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妇科患者合法权益

2017-09-15 15页 doc 46KB 17阅读

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妇科患者合法权益妇科患者合法权益 妇科患者合法权益、知情同意及告知相关知识培训 2012 年 3 月 18 日 手术知情同意制度 一、 由于手术操作过程较为复杂,有可能发生严重并发症以及治疗后果难以准确判定,故必须履行书面告知程序——手术志愿书。 二、 手术知情同意制度包括两方面内容: 1、 知情:患者对病情、手术方案、手术适应证、手术并发症,备用手术方案、费用开支等真实情况的了解。同时也应了解不做手术所承担的风险。 2、同意:患者在知情的情况下有选择接受或拒绝的权利。 三、医务人员须以简明易懂的方式和语言告知患者,在书面文件的基础...
妇科患者合法权益
妇科患者合法权益 妇科患者合法权益、知情同意及告知相关知识 2012 年 3 月 18 日 手术知情同意制度 一、 由于手术操作过程较为复杂,有可能发生严重并发症以及治疗后果难以准确判定,故必须履行面告知程序——手术志愿书。 二、 手术知情同意制度包括两方面内容: 1、 知情:患者对病情、手术、手术适应证、手术并发症,备用手术方案、费用开支等真实情况的了解。同时也应了解不做手术所承担的风险。 2、同意:患者在知情的情况下有选择接受或拒绝的权利。 三、医务人员须以简明易懂的方式和语言告知患者,在书面文件的基础上综合运用口头解释、图和照片等方法,一般应告知患者如下信息: 1、手术的目的、方法、成功率、预期效果、术中可能出现的问题、潜在危险、直接实施该手术的人员等。 2、术后康复过程中可能发生的问题。 3、预计需要支付的费用 四、 对患方履行知情同意人员的要求: (一) 由患者本人或监护人、委托代理人行使患者知情同意权。 (二) 患者具有完全民事行为能力的,在不违反保护性医疗制度的前提下,应将告知内容直接告诉其本人,必须履行书面签字手续的由其本人签字。 field is downwind, brooding House separate from the breeding shed, and ... Building chicken farms must also consider the construction of chicken manure treatment facilities such as septic tanks, methane-generating pit, do not let the chicken manure directly. Five to do a disease prevention and control, do not cut corners. Built into the chicken in chicken farm, will be required to do a variety of vaccine injections and disinfection in chicken farm, do not hold the chance, and do scientific farming. Reasonable problems in building a chicken coop hen house layout, can provide a good environment for chicken, making its full productive potential, so other than in understanding the physiological characteristics of the chicken itself, and must be properly planned and constructed sheds. A chicken layout considerations 1. Sites to choose away from populated areas, traffic convenient, away from the road 2. Gaozao terrain, a lot of sunshine. Winter sun as possible, summer wind, and not after the rain water. Larger, leaving room for development 3. Abundant water resources pollution-free, easy to access, sufficient power is guaranteed 4. Building structure, the economy, saving money, and saving energy, it is facing in accordance with local environmental and physiological condition, lighting is good, easy to ventilation, easy to operate, so conducive to cooling in the summer, to insulation in winter cold 5. Layout of premises should be reasonable, do distinguish between (三) 对于不能完全行使民事行为能力的昏迷、痴呆、未成年人、残疾人等患者,由符合相关法律规定的委托代理人代为行使知情同意权。 (四)在下列情况下,可由患者的委托代理人代为行使知情同意权: 1.患者虽具有完全民事行为能力,但如实告知病情、手术方案、手术风险后可能造成患者不安,进而影响医务人员开展诊疗工作的,由委托人代为行使知情同意; 2.患者虽具有完全民事行为能力,但不能理解或不愿了解手术措施,由委托代理人代为行使知情同意权; 3.委托代理人由患者在法律法规所规定的代理人中选择,按照患者配偶、父母、成年子女、其他近亲属的先后顺序依次担任; 4.患者以授权的方式指定委托代理人,并由双方(患者和委托代理人)按医院规定在授权书上签名。该委托代理人代表患者行使其在医院诊疗期间的知情同意权,签署各项医疗活动同意书。 五、 履行手术知情同意的要求: 在手术前,由术者或主要助手与患者及其家属详细交代病情、手术的目的、方法、成功率、预期效果、术中可能出现的问题、潜在危险等情况,经本人或其家属知情同意,医患双方签署同意书后,方可实施手术。 field is downwind, brooding House separate from the breeding shed, and ... Building chicken farms must also consider the construction of chicken manure treatment facilities such as septic tanks, methane-generating pit, do not let the chicken manure directly. Five to do a disease prevention and control, do not cut corners. Built into the chicken in chicken farm, will be required to do a variety of vaccine injections and disinfection in chicken farm, do not hold the chance, and do scientific farming. Reasonable problems in building a chicken coop hen house layout, can provide a good environment for chicken, making its full productive potential, so other than in understanding the physiological characteristics of the chicken itself, and must be properly planned and constructed sheds. A chicken layout considerations 1. Sites to choose away from populated areas, traffic convenient, away from the road 2. Gaozao terrain, a lot of sunshine. Winter sun as possible, summer wind, and not after the rain water. Larger, leaving room for development 3. Abundant water resources pollution-free, easy to access, sufficient power is guaranteed 4. Building structure, the economy, saving money, and saving energy, it is facing in accordance with local environmental and physiological condition, lighting is good, easy to ventilation, easy to operate, so conducive to cooling in the summer, to insulation in winter cold 5. Layout of premises should be reasonable, do distinguish between 2012 年 7 月 28日 手术医师患者知情同意告知方法培训 长期以来,医疗法规等一直不是临床医师在学生阶段学习的内容和重点,所以大多刚毕业的医师对这方面内容的了解都是一片空白,而随着法制建设的推进,这方面的问题逐渐凸显出来,如何使医生在临床工作中掌握手术知情同意方法,是妇科临床工作中不可忽视的一个方面,特别是刚毕业的临床手术医师,更应重视这方面知识的学习。今天,我们就针对手术医师“患者知情同意告知的方法及技巧”做一个培训。 一、培训目标 妇科手术医师在外科临床工作阶段,除重视医学知识、手术技能等的教导,还应掌握手术前知情同意谈话的方法。避免由于各种原因、不同程度上存在的代病人作主的“家长主义”情况,确实的落实病人的知情同意权。 二、 培训内容 1、 知情同意权的含义和相关法规 《执业医师法》第 26 条规定,医师应当如实向病人或者病人家属介绍病情,但应当注意避免对病人产生不利后果。知情同意权包括了解权、被告知权、选择权、拒绝权和同意权等,在术前应主动、及时、全面告知病人病情、诊断及其手术治疗方案。 2、明确告知对象 《医疗机构管理条例》第 33 条规定,医疗机构施行手术、特殊field is downwind, brooding House separate from the breeding shed, and ... Building chicken farms must also consider the construction of chicken manure treatment facilities such as septic tanks, methane-generating pit, do not let the chicken manure directly. Five to do a disease prevention and control, do not cut corners. Built into the chicken in chicken farm, will be required to do a variety of vaccine injections and disinfection in chicken farm, do not hold the chance, and do scientific farming. Reasonable problems in building a chicken coop hen house layout, can provide a good environment for chicken, making its full productive potential, so other than in understanding the physiological characteristics of the chicken itself, and must be properly planned and constructed sheds. A chicken layout considerations 1. Sites to choose away from populated areas, traffic convenient, away from the road 2. Gaozao terrain, a lot of sunshine. Winter sun as possible, summer wind, and not after the rain water. Larger, leaving room for development 3. Abundant water resources pollution-free, easy to access, sufficient power is guaranteed 4. Building structure, the economy, saving money, and saving energy, it is facing in accordance with local environmental and physiological condition, lighting is good, easy to ventilation, easy to operate, so conducive to cooling in the summer, to insulation in winter cold 5. Layout of premises should be reasonable, do distinguish between 检查或者特殊治疗时,必须征得病人同意,并应当取得其家属或者关系人同意并签字无法取得病人时,应当取得家属或者关系人同意并签字因病情紧急或者遇到其他特殊情况时,若无法取得病人意见又无家属或者关系人在场,经治医师应当提出医疗处置方案,在取得医疗机构负责人或者补充授权负责人员的批准后实施。但临床实际工作中如何选择告知对象,仍是困扰医师的难题。具有完全民事行能力的病人,行使知情同意权必须由其本人亲自作出方为有效,他人不得代为行使。而对未到法定16 周岁的人,他们缺乏自主能力,则由他们的亲属或监护人为他们作出决定。 以下情况可采用由病人授权委托其家属代理行使知情同意权: ?一个具有完全民事行为能力的病人因其遭受疾病打击,而神智不清、情绪不稳定时,因病人年老、文化教育水平较低等因素影响其对医疗措施的理解时,由代理人对医疗措施作出选择。 ?在医疗机构及其医务人员履行如实告知义务可能造成病人不安或带来不利影响时由代理人对医疗措施作出选择。此时,必须取得病人亲笔签名的书面授权委托书,证明病人委托他的家属代为行使知情同意权。 手术中常见的一种情况是切开探查术时,预定的手术名称与医生在切开后的情况不相符,需要追加或临时变更手术内容和手术方式。在这种情况下,医疗机构及其医务人员仍应征得病人本人的同意,如局部麻醉时,在病人无法行使该项权利,如全麻时,应及时征得病人家属的同意。 另一方面,知情权涉及病人的隐私权,只有承担医疗field is downwind, brooding House separate from the breeding shed, and ... Building chicken farms must also consider the construction of chicken manure treatment facilities such as septic tanks, methane-generating pit, do not let the chicken manure directly. Five to do a disease prevention and control, do not cut corners. Built into the chicken in chicken farm, will be required to do a variety of vaccine injections and disinfection in chicken farm, do not hold the chance, and do scientific farming. Reasonable problems in building a chicken coop hen house layout, can provide a good environment for chicken, making its full productive potential, so other than in understanding the physiological characteristics of the chicken itself, and must be properly planned and constructed sheds. A chicken layout considerations 1. Sites to choose away from populated areas, traffic convenient, away from the road 2. Gaozao terrain, a lot of sunshine. Winter sun as possible, summer wind, and not after the rain water. Larger, leaving room for development 3. Abundant water resources pollution-free, easy to access, sufficient power is guaranteed 4. Building structure, the economy, saving money, and saving energy, it is facing in accordance with local environmental and physiological condition, lighting is good, easy to ventilation, easy to operate, so conducive to cooling in the summer, to insulation in winter cold 5. Layout of premises should be reasonable, do distinguish between 护理工作的医护人员才有权利去看、检查或处理病人的身体,并了解、讨论有关病情和治疗。非经同意不得泄漏病人医疗上的秘密。某些医院或医师常将病情告知病人的亲属、朋友或同事,由于家属和单位有关人员与病人在利益等方面存在复杂的联系 有时将对病人的权利造成极大的损害 也可能引起法律纠纷。 4、告知内容 内容包括四个方面: (1)、全面告知, 如病人病情、诊断及其手术治疗方案病情包括疾病的轻重缓急及其变化情况诊断包括疾病名称、诊断依据手术方案包括手术的名称、目的、意义、可能出现的并发症及风险、费用,尤其是可供选择的手术方式、需要或可能切除的脏器、手术中和手术后可能出现的并发症及风险,切忌遗漏可能出现的并发症及风险,不使用“包括”“但”“不限于”“等”这样概括性极强而同时模糊性也最大的词语。对于教科书、医疗规范中所列举的常见并发症,尽管其发生的概率很低,仍然应当告知病人。 (2)、通俗告知 切忌堆砌专业医学术语,否则对病人的告知解释将失去意义,如胆囊切除术的手术同意书不能简单写到“手术可能引起胆道术后综合症”。 (3)精确告知 告知应当严谨、完整,不能有歧义,不仅要告知拟定的手术方式,还要告知可能调整的方案、原因和不同等。 field is downwind, brooding House separate from the breeding shed, and ... Building chicken farms must also consider the construction of chicken manure treatment facilities such as septic tanks, methane-generating pit, do not let the chicken manure directly. Five to do a disease prevention and control, do not cut corners. Built into the chicken in chicken farm, will be required to do a variety of vaccine injections and disinfection in chicken farm, do not hold the chance, and do scientific farming. Reasonable problems in building a chicken coop hen house layout, can provide a good environment for chicken, making its full productive potential, so other than in understanding the physiological characteristics of the chicken itself, and must be properly planned and constructed sheds. A chicken layout considerations 1. Sites to choose away from populated areas, traffic convenient, away from the road 2. Gaozao terrain, a lot of sunshine. Winter sun as possible, summer wind, and not after the rain water. Larger, leaving room for development 3. Abundant water resources pollution-free, easy to access, sufficient power is guaranteed 4. Building structure, the economy, saving money, and saving energy, it is facing in accordance with local environmental and physiological condition, lighting is good, easy to ventilation, easy to operate, so conducive to cooling in the summer, to insulation in winter cold 5. Layout of premises should be reasonable, do distinguish between (4)真实告知 不能片面夸大病情或疗效,也不能隐瞒不良后果,但应根据谈话对象的不同而有所区别,如肿瘤或病情危重时,对病人告诉病情的程度,事实上毫无保留地告诉肿瘤病人手术中可能不能切除肿瘤、或切除后可能复发等,有时将不利于手术的实施,应特别谨慎处理,必要时应与病人的家属商量之后再决定。 5、告知的确认形式 手术前知情同意书是告知病人其治疗方案和权利的文件,不论同意或拒绝 均应在同意书上签字表明态度。 field is downwind, brooding House separate from the breeding shed, and ... Building chicken farms must also consider the construction of chicken manure treatment facilities such as septic tanks, methane-generating pit, do not let the chicken manure directly. Five to do a disease prevention and control, do not cut corners. Built into the chicken in chicken farm, will be required to do a variety of vaccine injections and disinfection in chicken farm, do not hold the chance, and do scientific farming. Reasonable problems in building a chicken coop hen house layout, can provide a good environment for chicken, making its full productive potential, so other than in understanding the physiological characteristics of the chicken itself, and must be properly planned and constructed sheds. A chicken layout considerations 1. Sites to choose away from populated areas, traffic convenient, away from the road 2. Gaozao terrain, a lot of sunshine. Winter sun as possible, summer wind, and not after the rain water. Larger, leaving room for development 3. Abundant water resources pollution-free, easy to access, sufficient power is guaranteed 4. Building structure, the economy, saving money, and saving energy, it is facing in accordance with local environmental and physiological condition, lighting is good, easy to ventilation, easy to operate, so conducive to cooling in the summer, to insulation in winter cold 5. Layout of premises should be reasonable, do distinguish between 2012 年 9 月 18 日 手术前谈话的内容、技巧和艺术一 术前谈话的目的是妇科医生在手术之前向患者及家属或相关人、单位负责人等将患者的病情、将实施的医疗措施、医疗风险和预后情况等内容客观地告知他们,并对其有关咨询问题予以解答,以便得到患者和家属的了解和理解,对将要进行的手术治疗达成统一意见。 如何更好地进行手术前谈话已成为每一个妇科医生必须研究的课题。随着医学模式的改变,妇科医生面临的不仅仅是生物医学的疾病,而是现代社会生物医学的患者。人具有社会性,客观上要求妇科医生在术前谈话前,不仅仅是与病体的简单接触,而是接触具有社会性人的群体。因此,要达到术前谈话的目的,不仅要掌握适当的方法,更重要的是还要掌握高超的谈话技巧和艺术,这和妇科手术水平一样重要 也是一门科学问题。为此,一个优秀的妇科医生,不仅要会做好手术 同时更应该重视术前谈话技巧和艺术。妇科医生在执行手术操作之前向患者及家属或相关单位负责人等谈清患者的病情将要实施的医疗措施、医疗风险和预后情况等,客观地告知他们,并对其有关咨询问题予以解答,以便得到患者和家属的了解和理解和对将要进行的手术治疗达成统一意见。 field is downwind, brooding House separate from the breeding shed, and ... Building chicken farms must also consider the construction of chicken manure treatment facilities such as septic tanks, methane-generating pit, do not let the chicken manure directly. Five to do a disease prevention and control, do not cut corners. Built into the chicken in chicken farm, will be required to do a variety of vaccine injections and disinfection in chicken farm, do not hold the chance, and do scientific farming. Reasonable problems in building a chicken coop hen house layout, can provide a good environment for chicken, making its full productive potential, so other than in understanding the physiological characteristics of the chicken itself, and must be properly planned and constructed sheds. A chicken layout considerations 1. Sites to choose away from populated areas, traffic convenient, away from the road 2. Gaozao terrain, a lot of sunshine. Winter sun as possible, summer wind, and not after the rain water. Larger, leaving room for development 3. Abundant water resources pollution-free, easy to access, sufficient power is guaranteed 4. Building structure, the economy, saving money, and saving energy, it is facing in accordance with local environmental and physiological condition, lighting is good, easy to ventilation, easy to operate, so conducive to cooling in the summer, to insulation in winter cold 5. Layout of premises should be reasonable, do distinguish between 2012 年 11 月 25 日 手术前谈话的内容、技巧和艺术二 随着社会、法律、科学的进步,如何能够更好地进行手术前的谈话,已成为我们每一个妇科医生必须研究的课题。因为今天的医学模式课题,妇科大夫面临的不仅仅是生物医学的疾病 ,而是当今现代社会生物医学的病人。简单地说,大夫不仅是治病,而是病和人,即:人客观上就具有社会性,在进行手术前在谈话时,不是与病体的简单接触,而是接触具有社会性的群体,因此,要达到术前谈话的目的,不仅要掌握适当的方法,更为重要的是还要掌握一定谈话技巧和艺术,这和妇科手术水平一样重要,也是一门科学问题,为此,一个优秀的妇科大夫,不仅要会做手术,而且还要善于表达。那么,怎样掌握术前谈话的技巧和艺术呢,达到我们术前谈话的目的呢,举个简单的例子,例如:多年不见的好友相聚,非常激动,举杯一饮而尽,什么话也没有说,但此时已表达了久别重逢的感情。因此,要掌握好谈话的技巧和艺术,不能简单地理解光用嘴巴说,其实我们在平时的医疗过程中的一言一行病人都在观察着和感受着。我认为要真正掌握术前谈话的技巧和艺术,首先,要利用我们妇科大夫的形体语言,那就是要求我们牢记吴阶平前辈给我们的教诲:“一切为了病人,为了病人一切”。其次,要掌握本学科全面的知识和最新进展,同时还要了解不同病人及其家属的知识文化背景的差异。 术前谈话首先必需提前通知病人主要可负法律责任的亲属或单位负责人,约定明确的谈话时间和地点。其次主持术前谈话的妇科医field is downwind, brooding House separate from the breeding shed, and ... Building chicken farms must also consider the construction of chicken manure treatment facilities such as septic tanks, methane-generating pit, do not let the chicken manure directly. Five to do a disease prevention and control, do not cut corners. Built into the chicken in chicken farm, will be required to do a variety of vaccine injections and disinfection in chicken farm, do not hold the chance, and do scientific farming. Reasonable problems in building a chicken coop hen house layout, can provide a good environment for chicken, making its full productive potential, so other than in understanding the physiological characteristics of the chicken itself, and must be properly planned and constructed sheds. A chicken layout considerations 1. Sites to choose away from populated areas, traffic convenient, away from the road 2. Gaozao terrain, a lot of sunshine. Winter sun as possible, summer wind, and not after the rain water. Larger, leaving room for development 3. Abundant water resources pollution-free, easy to access, sufficient power is guaranteed 4. Building structure, the economy, saving money, and saving energy, it is facing in accordance with local environmental and physiological condition, lighting is good, easy to ventilation, easy to operate, so conducive to cooling in the summer, to insulation in winter cold 5. Layout of premises should be reasonable, do distinguish between 生必需是非常熟悉患者病情的主治大夫,危重病人或重大复杂手术需科室或院负责人参加。 术前谈话的内容一般包括患者疾病的诊断情况、手术治疗的必要性、手术方式选择依据、术中和术后可能出现的不良反应,并发症及意外情况、拟采取的预防术中和术后并发症及意外情况的有效措施、手术治疗的预后和经费估计等方面。 术前谈话的目的是要通过这次重要谈话,让患者及其家属了解到: ? 妇科手术治疗的集体团队精神。 ? 赢得患者及其家属对我们医疗服务和医疗水平的信任; ? 让患者感觉到他已享受到最科学合理的疾病诊断和治疗; ? 手术治疗的必要性; ? 消除对手术风险的恐惧心理,了解我们抵御风险的措施和能 力,以及抵御风险能力的有限性。 ? 综合和持续治疗的可能性。 ? 手术治疗效果的迟后表现性和不手术治疗效果的迟后表现性 和不可预测性。 ? 手术前谈话,妇科医生必须克服和消除一些不良心理状况。 field is downwind, brooding House separate from the breeding shed, and ... Building chicken farms must also consider the construction of chicken manure treatment facilities such as septic tanks, methane-generating pit, do not let the chicken manure directly. Five to do a disease prevention and control, do not cut corners. Built into the chicken in chicken farm, will be required to do a variety of vaccine injections and disinfection in chicken farm, do not hold the chance, and do scientific farming. Reasonable problems in building a chicken coop hen house layout, can provide a good environment for chicken, making its full productive potential, so other than in understanding the physiological characteristics of the chicken itself, and must be properly planned and constructed sheds. A chicken layout considerations 1. Sites to choose away from populated areas, traffic convenient, away from the road 2. Gaozao terrain, a lot of sunshine. Winter sun as possible, summer wind, and not after the rain water. Larger, leaving room for development 3. Abundant water resources pollution-free, easy to access, sufficient power is guaranteed 4. Building structure, the economy, saving money, and saving energy, it is facing in accordance with local environmental and physiological condition, lighting is good, easy to ventilation, easy to operate, so conducive to cooling in the summer, to insulation in winter cold 5. Layout of premises should be reasonable, do distinguish between
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