Врачебная ошибка

18.06.2011

Врачебная ошибка

www.advokatx.ru14.pngВрачебная ошибка - это брак в деятельности врача, медицинское нарушение, неправомерный отход от выполнения медицинских стандартов, протоколов.  

Врачебная ошибка или медицинское нарушение, непосредственно связанное с лечебно-диагностическими мероприятиями имеет свойство повторяться в различных ситуациях и в разных медицинских учреждениях.
- Неверный диагноз  в результате некомпетенции врача, диагностических дефектов, неправильной организации медицинской помощи  и т.д. 
- Неверно назначенное лечение ...
Возникновение врачебных ошибок имеет как объективные так и субъективные предпосылки.

Объективные предпосылки врачебных ошибок связаны с независящими от личности врача (иного медработника) факторами: некачественное лекарственное средство, поломка медицинского оборудования, физиологические особенности организма больного, нетипичная реакция организма на действие лечебно-диагностических мероприятий.

Субъективные предпосылки врачебных ошибок - это опыт, квалификация врача, добросовестность выполнения врачом протоколов, инструкций и лечебных стандартов, личные отношения врач - пациент, а именно степень их взаимного доверия.

Перечень специальностей, на долю которых выпадает основная доля врачебных ошибок  и или медицинских нарушений,  от которых гибнут люди или получают серьёзный вред здоровью, не велик.

Это хирурги, анестезиологи-реаниматологи, терапевты, акушеры-гинекологи, врачи (фельдшера) скорой помощи.

1. Приведу краткий перечень нозологических категорий, где наиболее вероятен риск медицинских нарушений, связанной с субъективным, зависящим от врача, фактором.

Например - несвоевременно поставленный диагноз, неверный диагноз или его отсутствие при угрожающих жизни состояниях:
-инфаркт миокарда,
-инсульт,
-острый живот,
-внематочная беременность,
-тромбэмболия легочной артерии (ТЭЛА),
-анафилаксические состояния,
-пневмония,
-онкологические заболевания и их осложнения,
-инфекции
-типичные лечебно-диагностические дефекты, врачебные ошибки, при ОЧМТ

2. Медицинское нарушение может проявиться в неверно (без соблюдения медицинских протоколов) выполненных лечебно-диагностических процедурах; например:
гастроскопия, лярингоскопия, промывание желудка через зонд - перфорации пищевода, желудка;
при колоноскопии - перфорации толстой кишки; и т.д.

3. Медицинское нарушение может выражаться в неверно выбранной тактике при экстренных и плановых хирургических операциях, например:
во время операций - повреждения сосудисто-нервных пучков, занесение в операционную рану инфекции;
во время планового или внепланового медицинского аборта - перфорации матки, неконтролируемый и вовремя не диагностируемый ДВС-синдром;

4. Неверный выбор или дозировка лекарственных препаратов – не достаточный эффект, побочные эффекты, токсические осложнения

5. Неверное ведение беременности (например, несвоевременное диагностирование ФПН), от сюда, высокая перинатальная смертность;

6. Неправильная репозициия костных отломков или вообще недиагностирование соответствующих повреждений;

7. Осложнения при вакцинациях, прививках.

Отдельная и очень болезненная тема. Дело в том, что на данном этапе оснащённости современными диагностическими и экспертными методами в России практически невозможно доказать непосредственные или отсроченные негативные последствия для организма от вакцинации, прививки (БЦЖ, АКДС ...). В то же время, этих осложнений очевидно очень много. Другое дело, что уполномоченные лица и государственные органы их стараются не замечать.

8. Наиболее частые медицинские нарушения, влекущие к негативным последствиям:
-несобранный анамнез,
-отсутствие или недостаточный элементарный пропедевтический осмотр,
-грубые нарушения алгоритма обследования,
-неоказание, несвоевременное оказание медицинской помощи,
-нарушение элементарных правил асептики и антисептики (немытые руки..)
-небрежное ведение медицинской документации,
-нарушения правил послеоперационного ухода, ухода за тяжелыми больными и новорожденными,
-абсолютное отсутствие ведомственного контроля со стороны надзирающих медицинских организаций

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