Analysis of Forensic Autopsy in 120 Cases of Medical Disputes Among Different Levels of Institutional Settings

Yu, Man; Ye, M M Guang-Hua; Li, B M Xing-Biao; Feng, Meiling; Han, Jun-Ge; Lin, Ming-Fang; Deng, Binbin; Li, J.D. Feng

doi:10.1111/1556-4029.12769

Cited by 4 publications

(3 citation statements)

References 13 publications

(14 reference statements)

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“…Emerging studies have focused on the intensified doctor-patient relationship in China [12]. Several previous studies have also shown the clinic-pathological discrepancy in separate regions in China [3, 13]. All these studies has technically failed to analyze the time trends of medical disputes and diagnostic discrepancy underlying disputed cases over a lengthy period.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic errors in fatal medical malpractice cases in Shanghai, China: 1990–2015

Gao

Zhao

et al. 2019

Diagn Pathol

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BackgroundMedical disputes remain unabated in China. Previous studies have shown the changes of diagnostic discrepancy over time in developed countries, but diagnostic discrepancy remains understudied in China, especially in the setting of medical disputes. We sought to describe the year-based changes of diagnostic discrepancies in medical disputes, and to identify factors associated with classes of diagnostic discrepancy.MethodsWe conducted a retrospective cohort study of all medically disputed cases from 1990 through 2015 in Shanghai, China, with use of necropsy as the gold standard for diagnosis. Cases were grouped based on national legislative eras. Diagnostic discrepancy was classified as major errors (class I and II), minor errors (class III and IV), no discrepancy (class V) and undetermined (class VI) based on discrepancy severity.ResultsThere were 482 medical disputes. Cases were predominantly males (male: female = 1.6:1) and concentrated in patients less than 10 years old or between 50 and 70 years. Major and minor discrepancy accounted for 51.7 and 34.8%, respectively. Fifty-five cases (11.2%) were non-discrepant (Class V). The dispute rate remained high before the first round of legislation (mean 0.31 per 1 million patients) but declined dramatically afterwards (R2 = − 0.82, p < 0.001 for time trends). Over the national legislative eras, the annual number of cases with diagnostic errors declined steadily. Incidence rates of discrepancy decreased significantly for class I (R2 = − 0.73, p = 0.024), II (R2 = − 0.48, p = 0.013), III (R2 = − 0.69, p < 0.0001), IV (R2 = − 0.69, p < 0.0001) and V discrepancy (R2 = − 0.58, p = 0.0018). Diseases from the respiratory system had significantly lower risks of any diagnostic errors (OR = 0.48, 95% 0.24–0.95, p = 0.036). A neoplasm carrier increased by 92% the risk of any diagnostic error (OR = 1.92; 95%CI 1.18–3.14; p = 0.009) and hypertension reduced by 78% the risk of minor errors (OR = 0.22, 95%CI 0.06–0.91, p = 0.036). Severity of discrepancy relieved over years and associated with ageing in patients with cardiovascular diseases (p = 0.01).ConclusionsThe rate of fatal medical disputes and diagnostic discrepancy declined after stepwise legislations in China. Respiratory diseases, neoplasm carrier and hypertension could be independent predictors for assessing diagnostic errors.

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Section: Discussionmentioning

confidence: 99%

Diagnostic errors in fatal medical malpractice cases in Shanghai, China: 1990–2015

Gao

Zhao

et al. 2019

Diagn Pathol

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“…The settlement of medical disputes is generally handled through consultation between doctors and patients. If the consultation fails, the parties may apply for mediation to the health administration department or directly file a civil lawsuit to the people’s court [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

The influence factors of medical disputes in Shanghai and implications - from the perspective of doctor, patient and disease

Liu

Wang

Bai³

2022

BMC Health Serv Res

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Objective This study aimed to explore the causes and factors behind medical disputes that occurred across eight hospitals in Shanghai over a three-year period (January 2018 to December 2020), thus providing targeted suggestions for amelioration. Methods Stratified sampling was employed to collect 561 cases in which medical disputes occurred at two tertiary hospitals, two secondary hospitals, and four primary hospitals in Shanghai. The causes were analyzed using descriptive statistics, while the factors affecting the dispute level (i.e., 1 through 4, with 1 being most severe) were analyzed via one-way ANOVA and logistic regression analyses. Results Doctors and patients variously contributed to the medical disputes; 86.1% were related to doctors, while 13.9% were related to patients. For doctors, there are seventeen factors that influenced medical disputes. In particular, the insufficient communication (28.82%) is the most prominent factor in the doctors’ factors. For patients, there are seven factors that influenced medical disputes. In particular, the misunderstanding of medical behavior (43.48%) is the most prominent factor in the patients’ factors. Of all investigated medical disputes, 406 were level 4 (78%), 95 were level 3 (18%), and 19 were level 2 (4%); there were no level 1 disputes. The reasons for different level placements included the disease classification, treatment effect, diagnosis and treatment regulation violations by doctors, and low technical levels. Conclusions In addition to strengthening training about clinical and communication skills, the hospitals should establish quality control mechanisms for case records and construct rapid, standardized referral mechanisms. The doctors should attach great importance to the quality and urgency of treatment given to critically ill patients, who must be informed about their prognoses in a timely manner to avoid medical disputes and physical deterioration. The patients should actively cooperate with their doctors in the treatment process, moderate any unrealistic expectations that patients may have about the outcomes. During the COVID-19 pandemic particularly, doctors and patients should strengthen empathy and mutual trust more, then defeat disease together.

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“…It is regarded as the interaction between a care provider and a care user. [1] Medical disputes generally refer to dissent between patients' families and medical care providers on medical results and reasons causing such results [2] . The doctor-patient relationship is generally harmonious in developed countries such as Britain and the United States as these countries own relatively comprehensive legal system and medical insurance system.…”

Section: Introductionmentioning

confidence: 99%

The Influence Factors of Medical Disputes in Shanghai and Implications - From the Perspective of Doctor, Patient and Disease (Observational Study)

Liu

Zhao³

et al. 2021

Preprint

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Objective Based on the cases collected in eight hospitals in Shanghai in recent three years, causes of medical disputes in Shanghai and influence factors of medical dispute levels were discussed, and targeted suggestions were put forward. Methods Multistage sampling were used to collect 561 cases of medical disputes occurred in two Class A Tertiary hospitals, two Class A Secondary hospitals and four community hospitals in Shanghai in recent three years. On the basis of questionnaire, the causes of medical disputes were analyzed by descriptive statistics and the factors affecting the level of medical dispute were analyzed by means of one-way ANOVA and Logistic regression analysis.Results Factors of doctor and patient are involved in the causes of medical disputes, with 87.1% disputes related to doctors and 13.9% related to patients. The doctor’s factors include lack of communication (28.82%), low technical level (16.91%), lack of sense of responsibility (8.86%), defective case records (6.92%), imperfect operation (6.44%), inadequate experience (6.44%), inadequate condition evaluation (5.8%), irregular management process (4.03%), violation of diagnosis and treatment regulation (4.03%), misdiagnosis and mistreatment (3.54%), belated diagnosis and treatment (2.58%), postoperative complications (2.42%), equipment problems (1.13%), missed diagnosis (0.81%), poor condition monitoring (0.48%), unreasonable charge (0.48%) and poor service attitude (0.32%). The patient's factors include misunderstanding of medical behavior (43.48%), high expectation of prognosis (25%), bad attitude (13.04%), inadequate medical knowledge (7.61%), disturbance (6.52%), poor compliance (3.62%) and mistrust (1.09%). Among all medical disputes, there are 406 cases of level-4 medical disputes (78%), 95 cases of level-3 medical disputes (18%), 19 cases of level-2 medical disputes (4%), and no level-1 medical dispute. Meanwhile, the classification of diseases, treatment effect, doctors' violation of diagnosis and treatment regulation, and low technical level are the reasons for the level differences in medical disputes.Conclusion Factors of doctor in medical disputes in Shanghai mainly include inadequate communication and low technical level while the patient’s factors mainly contain misunderstanding of medical behavior and high expectation of the prognosis. Level-3 and 4 medical disputes take up the major part in all medical disputes. The classification of diseases, treatment effect, doctors' violation of diagnosis and treatment regulation, and doctor’s deficient technical level are high-risk factors requiring critical attention in medical disputes.

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Analysis of Forensic Autopsy in 120 Cases of Medical Disputes Among Different Levels of Institutional Settings

Cited by 4 publications

References 13 publications

Diagnostic errors in fatal medical malpractice cases in Shanghai, China: 1990–2015

Diagnostic errors in fatal medical malpractice cases in Shanghai, China: 1990–2015

The influence factors of medical disputes in Shanghai and implications - from the perspective of doctor, patient and disease

The Influence Factors of Medical Disputes in Shanghai and Implications - From the Perspective of Doctor, Patient and Disease (Observational Study)

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