Chapter 11 A conflict that shouldn't happen

I have seen two completely opposite opinions on the website. One thinks that medical accidents are now identified by the Medical Association or the Health Bureau. This is their own judgment. It is obviously unreasonable and it is difficult to guarantee justice. Forensic doctors should participate in medical treatment. Accident identification. The other thinks that forensic doctors and doctors are separated from each other and should not participate in medical malpractice appraisal. I don’t know who is right and who is right, and they all make sense, but here forensic doctors participate in medical malpractice appraisal.

There was such a case last winter. The Medical Administration Department of the Cangyang City Health Bureau approached us and said that there was a medical malpractice dispute and we needed our help. Without further ado, I agreed first, and then got to know the basic situation. The thing is, the deceased was an elderly woman who had been involved in a car accident some time ago. On the day of the car accident, the situation was quite serious. The old man had multiple fractures and his consciousness was not very clear. However, after rescue, the old man was already stable. One night after he was transferred from the intensive care unit to the orthopedic surgery department for a week, the old man asked his family to bring a bedpan to relieve his pain. , suddenly fell ill, and passed away thirty minutes later.

The family members of this kind of situation must not be able to figure it out, especially the son, the old man raised himself up through all kinds of hardships, and passed away in such an unexplained way before he had time to enjoy the blessings, how can he not feel heartbroken?But to be honest, it may be because I have been a doctor. I also understand the hospital very well. No one who is a doctor wants to put the patient to death. I arrived in less than an hour after walking on the expressway. What I didn't expect was that the dean's office was in a mess. It seemed that the conflict was not small.

We sat down both parties and we needed to understand the situation. The person who came was the deceased's son and three other close relatives. The hospital also sent three people to introduce the situation, including the attending doctor. The strange thing is that after everyone sat down, the atmosphere was a bit dull, and no one was willing to speak first. I smiled and asked the family members to speak first. What the family members said was the same as what I just learned, but I noticed that he answered a phone call during the conversation, and he said: "Dad is very busy now, please wait at school first, and I will drive to pick you up in an hour." When he was about to continue speaking, I interrupted him and said to him: "The purpose of my coming today is to give you a fair statement. Please rest assured. The people who died at the same time have died. I I also ask for your condolences. In addition, at this time, please pay special attention to your living family members and take care of them. You can’t afford the next accident, so please arrange the children’s affairs first, and send another person Pick him up, and then shall we start again?" My words obviously made him think for a while, and after the matter was arranged, he continued, and I took a little note from time to time, although I already understood the situation.

The following is the attending doctor. It can be seen that he is still very young and very nervous. He licks his lips from time to time, and his legs are shaking subconsciously. Obviously, he did not consider whether his family members can understand him, and said a lot of professional terms. What I noticed is that he is very dedicated, because he came to check the room on Saturday and Sunday, two days before the incident. When I know everything I want to know, I know it's time for me to talk. First of all, I asked the hospital to take out the sealed medical records, unpack them in front of both parties, and after reading the medical records, I made a copy for the family members.

Then I asked the family members to send someone who knows medicine, and the hospital also sent someone to participate in the autopsy together. I know it's time to unravel the mystery. The autopsy result was not beyond my expectation at all. Frankly speaking, it was exactly the same as I imagined, because it was also in Cangyang County. I also encountered a similar case not long ago, but it was not caused by a doctor last time. It is not within the purview of the health department. After hearing the facts of the case, we suspected that this was a case of pulmonary embolism. The reason is this: This disease often occurs in patients who cannot get out of bed for a long time, such as people with fractures or serious illnesses. Long-term immobility slows down blood flow, and thrombosis will form in their lower limbs or other veins Of course, the blood flow of the elderly is relatively slow, so it is more likely to happen; when the thrombus falls off for some reason, it will go along the direction of blood flow, first return to the right heart, and this distance will go further and further. Width is not a big problem, but as soon as it leaves the heart and enters the pulmonary artery, the road below becomes smaller and smaller, often getting stuck near the left and right branches of the pulmonary artery, so that the entire lung loses blood circulation. Although people can inhale, the oxygen It cannot be transported out, and the lungs may even be necrotic. Do you think people will die?The only difference between this time and last time is that last time the injured old man superstitiously found a wizard after removing the plaster cast. The wizard played tricks and then squeezed his wound. Squeezing and pinching made the fixed thrombus fall off, which finally led to the death of the old man. We call it an inducement, and the wizard is more or less responsible. This time, it is very likely that the patient's activity of releasing his hands caused the thrombus to fall off. The hospital No responsibility at all.

At this time, the first thing that the forensic doctor should pay attention to is to ensure that the evidence is conclusive, so the heart and pulmonary artery must be cut in situ, and the evidence should be fixed after the embolus is found, because if the heart has left the surrounding anatomical structure, where did the thrombus come from? It is a bit unclear; then we have to find the source of the thrombus. This patient has a fractured pelvis, so special attention should be paid to the gastrocnemius muscle and iliac vein of the lower extremities. The thrombus was found in the transected gastrocnemius muscle.

The surgical director and the patient's family (a nurse) who saw the dissection process were convinced. The cause of death has been found, but the matter is not over yet. Not long after, the family members of the deceased found me. At this time, they were too regretful. Obviously, in this case, pulmonary embolism is an inevitable complication of plaster external fixation after fracture, and medical malpractice cannot be constituted. Doctor There are no mistakes in the treatment including plastering, so they are now facing two problems, the first is whether the hospital will sue them for disturbing public order, and the second is that people died in vain?The second question is about my own business. I answered them at the time: First, this situation is unavoidable. Any hospital with this disease will be unable to recover from the disease. Therefore, the family members should not blame themselves too much and change to a better hospital. Will it be better? Furthermore, we analyze the cause of death in this way: the direct cause of death is undoubtedly pulmonary embolism, but this is not the root cause. The root cause is a car accident, because without a car accident, there will be no fractures, and of course there is no such thing as no fractures. Complications of the fracture, the source of the contradiction is still in the car accident, and I have already reflected this in the conclusion of the appraisal.

The first problem is not in my field, but I still did one thing: I called the hospital and told them that the family members of the patients regretted the damage to the hospital and were willing to make compensation. The purpose of education has been achieved . I don't know if what I'm doing is right or wrong?Strictly speaking this is not my area of ​​responsibility. But I often think: If everyone, especially the family members of the patients, had more medical knowledge, would this conflict not happen?