Patient relationship model Active - passive ( Emergency rescue treatment for the patient to do something ) Guidance - Cooperative ( Acute

infectious diseases to tell the patient what to do ) Common - participatory ( Chronic disease management to help patients self-treatment ) Patient relationship is what ? Basic elements of the modern doctor-patient relationship Patient-centered -? Patient-centered medicine ights and o!ligations !ased ethics -? "uty # right-!ased ethics Patient consent and the right to choose -? $nformed consent Commerciali%ation & consumerism & contracting 'he ideal of the doctor-patient relationship "octor-patient communication !arriers Patient e(pectations and status differences !etween Patient )s emotional state when dealing Ethical standards !oth doctors and patients 'ransmission of information !etween doctors and patients "issatisfied patients "r* +ang "ui Percentage reason 'o do without ma,ing -. Care enough /0 "iagnostic error /0 'reatment failure .0 Character 1orse ./ 2ot careful enough .. Patient disputes mainly in three forms3 medical malpractice 4 medical malpractice4 medical mista,es $dentification of medical mista,es are civil proceedings 5 6edical 6alpractice is a medical administrative process 5 6alpractice Crime Criminal $dentification !elong handler Appeared in medical malpractice actions 4 as a patient and the hospital has three paths to choose 3 consultation and conciliation 4 6edical 6alpractice and 7itigation 6ultiple Choice Patients4 female4 0- years old* Because of cough 4 fever two days to hospitals for treatment 4 was diagnosed as upper respiratory tract infection 4 given intramuscular in8ections of streptomycin 9*:g*.9 minutes later 4 the patient was pale 4 shortness of !reath 4 followed !y convulsions 4 coma4 that line of emergency rescue4 -9 minutes after !reathing and heart!eat stop * Patient )s death4 his family did not thin, the hospital patient

s,in test on the line in8ection 4 is the hospital responsi!ilities* According to ; 6edical 6alpractice 4; which was a A* 6edical technological accidents B* 6edical 7ia!ility Accident C* serious medical errors "* 6edical Accident E* Complications

Patient $dentification <ystem Blood 4 !lood transfusion or administration Before surgery or invasive medical procedures 'ime out4 spea, out ight patient4 right site

. !ad attitude / underestimate patient symptoms 0 delay notify the physician +our communication s,ills shortage : wrong needle 4 give the wrong medicine Patient disputes - other health care team . pharmacist give the wrong medicine / inspectors digital error 0 escorts did not pay attention to transportation safety - inspectors improper e=uipment operation

'he rights and o!ligations of the hospital 6ain rights 3 the right to treatment ( disease inspection rights 4 the right to selfdiagnosis 4 medical prescription rights ) 5 medical research right 5 health care and other human rights and dignity * 6ain duties3 opening and practicing law 5 law or the parties have agreed to provide medical services in accordance with the o!ligations 5 loyalty to society and the patients) fiduciary duty 5 e(plain to patients and their families the disease4 treatment 4 and precautions o!ligation to inform 5 medical referral o!ligation 5 reporting o!ligations* 6a8or medical 4 etc*4 should !e according to the law and the relevant departments to the health authority reports 5 professional ethics o!ligations4 such as optimal treatment 4 medication 4 amount4 surgery is reasona!le4 the !est treatment options 4 so that patients suffering minimal 4 minimum and other medical e(penses * $ncluding the right to life and health 5 personality rights ( privacy4 name4 portrait 4 reputation ) 5 e=uita!le health care rights 5 independent medical authority ( including the choice of medical institutions and medical staff ) 5 informed and consent4 the patient )s condition of the disease 4 treatment measures4 such as the right to ,now the case of health care 4 and hospital treatment of !ehavior should !e ta,en prior consent of the patient or family consent !efore proceeding 5 medical file access rights 4 copy rights 5 supervision 5 claims for 5 re=uest a withdrawal right * 'hat may affect the fair and e=uita!le 6edical 6alpractice 4 mem!ers of the right to withdraw* >*<* /9 -patient relationship ><67E e(am ule ? .3 Patient is num!er one5 always place the interests of the patient first* a* Choose the patient)s comfort and safety over anyone else)s* !* 'he goal is to serve the patient4 not to worry a!out legal protection for the physician* Case study ight ovarian tumor due to a lady 4 living in a hospital surgery* Preoperatively4 hospitals and families of patients preoperative surgical voluntarily signed the !oo,4 mar,ed ; intraoperative surgical decision according to the condition and e(tent of surgery 4 such as malignant 4 there hysterectomy possi!le; 4 !ut did not 4 and others* $ntraoperative possi!ility that malignant ovarian tumors 4 and contact for rapid pathological 4 !ut in the case of a failed lin, 4 the implementation of the ; total hysterectomy 4 !ilateral salpingooophorectomy 4 omental partial resection4 resection of the lesion * ; Postoperative pathological findings 3 the nature of ovarian cystic teratoma tumor 4 critical malignant* Constitute a doctor-patient relationship Empirically ( medical practice ) 2o serious conse=uences will inform patients and their families ( Autonomous discretion )

1ithout o!taining the written consent of patients and their families ( $nform right ) @iolation of the patient)s right to information and right to choose4 constitute tort 0 4 a pregnant woman in la!or was admitted to hospital several pilot were unsuccessful 4 due to the ris, of surgery hus!ands and economic pro!lems in the cesarean section hesitant to sign a consent form 4 resulting in maternal-fetal Au 1ang ****** espect for the patient for their illness4 diagnosis4 treatment4 right to information 6edical institutions4 an operation or a special treatment4 the patient must o!tain consent and shall o!tain the consent of their family mem!ers or relations and signed 5 >na!le to o!tain the views of patients 4 the patient)s family or relationships shall o!tain the consent and signature 5 >na!le to o!tain the views of patients nor the presence of family mem!er or relative 4 or encounter other special circumstances4 the treating physician should !e raised and medical treatment program 4 o!tain medical institutions in charge of owner or authori%ed personnel responsi!le for approval and implementation* Case / 4 an anterior children ; ectopic thyroid ; is treated as ; thyroid hyoid !one cyst; removed4 doctors discovered after mista,enly cut4 !ut truthfully inform the families of the matter 4 does not ta,e remedial measures 4 resulting in children with disa!ilities ****** Case study yu due to car!on mono(ide poisoning coma at home the ne(t day was sent to a county hospital* >nder treatment at the medical staff 4 yu awa,ening ..399 on the same day 4 the condition to get !etter4 out of danger* B pm that night 4 7iu has !een temporarily discontinued 4 stop o(ygen * <ee yu has !een completely so!er 4 yu relatives volunteered discharged* "octors agree discharged4 !ut was not associated with the relevant formalities yu and their relatives 4 did not inform the relevant considerations* 'he ne(t day4 7iu appeared unresponsive4 headache and other symptoms4 many people went to city hospitals and other treatment 4 the diagnosis of to(ic encephalopathy * 7iu was a forensic identification of disa!ility * County People)s Cospital4 7iu relatives paper petition to court to re=uire the hospital for compensation 00 million yuan* Court of +irst $nstance that the hospital medical records re=uire the plaintiff 7iu hospitali%ation content 4 the plaintiff without sufficient evidence to overturn * yu then dismissed the claims * 7iu refused to accept the start of the appeals * County Court retrial of the case* After conducting various analy%es ruled that the hospital failed to fulfill this o!ligation due to !ear half of the responsi!ility for the patient compensation -94999 yuan *

Case analysis ? ? +orcing families to go home patients not healed 4 the treatment of delayed follow-up 4 with the serious conse=uences of disa!ility caused !y the patient have a direct causal relationship 4 should !ear corresponding civil lia!ility* Cospital esponsi!ility3 According to the relevant provisions of the appropriate discharge 4 should !e discouraged 5 insists discharged 4 should fulfill the relevant approval procedures 4 and inform the patient is harmful* 'he hospital medical records only proof 4 the evidence does not prove that it fulfilled this o!ligation shall !ear lia!ility* Points to prevent ? ? . medical personnel should !e prepared to medical records 4 detailed records of patients hospitali%ed content* (/) to enhance communication with patients 4 inform in advance the ris, of discharge * +or patients should not !e discharged should !e strongly discouraged 4 for specific reasons 4 mostly for patients to do ideological wor, * (0) $f the patient insisted to !e discharged 4 should fulfill the relevant approval procedures 4 and inform the dangers of the disease and after discharge to note 4 as,ed the patient !ac, to hospital to !e chec,ed regularly * And to inform patients and their families to o!tain written confirmation of the content *

'he patient)s e(pectations E(pectation of !eing respected E(pected to !e of concern E(pected to !e care

'he principle of coordinated patient relationship E=ual treatment is a prere=uisite $s the !asis for mutually !eneficial cooperation

Pay attention to credit is the ,ey 'hat generosity and self- protection awareness is guaranteed

6edical Ethics Patient safety as the core $nterests of patients first Patient perspective

Dhe8iang two Guang8i <pirit3 1ith e(=uisite interpretation techni=ues eflects the services with care "octors should have three ,inds of vision 3 6icroscopic e(amination of patients with organ 5 E(amined with the na,ed eye in front of the patient 5 Behind the telescope o!servation of the patient to understand their !ac,ground

@er!al communication Chat principles3 avoidance of dou!t 4 targeted 4 timely feed!ac, Conversation attitude 3 ,ind compassion4 respect for human dignity 4 respect for facts 4 inclusive understanding ( !asic E ,ey 3 Ceart ) Conversation s,ills 3 listening4 guiding 4 pro!ing 4 =uestioning4 silence 4 spea,ing applications4 use !eautiful language Eye contact ; 'he eyes are the window to the soul *; "isplay information soul of man $nterpersonal distance ( personal space research )

(><A data ) 3 $ntimate %one ( 9-9*: m ) Personal distance !and ( 9*:-.*/: m ) <ocial !and ( .*/:-0*: m ) Pu!lic !and ( 0*:-F*: m ) $nstrument se(ual attraction Clothing demeanor demeanor ( first impression ) Goal3 amia!le nearly respecta!le credi!le Gccupational <tandards ( smile ) Communication program <mile - friendly signal $dentity - an entry point for communication >nderstanding of assimilation 4 that the two sides have reached a consensus on certain things and feelings * Effect3 resonate in unison * 'an(ing - developing e(changes ( +ind topics of common interest ) 5 listen when appropriate nod & answer 'han,s - the truth of the return Grateful to have specific content to help tell the other side what is meaningful to you 4 sincere * ; Patient-centered ; structure chart >*<* /9 -patient relationship ><67E e(am ule ? H 2egotiate rather than order* a* 'reatment choices are the result of agreement4 not commands !y the physician* !* emem!er4 the patient ma,es medical decisions from the choices provided !y the physician* Patient- centered care <afety 3 +irst4 "o 2o Carm E(ample3 given the wrong medicine 1rongly 6ismatched !lood <ent to the wrong patient +all >nusual event notification mechanism no responsi!ility for systems4 processes proofing

Patient- centered ? Biological - psychological - social medical model - "isease (disease) anomalies on human !iology Condition * - Patients (illness) sic, sense of self 4 there may !e Physical illness 4 mental disorder may !e lost 4 and social relations 'one* - $llness (sic,ness) or others who are aware of this social $n a sic, state* 6ay or may not !e 4 !ut are re=uired to 'o social recognition 4 need a !rea, 4 need help and care* "isease patients An early stage liver cancer patients 4 we can say there is a serious ;disease; 4 !ut he had no o!vious discomfort 4 no ; patient ; 5 thus did not see, medical treatment4 without the ,nowledge of others 4 no one ,new he was ; sic, 4; he not !e regarded as ;patients *; Gnce the cancer progresses 4 symptoms ( patients ) and medical treatment 4 diagnosed with liver cancer ( disease ) 4 then he ; sic, ; of the* Patient communication channels Emotional communication 3 a doctor with a sincere attitude and good professionalism and prescri!ing !ehavior to treat patients with respect4 compassion 4 care for the patient 4 the patient will get the confidence to achieve the purpose of emotional communication 4 which is a prere=uisite to esta!lish contacts * 6edical Communication3 "octor with super! medical technology4 through careful diagnosis and treatment 4 can promote good doctor-patient relationship !uilding 4 forming smooth communication channel e(changes * Effect of communication 3 Patients see,ing the ultimate goal is to o!tain the desired effect 4 the condition improved rapidly through treatment or cure 4 doctor-patient communication is the ,ey to communication * +ollow-up communication 3 the doctor some special cases 4 to maintain lasting connections and access 4 may gain valua!le information on medicine 4 and to promote social effects 4 close doctor-patient relationship *

"uring cardiac e(amination 4 how should reflect patient-oriented thin,ing ? ? /9.. AC$ Conditions Cands and stethoscope chest piece should !e warm 5

1ithout affecting the test results under the premise of minimi%ing the e(posed parts of the chest 5 6ale doctor e(amining female patient 4 a female doctor or nurse should !e present 5 E(amination 4 the patient can not cope with illness 4 the position should !e !ased on patient comfort !ased4 patients feel tired when divided into su!- chec,ing* 6ultiple Choice A female patient to the hospital 4 admissions !y a male doctor * Patient conscious these days stool !leeding symptoms* 'he doctor as,ed her a few =uestions 4 follow the normal procedure is to !e performed anal e(amination * 'he following =uote e(act words the doctor3 ; 'o ma,e anal e(amination 4 you told me to go inside *; +emale Patient3 "octor4 my mother on the outside 4 you do not go together* At this time A call female patient wait a minute4 wait a female doctor came to her when called female doctor chec,ing * B called several doctors come together more chec,s* C himself a man to give her chec,s* " himself a man to give her chec, and called her mother on the side* 'he title selected " 6ale doctor chec,ing in to the sensitive parts of female patients 4 the need for the presence of other women 4 such as female doctors 4 nurses4 student interns 4 to accompany 4 other female patients 4 etc* 4 pay attention to shelter* And female patients must not e(cessively conversation 4 chat* >nnecessary tests shall 4 e(cessive chec,s* $t)s not how much we do4 !ut how much love we put in the doing* $t is not how much we give4 !ut how much love we put in the giving* (6other 'eresa4 ;small things with great love;)