu, her surgery is very risky.
After consultation with Shen Mama, the doctor decided to request an expert from Zheyi Hospital to come to Shenyang to perform the operation for Shen Li. Detailed details of the operation and the risks involved were explained to Shen Mama. Finally, under the auspices of the notary, Shen Mama signed a statement. book. “We promise that if there is a dispute after the operation, we will take a legal approach and we will absolutely not take any illegal or improper means to disrupt the hospital's normal order.†This is the last few sentences signed by Zhang Family and Shen Mama.
The origin of the notarization system
This system of notarial medical behavior is not a new phenomenon in our city, but a special case that originated in 2007.
In August 2007, Mr. Xu, who lives in Hucheng, performed a kidney transplant operation in the provincial hospital. When he returned to the Central Hospital, he was diagnosed with colon cancer and must be operated as soon as possible.
However, Mr. Xu’s detailed medical report showed that at the time his platelet count was only 15,000 per milliliter, which was far below the normal level of 100,000 to 300,000 per milliliter. Platelets play a major role in coagulation and hemostasis. The number of platelets is too small and is the most common surgical contraindication. Because the patient is very likely to die from bleeding because of surgery.
Mr. Xu’s family requested surgery. The doctor also believed that surgery should be performed. However, what happens if the patient has an accident?
Gu Zhangsheng, deputy director of the Central Hospital, consulted relevant data and found that there are already a few hospitals in China who have adopted the method of surgery after notarization. As a result, the hospital organized related experts to discuss and formulated prudent treatment measures, and decided to conduct medical notarization before the operation—a third-party notarization of the entire disease notification process, and in case of medical dispute, there could be a Legally effective notarial certificate.
The hospital consulted with the patient's family and received approval from the family. They invited a notary. After more than one hour of conversation, Mr. Xu and the hospital signed a notary certificate.
On the notarial certificate, in addition to enumerating various surgical risks and preventive measures that the hospital will take, there is a statement signed by Mr. Xu’s family. The contents of the declaration are the same as those of Zhang Shu’s family and Shen’s mother.
Afterwards, the operation proceeded quickly and smoothly, without any disputes. "The introduction of a notarial system for medical behavior in hospitals is an attempt to address the tension between doctors and patients," said Gu Zhangsheng. In recent years, doctor-patient disputes have gradually increased. In the face of high-risk surgical cases, one side is a critically ill patient who needs surgical treatment, and one side is a medical dispute that causes the medical staff's chilling operation to fail. How to do?
In 2007, Gu Zhangsheng, the head of the medical department of the Central Hospital at the time, thought of various methods: “In accordance with the hospital’s regulations, doctors must communicate with the patient’s family before each surgery or treatment program is implemented to inform the patient of possible risks. Only after getting approval and signing an informed notice can the treatment plan be implemented, but in fact, in the event of a dispute, some family members do not acknowledge the contents of the notice, and then claim compensation from the hospital and even quit their anger. We can prove that there are many examples of this, in order to prevent problems before, we have also thought about using recordings and other methods, but for a variety of reasons can not be implemented." "This is not a smooth idea." Gu Zhang said. This kind of notarization system, which has effectively reduced medical disputes caused by disagreements between the doctors and the patients on the notification process and speech expression, has been increasingly recognized in recent years.
In the next four years, the number of notary public hospitals and key patients increased year by year. In 2007, there were 2 cases; in 2008, 15 cases; in 2009, 34 cases; in 2010, 64 cases; in 2011, there were 72 cases.
Is it "life and death" or a gentleman's agreement?
As soon as the notarial system of medical behavior was introduced, the controversy arose: Does the hospital shirk responsibility? Is the sign of "life and death" signed between the hospital and the patient? With the notice, why should it be done? “This dispute is indeed a lot, but the purpose of our notary system is to allow medical personnel to objectively and comprehensively inform family members when a third party is involved. After a notary, a medical accident occurs and the hospital is not completely irresponsible. "Gu Zhangsheng said:" We are only guiding families to resolve disputes in the event of disputes and reduce the incidence of vicious events."
According to reports, in the process of notarization, the participants included staff of notary agencies, doctors in charge of management, staff of hospital medical management departments, patients, or family members of patients. Patients undergoing surgical treatment still required the participation of anesthesiologists. Every notarization must be notified by the notary public, the doctors, anesthesiologists, etc., in the course of the implementation of the medical activities. The family members are informed of the risks, the two parties sign the corresponding informed notice, and the family members sign the promise. The time is usually one to two hours.
After the family members have a detailed understanding of the situation, the notary will ask five questions: About the risks in treatment Has the doctor told you? Do you understand and understand the words of the hospital? Is the decision taken after careful consideration of this treatment, and willingness to undertake possible accidental medical risks? Whether the contents of the statement are true or not, whether you signed it voluntarily? Are the relatives' opinions on this treatment consistent?
Of course, hospitals do not adopt a notarized form for all patients, and hospitals also strictly control the objects of medical notarization. They are roughly divided into six categories: Patients may be extremely risky because of their age, underlying diseases, or complicated conditions. The effect is poor; limited to the actual conditions of the hospital in the city center, it is recommended to transfer to a superior hospital and the patient insists on surgical treatment in the downtown hospital; because of complications in the early stages, a medical dispute has been formed but requires surgical treatment; there have been disputes with the hospital in the city center. Patients or their families, this hospitalization requires surgery; the internal (pediatric) conservative treatment is poor or the condition may be worse; the doctor's proposed treatment program does not match.
“These patients are faced with extremely high surgical risk without exception. Doctors will definitely try to avoid these risks with risky treatment options, but in case of mishap, we also hope that patients and patient families can pass the law. Measures to protect their own rights and interests.†The person in charge of the medical department of the Central Hospital said, “If it is an emergency patient, it will not be taken this way. For the hospital, it is the duty of the medical staff to rescue the wounded.â€
Some doctors stated that “preoperative notarization has legal basis in terms of behavior, facts, and documents. A reasonable and reasonable approach allows doctors to be more accountable after obtaining the consent of patients and their families. It also allows doctors to maximize their skills and potential. Play and actively treat patients."
Experts said: "Preoperative notarization is equal to advancing the post-mortem medical appraisal. It is an effective means to reduce medical disputes. It is also a kind of gentleman's agreement. ."
Unquestionable fairness and fairness agreement
Experts believe that notarization of medical behavior allows patients to be fully informed and fully prepared for all possible accidents. Once an accident occurs, the understanding of the patient and his/her family can be obtained. This can eliminate the worries of the medical staff and cause both parties to share the responsibility and risk. Once the original expected and notarized accident occurs, the doctor and the patient will have contradictions and have legal effect. The third party stands on an impartial basis to make a ruling and it is easy to coordinate differences.
Can the medical authorities dispense with all liability for medical accidents? In actual fact, notarization does not exempt medical staff and does not eliminate specific disputes between doctors and patients. Notarization only helps the patient to face the possible medical risks more rationally, and choose the treatment plan carefully.
“As a notary officer, a neutral third party is used to prove that the hospital has fulfilled the informed notification behavior. The patient also heard the doctor’s notification.†The person in charge of the Nantaihu Notary Public Office said that from the contents of the notary certificate, if the hospital There is fault, the patient is not satisfied, and the patient can still pursue his related responsibilities through legal means. “And as long as both parties are voluntary, the content does not violate national laws and the notarization is legal and has corresponding legal effects. Even if it is notarized, the hospital cannot shirk the legal responsibilities that the hospital should bear.â€
“We are just looking for a way to reasonably prevent medical disputes.†Gu Zhang said that before each notary is implemented, the hospital will find the family first to explain the situation. If the patient and family do not agree, the doctor will also find another solution.
“This requirement is not excessive, and the hospital should take responsibility for it. They did not shirk.†After the clear and understanding of the notarial system of medical behavior, Zhang Shu family and Shen mother agreed that if there is a dispute, the public certificate is clearly written. We can still take legal steps to solve the problem and the hospital cannot shirk its responsibility.
After the implementation of the notarial system of medical behavior, the incidence of medical disputes in central hospitals has been declining year by year. In the past three years, the number of medical disputes in downtown hospitals has shown a downward trend compared with the number of hospitalized patients and the number of IV operation tables. Of the nearly 200 notary patients in the Central Hospital, there was no case of litigation.
“Next, we still need to further enhance the professional ethics of medical personnel, improve the quality of medical services, and adopt various measures to gradually establish a three-level medical dispute prevention system.†Gu Zhangsheng said that after all, as a hospital, improve the quality and quality of medical services. Is the key to survival, and the notarial system of medical behavior is only a means to prevent medical disputes.
Related Links
The notarization system is a preventive legal system. The notary publicly certifies the authenticity and legitimacy of civil legal acts and legally appropriate documents in accordance with legal procedures according to the application of natural persons, legal persons or other organizations. There are some medical behaviors that may make doctors difficult and difficult. The patients are in critical condition but the treatment risks are extremely high. In the past century, the medical notarization was quietly launched in the country. At the same time, many medical units were imitated and explored.
Medical notary system in our country
In March 1999, Wuhan No. 2 Hospital of Wuhan Iron and Steel Co., Ltd. had the first case of medical notarization. This is also the first case of public-surgical notarization conducted by the public newspaper in China.
In 2000, a patient with congenital severe eye disease in Xishan, Jiangsu Province signed a medical agreement with the hospital and submitted it to a Notary Public Notary.
In April 2001, Henan Province also implemented its first pre-operative notarization. The Henan Provincial Armed Police Corps Hospital and the 78-year-old patient, Dong Laotai, and their family members signed a preoperative agreement and conducted notarization to share risks.
Since then, Beijing, Shanghai, Shandong, Anhui and other provinces and cities have gradually appeared before surgery.
In our city, from August 2007, the city’s hospitals debuted the medical notarization system. Four years later, the system’s operation has been gradually improved. It has received extensive attention in recent days when central and provincial media interviewed the city’s health work. The person in charge of the Health Department highly affirmed.
Treatment plan before the determination of the first notary
On September 23, the family of Zhang Shu (a pseudonym) took a few pieces of paper from the staff of the South Taihu Notary Public Office. The above records are the contents of the surgery and risks that Zhang Shu will accept and the corresponding statement.
After listening to a detailed description of Zhang Shu’s possible risks in the hospital in the city center, the Zhang family signed their own names and printed them by hand.
Zhang Shu, 49, has been treated for five months because of injuries, fractures and dislocations of the cervical spine, and skull injuries. However, she is still unclear.
Surgery is the best treatment. However, Zhang Shu’s “anterior cervical decompression and internal fixation†and “cervical posterior decompression internal fixation†are not simple operations. In front of his eyes, Zhang Shu is unconscious and weak. He is confined to hospital conditions. If he is operated on, he may cause cardiovascular and cerebrovascular accidents, heart and lung function, kidney failure, and even death.
The doctor-in-charge suggested that Zhang Shu should be transferred to a provincial hospital with better medical conditions. Perhaps the operation will be even greater. However, due to various considerations, the Zhang family did not accept this proposal.
On the one hand, critically ill patients need surgical treatment. It is inevitable that there will be various risks on the one hand when the surgery is performed. Both the doctor and the patient are hesitant, but the patient can't afford to wait. What should I do?
In order to avoid disputes in the future, before determining the next treatment plan, the hospital proposed to invite third parties to notarize the entire informed notification process and clarify the rights and obligations of both parties.
On the morning of September 23, under the auspices of the staff of the Southern Taihu Notary Office, Zhang Shu’s management doctors, anesthesiologists, and medical management officials explained to the Zhang family the necessity of surgery, the current risks, and possible Adverse consequences, targeted measures that the hospital will take, etc.
Finally, the hospital also said that Shanghai experts will be invited to perform surgery for Zhang Shu and do his best to treat him before and after surgery. An hour later, the Zhang family signed the statement after fully understanding the operation and possible consequences.
On the same day that the Zhang family signed the declaration, Shen's mother, who lives in Daochang Township, Wuxing District, signed the name on the public certificate.
Shen Mama’s daughter, Shen Li (a pseudonym), is 13 years old and suffers from congenital atrial septal defect, moderate mitral and tricuspid valve regurgitation, and mild pulmonary hypertension. Shen Li, who suffers from heart disease, is in urgent need of surgery. But like Zhang Shu, her surgery is very risky.
After consultation with Shen Mama, the doctor decided to request an expert from Zheyi Hospital to come to Shenyang to perform the operation for Shen Li. Detailed details of the operation and the risks involved were explained to Shen Mama. Finally, under the auspices of the notary, Shen Mama signed a statement. book. “We promise that if there is a dispute after the operation, we will take a legal approach and we will absolutely not take any illegal or improper means to disrupt the hospital's normal order.†This is the last few sentences signed by Zhang Family and Shen Mama.
The origin of the notarization system
This system of notarial medical behavior is not a new phenomenon in our city, but a special case that originated in 2007.
In August 2007, Mr. Xu, who lives in Hucheng, performed a kidney transplant operation in the provincial hospital. When he returned to the Central Hospital, he was diagnosed with colon cancer and must be operated as soon as possible.
However, Mr. Xu’s detailed medical report showed that at the time his platelet count was only 15,000 per milliliter, which was far below the normal level of 100,000 to 300,000 per milliliter. Platelets play a major role in coagulation and hemostasis. The number of platelets is too small and is the most common surgical contraindication. Because the patient is very likely to die from bleeding because of surgery.
Mr. Xu’s family requested surgery. The doctor also believed that surgery should be performed. However, what happens if the patient has an accident?
Gu Zhangsheng, deputy director of the Central Hospital, consulted relevant data and found that there are already a few hospitals in China who have adopted the method of surgery after notarization. As a result, the hospital organized related experts to discuss and formulated prudent treatment measures, and decided to conduct medical notarization before the operation—a third-party notarization of the entire disease notification process, and in case of medical dispute, there could be a Legally effective notarial certificate.
The hospital consulted with the patient's family and received approval from the family. They invited a notary. After more than one hour of conversation, Mr. Xu and the hospital signed a notary certificate.
On the notarial certificate, in addition to enumerating various surgical risks and preventive measures that the hospital will take, there is a statement signed by Mr. Xu’s family. The contents of the declaration are the same as those of Zhang Shu’s family and Shen’s mother.
Afterwards, the operation proceeded quickly and smoothly, without any disputes. "The introduction of a notarial system for medical behavior in hospitals is an attempt to address the tension between doctors and patients," said Gu Zhangsheng. In recent years, doctor-patient disputes have gradually increased. In the face of high-risk surgical cases, one side is a critically ill patient who needs surgical treatment, and one side is a medical dispute that causes the medical staff's chilling operation to fail. How to do?
In 2007, Gu Zhangsheng, the head of the medical department of the Central Hospital at the time, thought of various methods: “In accordance with the hospital’s regulations, doctors must communicate with the patient’s family before each surgery or treatment program is implemented to inform the patient of possible risks. Only after getting approval and signing an informed notice can the treatment plan be implemented, but in fact, in the event of a dispute, some family members do not acknowledge the contents of the notice, and then claim compensation from the hospital and even quit their anger. We can prove that there are many examples of this, in order to prevent problems before, we have also thought about using recordings and other methods, but for a variety of reasons can not be implemented." "This is not a smooth idea." Gu Zhang said. This kind of notarization system, which has effectively reduced medical disputes caused by disagreements between the doctors and the patients on the notification process and speech expression, has been increasingly recognized in recent years.
In the next four years, the number of notary public hospitals and key patients increased year by year. In 2007, there were 2 cases; in 2008, 15 cases; in 2009, 34 cases; in 2010, 64 cases; in 2011, there were 72 cases.
Is it "life and death" or a gentleman's agreement?
As soon as the notarial system of medical behavior was introduced, the controversy arose: Does the hospital shirk responsibility? Is the sign of "life and death" signed between the hospital and the patient? With the notice, why should it be done? “This dispute is indeed a lot, but the purpose of our notary system is to allow medical personnel to objectively and comprehensively inform family members when a third party is involved. After a notary, a medical accident occurs and the hospital is not completely irresponsible. "Gu Zhangsheng said:" We are only guiding families to resolve disputes in the event of disputes and reduce the incidence of vicious events."
According to reports, in the process of notarization, the participants included staff of notary agencies, doctors in charge of management, staff of hospital medical management departments, patients, or family members of patients. Patients undergoing surgical treatment still required the participation of anesthesiologists. Every notarization must be notified by the notary public, the doctors, anesthesiologists, etc., in the course of the implementation of the medical activities. The family members are informed of the risks, the two parties sign the corresponding informed notice, and the family members sign the promise. The time is usually one to two hours.
After the family members have a detailed understanding of the situation, the notary will ask five questions: About the risks in treatment Has the doctor told you? Do you understand and understand the words of the hospital? Is the decision taken after careful consideration of this treatment, and willingness to undertake possible accidental medical risks? Whether the contents of the statement are true or not, whether you signed it voluntarily? Are the relatives' opinions on this treatment consistent?
Of course, hospitals do not adopt a notarized form for all patients, and hospitals also strictly control the objects of medical notarization. They are roughly divided into six categories: Patients may be extremely risky because of their age, underlying diseases, or complicated conditions. The effect is poor; limited to the actual conditions of the hospital in the city center, it is recommended to transfer to a superior hospital and the patient insists on surgical treatment in the downtown hospital; because of complications in the early stages, a medical dispute has been formed but requires surgical treatment; there have been disputes with the hospital in the city center. Patients or their families, this hospitalization requires surgery; the internal (pediatric) conservative treatment is poor or the condition may be worse; the doctor's proposed treatment program does not match.
“These patients are faced with extremely high surgical risk without exception. Doctors will definitely try to avoid these risks with risky treatment options, but in case of mishap, we also hope that patients and patient families can pass the law. Measures to protect their own rights and interests.†The person in charge of the medical department of the Central Hospital said, “If it is an emergency patient, it will not be taken this way. For the hospital, it is the duty of the medical staff to rescue the wounded.â€
Some doctors stated that “preoperative notarization has legal basis in terms of behavior, facts, and documents. A reasonable and reasonable approach allows doctors to be more accountable after obtaining the consent of patients and their families. It also allows doctors to maximize their skills and potential. Play and actively treat patients."
Experts said: "Preoperative notarization is equal to advancing the post-mortem medical appraisal. It is an effective means to reduce medical disputes. It is also a kind of gentleman's agreement. ."
Unquestionable fairness and fairness agreement
Experts believe that notarization of medical behavior allows patients to be fully informed and fully prepared for all possible accidents. Once an accident occurs, the understanding of the patient and his/her family can be obtained. This can eliminate the worries of the medical staff and cause both parties to share the responsibility and risk. Once the original expected and notarized accident occurs, the doctor and the patient will have contradictions and have legal effect. The third party stands on an impartial basis to make a ruling and it is easy to coordinate differences.
Can the medical authorities dispense with all liability for medical accidents? In actual fact, notarization does not exempt medical staff and does not eliminate specific disputes between doctors and patients. Notarization only helps the patient to face the possible medical risks more rationally, and choose the treatment plan carefully.
“As a notary officer, a neutral third party is used to prove that the hospital has fulfilled the informed notification behavior. The patient also heard the doctor’s notification.†The person in charge of the Nantaihu Notary Public Office said that from the contents of the notary certificate, if the hospital There is fault, the patient is not satisfied, and the patient can still pursue his related responsibilities through legal means. “And as long as both parties are voluntary, the content does not violate national laws and the notarization is legal and has corresponding legal effects. Even if it is notarized, the hospital cannot shirk the legal responsibilities that the hospital should bear.â€
“We are just looking for a way to reasonably prevent medical disputes.†Gu Zhang said that before each notary is implemented, the hospital will find the family first to explain the situation. If the patient and family do not agree, the doctor will also find another solution.
“This requirement is not excessive, and the hospital should take responsibility for it. They did not shirk.†After the clear and understanding of the notarial system of medical behavior, Zhang Shu family and Shen mother agreed that if there is a dispute, the public certificate is clearly written. We can still take legal steps to solve the problem and the hospital cannot shirk its responsibility.
After the implementation of the notarial system of medical behavior, the incidence of medical disputes in central hospitals has been declining year by year. In the past three years, the number of medical disputes in downtown hospitals has shown a downward trend compared with the number of hospitalized patients and the number of IV operation tables. Of the nearly 200 notary patients in the Central Hospital, there was no case of litigation.
“Next, we still need to further enhance the professional ethics of medical personnel, improve the quality of medical services, and adopt various measures to gradually establish a three-level medical dispute prevention system.†Gu Zhangsheng said that after all, as a hospital, improve the quality and quality of medical services. Is the key to survival, and the notarial system of medical behavior is only a means to prevent medical disputes.
Related Links
The notarization system is a preventive legal system. The notary publicly certifies the authenticity and legitimacy of civil legal acts and legally appropriate documents in accordance with legal procedures according to the application of natural persons, legal persons or other organizations. There are some medical behaviors that may make doctors difficult and difficult. The patients are in critical condition but the treatment risks are extremely high. In the past century, the medical notarization was quietly launched in the country. At the same time, many medical units were imitated and explored.
Medical notary system in our country
In March 1999, Wuhan No. 2 Hospital of Wuhan Iron and Steel Co., Ltd. had the first case of medical notarization. This is also the first case of public-surgical notarization conducted by the public newspaper in China.
In 2000, a patient with congenital severe eye disease in Xishan, Jiangsu Province signed a medical agreement with the hospital and submitted it to a Notary Public Notary.
In April 2001, Henan Province also implemented its first pre-operative notarization. The Henan Provincial Armed Police Corps Hospital and the 78-year-old patient, Dong Laotai, and their family members signed a preoperative agreement and conducted notarization to share risks.
Since then, Beijing, Shanghai, Shandong, Anhui and other provinces and cities have gradually appeared before surgery.
In our city, from August 2007, the city’s hospitals debuted the medical notarization system. Four years later, the system’s operation has been gradually improved. It has received extensive attention in recent days when central and provincial media interviewed the city’s health work. The person in charge of the Health Department highly affirmed.
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