Medical errors Classification Causes of the occurrence. Classification of medical errors

In accordance with existing Russian legislative norms, the health of a citizen Russian Federation It is the highest value of the state and is under its protection.

The country's health care system is constructed in such a way that every citizen has the right to get high-quality free, however, as well as paid, medical care.

However, despite such declarative statements, there are no legal criteria in the legislative system and the norms of identifying the level of quality of medical services provided, which is most often manifested in medical errors. In addition, defects of medical care often have deplorable, not always corrected, results.

The question arises:

what you need to know the patient about possible reasons and types of low-quality medical services so that if necessary, to be able to protect your rights and interests in a legitimate key?

Causes of medical errors

It should be borne in mind that the unified classification of miscarriage errors is not presented in any official source. Based on the regulatory and legal requirements and prescriptions set forth in various legislation, it can be argued that medical errors in most cases are associated with a human factor. This refers to the overall professional incompetence of a medical worker, insufficient argumentation of decisions and actions, as an option, intuitive decision-making. It can also be safe to the human factor to take the fatigue of a specialist, professional workload and inattention.

Medical dispute lawyers believe that medical errors associated with the technical failure of additional systems are not excluded, such as equipment, tools, treatment methods, and so on. Medical equipment as well as equipment in other spheres of human activity may fail at the most inopportune moment, the tools break, and the methods of treatment are irrelevant. As a result, the patient, not even the fault of the doctor, receives inaccurate diagnostic results or, as an option, late medical care.

Medical errors may be associated with an atypical disease flow by the presence of complications and so on.

By the way, this is the most common type of medical error, because even taking into account the patient's individual reaction to medical preparations And treatment methods The most experienced and highly qualified doctor is not insured against professional failures.

As an option, errors of medical workers can be associated with the coincidence: when the complex course of the disease and the insufficient experience of the doctor give an undesirable result and so on.

Types of medical errors

Regardless of the causes of medical errors big role Plays the stage on which they were committed. Based on the practice of lawyers for medical disputes of the legal center, Malina, the most common mistakes of doctors are associated with incorrect diagnostics. As a result, the patient establishes incorrect diagnosis and, accordingly, is assigned, incorrect treatment. Naturally, it is not necessary to expect improving the patient's health status in this case.

Errors of technical species

associated with incorrect medical settlements, operations, measurements, inaccuracy of records, extracts, and so on. This type of errors are less significant than the previous one, however, in the overall medical care system, a bad joke can play at the most inopportune moment.

Organizational errors

invite the presence of shortcomings in the process of organizing medical care and the procedure for its provision. With such a type of errors, deontological errors of doctors are naturally connected - their direct behavior with patients and other medical personnel.

It is important to understand that no one is insured from medical errors - neither the patient, nor, in fact, a medical worker. In any case, in order to protect its rights in the legislative veil, the assistance of competent and highly qualified medical law is needed.

Lawyers of the legal center of Suvorov Group have sufficient successful experience of solving legal problems of a medical nature, will help to obtain compensation for admitted medical ability and achieve for the defendant of relevant legal punishment.

Medical error may pass without a trace for the patient, and may result in tragic consequences. But not always the cause of the error is the incompetence of a doctor or its reluctance to work. Sometimes it is much more difficult. Read more about the reasons for medical errors, read in the article.
Recently, the topic of medical errors is increasingly sounds in the media. At these words, the most real crimes are often hidden. For example, recently in one of the TV shows it came about a drunken doctor. But there is nothing to discuss. This is a deliberately criminal act and is subject to criminal prosecution. It is better to talk about real medical errors that occurred by chance.

Causes of medical errors

The reasons for medical errors are much the most frequent of them - incorrect diagnosis. The second group includes errors in medical tactics. They are closely related to the errors of the first group. Wrong diagnosis entails the wrong treatment. Third Group - Organizational errors. The most striking example is Mikhail Zurabov, promoted by the Ex-Minister of Health, the liquidation of pediatric service and the ubiquitous introduction of general practitioners. And finally, the fourth group is deontological errors, that is, mistakes in the doctor's behavior.

Now about objective reasons that lead to medical errors. One of them is the emergence of new, previously unknown diseases, such as, for example, AIDS or malignant pneumonia. Naturally, the doctors will be mistaken! Diagnosis is generally complex. The limitations and inaccuracy of medical knowledge are affected.

Recognize the disease is not easy, because it can leak atypically, not at all as described in the textbooks. In addition, it happens that the same disease in two patients appears in different ways. And the difficulties of diagnosis in children of younger age!

Prevention of medical errors

It is impossible to avoid medical errors. However, it is possible to reduce their quantity. But how? The main path is a systematic error analysis in each medical institution. In a good clinic, anyone, even the smallest protrusion of a doctor who did not entail the consequences for the patient, breaks up the very next day. And serious mistakes are discussed at a hospital conference with the obligatory participation of students. It does not matter who allowed them is a professor, associate professor, head of the department or duty officer. The worst thing that could happen is if the doctor hid his mistake (it's easy to do in medicine), and through the Annal amount of his colleague, he repeated the same mistake only because it was not dismantled in time.

Doctors do not have the right to make a mistake, but, alas, they are still mistaken. IN last years In St. Petersburg, the number of criminal cases in the facts of medical errors are growing. And if in 2001 in the Northern capital, only five such cases were initiated, then in 2015 - twenty-two. This year, it is already known at least about two cases of improper treatment, which initiated criminal proceedings.

Statistics are unpleasant, however, this does not mean that we have become much worse to treat. Just if before the person who was affected by the unprofessionalism of the physicians, was alone trying to cope with the consequences of unskilled treatment, now it is done with social networks, appeal to court. People have become more competent, they are ready to prove their righteousness to a victorious end.

Of course, the doctor is responsible for his patient's health. He must be a professional and to some extent a psychologist to find an approach to the client. But do not forget that the patient's behavior plays a far from the last role on the way to recovery. Even a perfectly selected course of treatment will not bring the desired results if the patient does not tell the doctor all the details of his health and will not comply with the recommendations of the specialist. So pledge effective treatment - This is not only a doctors' professionalism, but also the adequacy of the client.

IMPORTANT!

How to reduce the risk of errors?

Collect information about your illness. If possible, get advice from different professionals, make a clear picture of what you support and how you are treated.

Show activity. Ask about all medicines, procedures and manipulations that you are prescribed. You have the right to know everything connected with your health.

Be sure to tell the doctor about all the medicines that you accept, as well as about allergies.

Learn about reputation medical center. Some clinics have created special internal quality control services for therapeutic services.

ON A NOTE

Where to complain?

If you think you are incorrectly treated, first, contact the head of the polyclinic or hospital department, where you are watching. If the complaint goes unbightened, write to the chief doctor of the institution, and you will appoint another doctor.

If a medical error led to damage to health, the physician can be called responsibility for non-professionalism or negligence. To do this, it is necessary to apply to the City Committee for Health and to the Insurance Company provided to you polis Oms (its number is specified in your insurance certificate). To obtain material compensation for harmful to health, you should contact the court.

The actions of doctors can also complain about the Ministry of Health and Roszdravnadzor. For legal support, you should contact the League of Patients, to lawyers specializing in this kind of affairs.

Errors are different. Sometimes they are allowed when conducting preventive events. After all, in practice, there are cases of violation of the grafs of animal vaccinations, as a result of which there are occasional cases, for example, pigs in the farms. True, due to the lack of specific means of prevention (vaccines and serums), cases are possible (which is observed) the occurrence of diseases and not the fault of the doctor. But still, in the minds of people, any disease is somehow connected with the doctor.

Errors are possible even when disinfection of the premises. This is evidenced by the dissemination of the recent ulcers of the ball in bulls and cows in the industrial method of detention. The reinforced concrete sections of the slotted floor contain an excess amount of lime, which is dissolved with high humidity. Such "trifles" is often not paid and used for disinfection caustic nat. And surplus alkali just led to the formation of deep ulcers on the finger, which are later infected, resulting in a purulent necrotic process.

But more often there are errors diagnostic, as a result of which mistakes are allowed in treatment. It is their analysis most of all contributes to the professional education and improvement of a doctor of veterinary medicine, the formation of medicinal thinking.

Below is a classification of medical errors proposed in humanitarian medicine M.I. Krakowsky and Yu.Ya. Gritsman, improved relative to the specifics of the work of a doctor of veterinary medicine.

Errors in diagnosing diseases:

1. Missed diagnosis.Sometimes the doctor during the examination of the sick animal does not find some signs of the disease, although it stopped taking food. The disease is just beginning to develop, it is still difficult to recognize it. But the presence of a painful state requires a detailed examination of the animal and carrying out the so-called preventive, preventive treatment. Any disease flows two-stage. In the first, Patochimo stage clinical signs Uncharacterne, but for them the doctor may and should provide for the development of one or another disease. The doctor sometimes simply expects the appearance of characteristic clinical signs without taking measures to prevent them.

2. Incomplete diagnosis. Sometimes the doctor correctly diagnoses the main disease of the animal, but does not pay attention to some complications or other signs that accompany the main disease. Treatment in this case will be defective.

3. Erroneous diagnosis.In such cases, the animal body transfers the cargo not only not recognized by the physician disease, but also improperly prescribed drugs.

Errors in Tactics Treatment:

1. Error in choosing the timing of treatment.There are a number of diseases in which urgent help is needed by an animal. This is the intestinal loss due to penetrating injuries, infringement of hernia, sharp tympania of various origin, poisoning and many others. It is impossible to postpone treatment with such diseases, it is urgent.

2. Errors in identifying the main directions of treatment.They, as a rule, are a consequence of an incomplete diagnosis.

3. Defective treatment (disregard by individual methods or trends, as well as complications of the main disease).

4. Incorrect treatment(unreasonable use of various drugs, treatment methods, operational intervention Without justifying his necessity, etc.).

Drug errors:

1. Errors in execution techniquediagnostic manipulations, instrumental and special research methods.

2. Errors in treatment technique(incorrect administration of the magnetic probe, incorrect overlapping of seams on the intestines or a scar during operational treatment, incorrect birth during heavy childbirth in a cow, etc.

3. Organizational errors: They are allowed by specialists of veterinary medicine often when planning and carrying out measures to eliminate or prevent infectious disease in farms or settlements.

4. Mistakes in the doctor's behavior. They deserve the most serious attention. Envy, petty joy in case of colleague error - all this creates a very unfavorable climate in the team and is reflected negatively on the results of his work. Invalid "criticism" of its predecessor, which, allegedly, incorrectly diagnosed the disease or was treated. Doctors, and especially young, seeking a kind of self-affirmation, often negligiously belong to their younger face colleagues, whose work is so necessary for the successful performance of the tasks.

Errors are most often a consequence of the vicious opinion of the doctor, and not his negligence. Some of them depend on the insufficient level of knowledge and small experience, others - from the imperfection of research methods, the third is explained by the presence of rarely encountered clinical signs of the disease.

But you can not mix a medical error with negligent actions of a doctor who could foresee possible consequences His actions were obliged to prevent them. There are also errors caused by the unscrupulous fulfillment by the doctor of their official duties. For this, the guilty are responsible in accordance with existing laws.

IN medical practice Drug mistakes are discussed at conferences, on the pages of magazines. Errors of specialists of veterinary medicine attention is almost no focus. As a rule, conferences and seminars are based on positive examples, not errors. But in veterinary medicine, it is assumed a mandatory opening of the corpses of the dead animals in order to compare the diagnosis of clinical and pathologist. For a conscientious doctor, this is a school of raising business qualifications, one of the means of preventing medicinal errors, the way to improve therapeutic work. In such cases, he learns to put a pathogenetic diagnosis and develop methods of pathogenetic treatment of patients with animals for the future.

I.I. Benedicts divides medicinal errors to objective, subjective and mixed. For such a classification, you can consider the mistakes of the doctor of veterinary medicine.

Objective errors in medical practice are found quite often and amount to 30-40% of the total number of them (Giolevsky A.S., Tarasova K.E.). We do not have digital data regarding veterinary practice, but we believe that due to the specific working conditions of the specialists of veterinary medicine, the imperfections of some diagnostic methods, as well as as a result of underestimation in recent years, this figure will be somewhat large.

The main reasons for the diagnostic errors of an objective nature can be considered as follows:

1. Intensification and industrialization of animal husbandry dramatically changed the conditions for feeding and animal content. If the influence of insufficient feeding on the body has been known for a long time, then with the issue of excessive feeding, and especially protein, with the imbalance of rations on mineral-vitamin components, the zooetspecialists are not aware enough. Namely, such feeding (as well as sufficient) under certain conditions can cause a number of diseases. After all, the adaptive capabilities of the animal organism are not limitless and with their violation there are pathological shifts that lead to various diseases.

The content of livestock on the slot floor is considered the most economical, hygienic, but not physiological: in such conditions, uniform load is impossible throughout the plane of the hoofs. And this leads to overload of certain areas of the base of the skin, to the inconsistent work of individual muscles, tendons, which cannot but influence the health of animals. Hydgodina stipulated by beef production technology also violates the physiological processes in the body. All this leads to the emergence of animal diseases, complex in etiologies, complex in the nature of the tissue changes covering various animal organism systems. These changes are still hardly diagnosed due to insufficient knowledge of one or another disease. It is not by chance that the expressions of the "High Productivity Diseases" appeared in the literature of recent years, etc.

Let us give an example. Recently, a disease has begun to register the disease, which is manifested by non-thrust tendons in the bulls in combination of beef. Specialists of veterinary medicine, taking into account literary data, of course diagnosed it as a violation of vitamin and mineral exchange. However, treatment did not always give the desired results. 1 Only in recent years has been established that this is a multifactoric disease that flows on the principle of collagenosis. In this case, the doctor simply could not put the correct diagnosis, not knowing the scientifically substantiated mechanism for the occurrence of the disease.

Specialization of animal husbandry contributed to the emergence of many insufficiently studied diseases. And the known diseases in the new conditions for feeding and retaining animals are often manifested atypically, which also leads to an error in diagnosis. To eliminate such errors, close cooperation of scientific and practical veterinary medicine is necessary.

2. Objective diagnostic errors are often allowed by a young doctor due to the inability to systemally examine the animal, as a result of which the individual symptoms of the disease are incorrectly evaluated and the incorrect diagnosis is made on this basis.

Such examples can be given a lot. These are the mass tympania of the lambs in May due to the intestinal blockage moniasias (and the doctor did not spend coprological studies, although the anti-fortiest drugs did not give the desired results), Athonian forenswrows, the reason for which the doctor did not find it, and treated the symptom. There are cases when the doctor anaerobic phlegmon in the neck of the neck accepted the Emcar, and therefore, proved the need to slaughter an animal and conducting relevant special measures to prevent the dissemination of the disease, although the animals used to be vaccinated against Emkara.

Consequently, at a novice doctor, diagnostic errors are often due to weak preparation, insufficient possession of clinical research methods.

In the actions of the doctor who is engaged in the treatment of animals, four stages can be distinguished: familiarity with history, clinical and laboratory study, study of diagnosis and treatment. The most important is history. It makes it possible to correctly diagnose in more than 50% of cases, a clinical study is 30%, and laboratory - only 20%. Therefore, anaman data should be given proper attention. Of course, if the doctor is known to the doctor, the history will be short and aimed at identifying the cause of the disease. With an incomprehensible clinical picture, the history should be detailed to make a preliminary diagnosis that is confirmed or varies during an animal survey on the basis of its data. And each time a specialist pays special attention to objective clinical picture And should not fall under the "hypnosis" of the previous diagnosis.

A detailed clinical examination allows you to put a pathogenetic diagnosis or diagnosis of the disease in the animal. This is a responsible stage, because on the basis of the diagnosis, the doctor prescribes and pathogenetic treatment, and, therefore, he should not allow mistakes.

Thus, the diagnostic process consists of anamnesis, the study of the patient of the animal, analyzing the results of the study of the diagnosis and the development of treatment methods. The underestimation of some of these components (as well as the revaluation) can cause a diagnostic error. Therefore, each doctor of veterinary medicine should emphasize the diagnostic process: after all, errors in the treatment begins for diagnostic errors.

It happens that in the first years of production activities, young doctors often strive to simply "guess" the diagnosis, without considering some, in their opinion, insignificant symptoms. A superficial, incomplete study of the animal is the cause of the diagnostic and therapeutic error. Thus, with rectal studies of cows in the farm, the doctor diagnosed in one of them a four-month pregnancy only on the basis of an increase in the size of the uterus. At the same time, he did not take into account the thickening and sealing of the cervix and body of the uterus, fluctuation and the simultaneous increase in both horns. And only later, when the animal manifested themselves general signs Diseases, with a more detailed study, a pyometer was diagnosed. Such a mistake can be attributed to the doctor's self-confidence, there is no experience.

Often the doctor of veterinary medicine raises the diagnosis, without seeing the animal, to describe its state of the owner or when inspecting an animal at a distance. Here the intuition is triggered, which is owned by experienced specialists. Observation makes it possible to form a preliminary idea of \u200b\u200bthe diagnosis, which is further confirmed or rejected by clinical and laboratory studies. The ability to instantly diagnose the disease is given in solid knowledge and acquired years of experience. Moreover, this experience includes its own achievements, and achievement of science, technology and production. The doctor must develop intuition in itself, which is based on vocational training, observation, the ability to analyze the experience of colleagues and its own.

3. The activity of a doctor of veterinary medicine is inextricably linked with science. Therefore, the diagnosis is not guessed, but justifies. And intuition, not supported by knowledge and experience, often brings. Examples can be given. When examining a horse, a young doctor diagnosed lymphoscremal in the field abdominal wall. But his comrade, noting a significant inflammatory response at the place of injury, proposed to refrain from the Iodine Iodine solution adopted in such cases into the cavity with formaldehyde. And after the course of anti-inflammatory therapy, the animal was diagnosed with abdominal hernia. Consequently, the intuition of a more experienced doctor helped prevent an error that could be irreparable.

In another case, an experienced doctor diagnosed the animal cancer only on the basis of the presence of small warts on the eyelids. His young colleagues with such a diagnosis did not agree and subjected to cows to surgical treatment. And after 10-12 days, the neoplasm has spread to the eyeball and periorbitte, i.e. Operational intervention provoked a relapse, which led over time to the animal sejection. This case again confirms that intuition is the advantage of an experienced specialist.

4. One of the reasons for objective diagnostic errors is the insufficient technical equipment of veterinary medicinal institutions, as well as the inability of many veterinary medicine specialists to use at least those devices that are. Electrocardiography, oscillography and a number of other diagnostic methods are still practically used. And electronic computing machines that allow 20-25% to reduce the number of diagnostic errors (Cherepanov L.S., etc.) in veterinary medicine - so far a distant future.

5. Among the factors that can cause an objective error should be noted the volume of work and the range of duties of the doctor of veterinary medicine. It is known that the main work of a specialist, especially in the conditions of the economy, is the prevention of infectious and unsuccessful animal diseases. In addition to performing official duties, the doctor often has to engage in other public affairs. Due to the lack of time, the diagnosis and treatment of patients with animals is carried out by a doctor with a hurry, often in the afternoon. And in medicine it has been proved that the diagnosis of a broken and inattentive examination of a patient in 37.5% of cases is erroneous (Elder Yu. P., 1957). Apparently, in the practice of veterinary medicine, this indicator will not be lower.

Subjective diagnostic errors depend on the individual characteristics of a doctrine of veterinary medicine (type nervous system, mental abilities, professional focusing, etc.):

1. It is known that the doctor with a strong balanced and rolling type of nervous system (Sanguinik) is more able-bodied, sociable, deeply analyzes the results of studies, aged in difficult situations that occur during the diagnosis and assistance to the animal. In the practice of such a doctor, the mistakes caused by a complex drug situation are rare. Conversely, with the same level of knowledge, the doctor with an unbalanced type (choleric) errors allow for more (Benediktov I.I., Karavanov G.G.).

Proteades, superficiality and other negative character traits are closely related to the type of nervous system and can also cause drug errors. These leads the so-called excessive spontaneous activity of the doctor, especially in the absence of experience, responsibility, self-control feelings. There are specialists from veterinary medicine, which masterfully own surgical equipment, with insufficiency of clinical thinking. It is they who allow many mistakes.

Let us give an example. Doctor who was fond of operational treatmentBy diagnosing traumatic reticulitolitonitis, operated on a highly productive cow with signs of atony. Without finding a foreign body in the grid, he successfully completed the operation and appointed a few days a gentle diet. In two days, the cow died from Sepsis, which developed due to purulent endometritis. Thus, due to the doctor's self-confidence, which aims itself for an erroneous diagnosis, a rough diagnostic and tactical error was admitted. Resistant atimas in this case was one of the symptoms of intoxication of the body and the beginning of the septic process. And the doctor did not even have guessed to measure the body temperature, at least before the operation.

The doctor's activity reflects the mood - an emotional tone of a person who depends on the state of health, psychological compatibility with the surrounding, individual characteristics. Wring a doctor is able to regulate its emotional state and less makes errors. The depressed mood interferes with the internal collections of the doctor, reduces mental activity, the possibility of a critical assessment, and this may lead to an error of a subjective nature.

2. The doctor's work also affects the type of its memory. It is mobile, emotional, shaped (visual), auditory, verbally logical. A person may have one, two and even three types of memory, and can also be purposefully developing them in themselves. Professionally necessary for a doctrine of veterinary medicine should be recognized verbally logical and figurative types, for it is that they expand the diagnostic capabilities of a specialist. After all, mistakes are most often allowed when the symptoms of one or another disease differ from the classical described in the textbook. The development of atypical symptoms is associated with the action of certain factors, as indicated earlier. In such cases, a thoughtful analysis of the research results is needed, the relationship of the symptoms of the disease with environmental conditions and anamnesis data. Otherwise, diagnostic will be allowed, and for her and practical error, which can lead the death of the animal.

In one of the farms there were massive posture complications at Baranov. Diagnosing them as an emergency inflammatory swelling, the doctor prescribed antimicrobial and anti-inflammatory therapy. Such treatment turned out to be ineffective, the death of animals began as a result, as was established by the pathologan student, anaerobic sepsis.

As known, characteristic sign anaerobic infection is a creative tissue swelling. And attitudes in the study of animals, the doctor did not find. But at the same time, he did not take into account the features of inflammation at rams (fibrinous), anatomical structure scrotics, unsanitary conditions of content in the aftermath period, as well as the fact that anaerobic microorganisms Constantly multiplied in the benchmarks of ruminants and stand out with wheel masses. Finding into the wound closed fibrin, they develop and show pathogenic effects, braking their toxins inflammatory response. This contributes to the absorption of them into the blood and intoxication of the body. The doctor as a result of an error in the diagnosis appointed anti-inflammatory funds, which accelerated the development of anaerobic sepsis. He also did not remember that for malignant edema, which was later installed with the help of laboratory studies, attitudes are uncharacter. Timely delivered correct diagnosis would bring losses to a minimum. But not enough logical thinking was the cause of the error.

3. An important role in the practical activity of a doctor of veterinary medicine is played by a professional impulse. This is a friendly readiness to perform his medicinal debt daily. And if these qualities are not developed enough or there are no them, you can not expect professional passionism.

The doctor decided to experience the probe of Meliktyan. But due to the lack of experience, he was unable to introduce a magnet in the barn of cow and went to consult on this occasion from a more experienced comrade. During this time, the owner took his cow home. But the doctor, having decided to master the technique of his introduction, went to a slaughter point, where she began to work out in detail on predicted animals. Do not be persistent, after the first failure could completely abandon this diagnostic method.

Not always a person with satisfaction fulfills his duties. The reason for this may be fatigue, certain life circumstances. Labor devoid of professional inspiration creates a soil on which diagnostic and practical errors are multiplied.

4. Many mistakes allow veterinary medicine experts due to the inept, improper, patterns of medicinal substances. It is known that the disorders of the gastrointestinal tract in animals in one case act as a disease, and in the other - as a symptom, a protective reaction aimed at eliminating some toxins from the body. Unfortunately, many in such cases, without sobering, use drugs that brake the secretory and motor functions of the gastrointestinal tract. And this leads to further suction of poisonous substances and intoxication (if it was a symptom of poisoning).

Specialists of veterinary medicine should be well known and positive, and the negative properties of those substances they enjoy. According to the Indian doctor of drying, medicines in hand knowing man The beverage of immortality and life is likened, and in the hands of ignoramus - such fire and sword.

The pharmaceutical industry increases the release of new drugs every year, which, of course, the doctor should know. But pharmaceutical preparations do not cure the patient. At best, they only contribute to the body in its restoration work. Medicinal substances Use only to eliminate unpleasant symptoms of the disease until the natural processes in the body will complete the treatment.

Some drugs sometimes interfere with the treatment process, change the course of the disease and make it difficult to diagnose. So, in cases of unclear diagnosis, antibiotics are often unreasonably use. After them, the condition of the animal can improve. But at the same time, the cause of the disease remains not detected and not eliminated, and its clinical signs are changing under the action of antibiotics. This prevents properly classifying the disease, to put a pathogenetic diagnosis, and, consequently, to conduct adequate disease treatment.

You can refer to the use of novocaine for anesthesia when inflammatory processes on the limbs in animals. In this case, pain is a protective reaction that does not allow the animal to rely on, it can only be weakened by using weak novocaine solutions.

In addition, each drug, in addition to the main manner, shows the side effect, especially pronounced with its improper appointment, nature often have to solve double tasks: to deal with the disease itself and additionally with the consequences of the use of drugs. Therefore, experienced doctors sometimes cancel pharmaceutical preparations, providing the opportunity to mobilize all their strength and naturally to cure. The dog, the sick with rabies, has not yet cured. But if she, sick, running away from home in a timely manner, often returns after a few months exhausted, but healthy.

Use the preparations must be skillfully. It is remembered when the doctor has prepared erroneously and introduced a horse not 0.1, and 1% carbonic solution, increasing the dose of 10 times. Seeing the effect of the drug, he was so confused that he did not even guessed to remove him atropine, and the horse died.

It is known that if with careless intravenous administration under the skin, calcium chloride, chloralhydrate, some organic paints, develop necrotic processes in places of their hit. The introduction of such solutions requires a doctrine of accuracy and vigilance. And if randomly these substances came under the skin, they should immediately reduce their concentration by local administration of novocaine solution or at least distilled or digested water. And calcium chloride is well neutralized by sodium sulfate.

Many veterinary workers admit mistakes in the work. But sometimes the mistake itself is not dangerous, but her silence, an attempt to hide her from the owner of the animal and his comrades by profession. A doctor who made a mistake causes harm to the patient, and if he hid it - hundreds of patients: after all, he did not warn his colleagues about the consequences of his mistake and ways of preventing complications.

That is why it is desirable in the educational process to make a detailed analysis of the mistakes made, to give a scientific substantiation of methods that exclude their repetition.

5. The cause of medical errors may be insufficiently developed ability to clinical thinking, the unwillingness of the doctor to see and evaluate the atticness of the disease too important for proper diagnostics. And this is the result of a lack of knowledge, episodicity of working with special literature, non-critical use of his experience and his comrades.

Such errors often admit the doctors of veterinary medicine in the first years of their practical activity. This is also explained not to the lack of knowledge, but the absence of their focus. According to experienced, qualified specialists, the trouble of most doctors is not to know that they do not know enough, but in the fact that they do not see enough.

6. There is an opinion that the ability of the doctor entirely depends on practical training. But the training of a specialist includes a constant combination of theoretical, scientific and clinical and experienced knowledge, obtained by studying special literature, personal observations and daily analysis of clinical material. Of course, practical training should not be neglected, it often helps to avoid many mistakes. The doctor of veterinary medicine not only assigns treatment, but also often holds it independently, so it is not insured with an error. Characteristic example:

During the treatment of a horse with signs of colic, the doctor mistakenly introduced a solution through the probe not in the stomach, but in the trachea, as a result of which the animal died of asphyxia. And although the animal coughed, worried, the doctor, without having practical experience, developed clinical thinking, did not immediately notice the mistakes and did not react to it.

7. One of the reasons for the diagnostic error I. I. Benedicts considers the absence of self-criticism, inability to critically evaluate their judgment and actions. Self-criticism, of course, is acquired by experience, but the doctor must also develop this trait in itself.

Self-criticalness is associated with the attitude towards work: as a rule, this feature is well developed at a conscientious specialist. If the doctor does not analyze the data and obtained in the study of animals, it will often allow diagnostic errors.

Mixed errors are associated with objective factors, but the degree of their manifestation depends on the subjective properties of the doctor. To this group can be attributed:

1. Features of the development of the disease, complex, atypical clinical signs that make it difficult to timely and proper diagnosis. For example, the classic sepsis in animals has been studied for a long time, but due to widespread use. antimicrobial drugs Today, the pathogenesis of the disease has changed somewhat, and its clinical signs. And only a certain experience of the doctor makes it possible to put the correct diagnosis.

Somehow the surgical clinic was delivered from the chick of chick, patient for inflammation of the knee joint. With a detailed examination, in addition to the signs of purulent arthritis, sepsis was diagnosed. His signs of the economy did not see, apparently, due to prolonged antibiotic therapy. But he had to foresee septic phenomena and timely surgical intervention Could save the animal.

2. Diagnostic errors are possible in cases where the doctor analyzes the main symptoms and does not take into account minor, weakly pronounced. To make a pathogenetic diagnosis, they cannot be taken into account, because they appeared in the dynamics of the pathological process and may indicate some complications.

3. The cause of the error may be a severe condition of the animal, which did not allow, due to a forced lying position, to carry out the necessary additional research. Many people have such diseases such as postpartum eclampsia, postpartum paresis. Ichkinic signs are not always characteristic, and it is impossible to carry out additional studies.

4. Incorrect history can also cause an error, especially in the practice of a young physician. Modern methods The content of animals in specialized farms exclude individual observations of animals, so it is not necessary to count on always an objective history obtained from the service personnel. In addition, there are cases when the person's fault of the person sick or dies, and then the doctor can give incorrect anamnestic data. In such cases, to prove the erroneous anamnesis, it can only count on his knowledge and experience.

5. The cause of the diagnostic error sometimes there is a diagnosis of intuition, which does not always coincide with reality. This diagnosis often arises as a hypothesis or as an attempt to identify a disease without a thorough study. Thus, many doctors are unreasonably diagnosed in old dogs of eye diseases as cataract, and at SUK, all neoplasms of dairy packages are considered malignant (without histological examinations). An experienced physician who adds it to deep and comprehensive analysis of the symptoms obtained in the study of the patient of the sick animal can be diagnosed.

6. The drug error can also be due to widespread diagnoses or drugs. So, many veterinary medicine specialists today are ordinary D-hypovitaminosis in calves diagnose as collagenosis - a new disease, less studied.

Excessive use of feed antibiotics led in some cases to violation of the formation of immunity after the vaccination of animals. And today doctors abuse antibiotics during fever of any origin. The emergence of antibiotic-resistant races of microorganisms can seems to be considered as a result of excessive use of antibiotics. After all, in practice, the sensitivity of microorganisms to these drugs rarely reveal. It is also known that antibiotics often distort the clinical picture of the disease and make it difficult to formulate the correct diagnosis.

7. The reason for the error can also become the so-called "sungthen" diagnosis. Often young professionals are the opinion of a more experienced comrade take on faith. And if the authoritative doctor has diagnosed correctly, then his young colleague allows a new mistake, the word is not a sick animal, but a disease. At the same time, it does not take into account changes in the body in the treatment process, and the previously established diagnosis in a certain time may not respond to the actual state of the patient of the animal.

There are such cases when the animal owner appeals to the doctor with a finished diagnosis and one without seeing the patient, prescribes treatment.

8. The reason for the diagnostic error can be the revaluation of laboratory studies. Their indicators depend on many factors. In addition, they are carried out often with laboratory technicians who do not have any animal data, and, like every person, can be mistaken. Lab conclusions must be analyzed, correctly evaluate and compare with clinical data. Laboratory data are auxiliary, and the main thing in the diagnostic process should be a clinical study.

In practice, there are cases when an error in laboratory Research Brucellosis caused the chosen of high-length cows. It is no coincidence that recently the positive tuberculin test is checked by microbiological and pathological studies.

Here are three groups of medicinal errors. Apparently, such a classification should be considered conditional. After all, often objective errors are the result not a timely corrected subjective. Proper diagnosis of even the most complex pathology is a matter of honor for a doctor and requires constant improvement of the quality of medical work.

Taking into account the noted, it can be argued that any error is subjective. But the factors that lead to it can be objective. FROM further development Science, optimization of feeding conditions and the content of animals, the number of such factors will gradually decrease. But at the same time, the role of the subjective factor will grow. Therefore, the problem of drug errors should be unleashed in comprehensive: improvement of the training and retraining system of veterinary medicine, the organization of veterinary medicine service in general and drug-preventive work in animal husbandry in particular.

Unfortunately, the mistakes of the doctor so far nonsensess, especially in the first years of his work. In many ways, this stage is characterized by a natural sense of uncertainty in their forces and knowledge. In the measure of experience, as a result of self-education and self-education, such feelings gradually disappear, which reduces the number of errors in the work. But mistakes allow not only beginner doctors, but also experienced specialists who have forgotten about the need for a constant increase in their qualifications.

The activity of the doctor of veterinary medicine is so difficult that it is simply impossible to exclude the error. Therefore, to demand absolutely unmistakable action from specialists - it means not to reckon with reality. But still every doctor of veterinary medicine should strive to ensure that the number of errors decreased over the years.

Errors should be distinguished by the character and the degree of their negative consequences. It should be more tolerable to errors with a random, generated lack of experience, overwork and other objective reasons. No one becomes immediately an experienced specialist, experience comes in the process of painstaking work on itself.

It often claims that the doctors will be too expensive "Honor of Unidir," do not want to admit their mistakes. There is nothing wrong with this, because every doctor of veterinary medicine should go to his professional honor, wherever he does not work for any position. And not necessarily admit your mistake in all. People who are not familiar with the specifics of the doctor's work are unable to perceive this error. Of course, doctors are mistaken, but most often their mistakes they independently or with the help of colleagues correct. And to publicly recognize them or point out to the one who was mistaken is completely optional, unethical. This is equivalent to prohibiting medical activities. After all, the doctor without confidence of livestock breeders, without authority - is not a doctor.

Therefore, in the team of non-specialists, it is not customary to spread relative to errors. But already among the colleagues, the wrong steps of a specialist, if necessary, criticized. And while the doctor remains a doctor, all his miscalculations, professional mistakes are discussed only with colleagues.

This is especially true of young professionals who, being bona fide employees, due to lack of experience, are still mistaken more often. Top generation colleagues should be believed in them, believe that soon this doctor will gain experience and authority among colleagues and will be less mistaken. Let you be for his mistakes, someone smokes, will throw reproach to your side, but do not insult a young colleague, take it under your defense - and you are not mistaken: trust doubles human strength and abilities.

Professional errors should be taken to discuss among colleagues, in order to avoid possible repeating them. The ability to identify someone else's mistake and specify a colleague on it requires not only thorough professional knowledge, but also to comply with the relevant ethical principles. In order not to insult a young specialist, criticizing it, it is desirable to comply with certain norms of behavior. So, it is better to hold such a conversation alone. At the same time, at first calm the colleague, referring to the fact that it was not easy to manage with the entrusted business and in such a situation, most doctors allowed certain errors, and therefore should not be shy. Advise how best to do and ask again to task. If you yourself do not know well how to perform this work, then it is better not to resort to criticism. Before pointing out mistakes, praise the employee for the work that he fulfilled immaculately. In some cases, the conversation about errors is better to postpone at another time when a person can perceive your critical comments calmly.

In humanitarian and veterinary medicine, the expression "right to error" is common, "on errors learn" and the like. It turns out that errors should exist as tutorial. In fact, this statement is vicious. Error is evil, marriage in the doctor's work. And the one who is trying to justify this evil claiming that the drug mistakes are inevitable, is in the position of ethical surrender, which is immoral and unworthy of the high title of the doctor. Sometimes he makes mistakes, but nobody gave him the right to it. Therefore, you should take from your mistakes to the maximum instructive, thereby enriching both your own practice and the overall experience of veterinary medicine.

The doctor is an ordinary person, as well as specialists from other industries, and its responsibility for professional errors should have objective moral and ethical criteria. If ignorance is not a crime, then another thing is the lack of professional knowledge at all: a doctor who does not know the elementary basics of anatomy, physiology, clinic, cannot be allowed to work.

Errors should be distinguished by random and conscious, allowed due to irresponsibility or the frivolity of the doctor. The latter borders with a professional crime for which one should be responsible in accordance with the law.

Consequently, the doctor may be mistaken, and it is important to correct the error on time, and even more importantly - it is foreseen and not allowed it. Sometimes it seems to have everything necessary for successful work, but still admits diagnostic and practical errors. In some cases, they are due to the peculiarities of its nature or physical condition, other objective factors. Among the latter are insufficient scientific developments on many issues of practical veterinary medicine, the imperfection of our knowledge, the features of the course of the disease, the complexity of diagnosis, insufficient equipment of the workplace, etc.

But nevertheless, each specialist should strive for a gradual decrease in the number of errors so that the admitted miscalculations have become a lesson for both for him and for his colleagues.

Each of us uses medical services - both paid and free.

For various reasons, we turn to the clinic, trust your health and life doctors. In exchange, we expect to get qualified, timely assistance and proper treatment.

Unfortunately, in reality, medical errors are inevitable. Their number is growing every year, as well as the number of complaints of patients on doctors for illiterately or not in time rendered medical care.

What to do and where to turn if you did not give medical care or the doctor's carelessness led to a serious impairment of health?

What is a medical error?

The law does not contain the concepts of medical error. But the main landmark gave Professor Davydov back in 1941.

Medical error is a conscientious error of a doctor who does not contain a crime composition and is based on the imperfection of the current state of medical science and research methods.

At the same time, the misconception is based on a particular course of the disease in a patient or on a lack of experience and knowledge of the doctor, but without elements of negligence, negligence and professional ignorance.

Medical error - the delusion of the medical worker, which led to adverse effects for the patient, up to death.

Medical error eliminates unscrupulousness or in relation to patients.

Classification and causes of medical errors

It is easy to notice that the vagueness of the definition of a medical error opens the way to permissiveness. Such an act is difficult to prove. Therefore, it is important to allocate its qualifying signs.

These features include:

• tactical - incorrect organization of the medical process;
• technical - incorrect registration of medical records;
• diagnostic, Medical errors and errors in prevention. This is a conditional separation, since the diagnostic with therapeutic is closely connected.

Also special attention should be paid to the reasons for medical errors. Separate objective and subjective causes of medical error.

TO objective believe:

• disadvantages of health care, including improving the qualifications of doctors;
• objective diagnostic difficulties - short-term (up to 3 days) Patient stay in hospital, severe condition of the patient, the difficulty of diagnosis.

TO subjective believe:

• personal features of the doctor, the lack of sufficient experience and qualifications;
• insufficient, bad or incorrect study and observation;
• insufficient knowledge;
• incorrect data evaluation or incorrect conclusions.

Often, the incompetence of the doctor becomes the cause of a medical error.

Where to handle with a medical error?

The consequences of medical errors can be the smallest, up to the death of the patient. At the same time, it is extremely difficult to prove that harm to health has been caused by the doctor's unprofessional actions, but it is possible.

Use all possible options:

• Contact the Chief Doctor of the Medical Institution

If you think that you had an improper treatment, it is worth contacting the head physician of the hospital with a statement. It must be done first.

Your application will check. The results will notify in a 30-day term.

Medical institution can go to meet you and suggest solving problems - additional treatment or compensation. This method is suitable if it comes to the big damage.

• Contact an insurance company

The option is acceptable when it comes to great cash compensation.

If you were treated under the OMS contract, you will need to assemble a specific package of documents for handling:

1. copy of a medical card or extract from the history of the disease. They are required to provide in the institution where you were treated;
2. statement - in it, indicate where you were treated, in what time frames, which diagnosis was put, who was at the attending physician, what procedures you passed, how damage was caused.
3. documents confirming the amount of damage.

For causing harm to the patient, not only the doctor is responsible, but also the medical institution in which it works.

The submitted statement is considering the management of the medical institution within 10 days.

If the fact of the medical error is disputed, an independent medical examination is carried out. According to its results, the amount of compensation for material damage is appointed, which is issued by a special order of the head of the medical institution. It indicates the size and terms of compensation. Money is transferred to your bank account.

Remember that you must issue a copy of the compensation order.

• Subscribe to court

The court should be addressed to recover compensation for property and moral damage caused to your health. Direct the statement of claim and attach the results of an independent medical examination.

In the framework of the trial, in addition to compensation for damage, you can demand to bring a medical worker to disciplinary, administrative or criminal responsibility that made a medical error.

Compensation of material and moral damage is accumulated through the court.

If you addressed the private clinic, such as dentistry, then before turning to court you should send a claim. This is a mandatory rule.

Guided by the Law of the Russian Federation "On Consumer Protection", you have the right to demand compensation for poorly provided services. If the clinic responds with refusal, boldly apply for a court.

Before submitting a statement of claim to the court to a private clinic, send a claim with the requirement of compensation for material damage.

Based on Art. 1085 of the Civil Code You are also entitled to demand compensation lost due to the loss of earnings.

• In prosecutor's office

This body should contact when a criminal case should be aroused against the doctor. For example, in the event of irreversible harm to health or causing death by negligence.

Criminal liability for a doctor for an error

Behind the medical error of the health worker can be responsible:

• disciplinary (remark, reprimand, dismissal, deprivation of award);
• civil law (compensation for damage in full through the court and compensation for moral damage);
• criminal.

Attract a doctor to criminal responsibility for causing grievous harm to the health or death of the patient.

What article of the Criminal Code is threatened for a medical error?

Medical worker will suffer punishment under Art. 118 of the Criminal Code for causing serious harm to the health of the patient in the form of:

• limitations of freedom up to 4 years;
• forced work up to 1 year;
• imprisonment up to 1 year.

Additional sanction - deprivation of the right to work in the medical sphere up to 3 years.

For a medical error that entailed the grave harm to the health of the patient, the doctor can "get warm" to prison for a year.

If the actions of the health worker led to the death of the patient because of the inappropriate execution of their professional duties, then it will be judged by Art. 109 of the Criminal Code. The court has the right to appoint:

• restriction of freedom for 3 years;
• forced work up to 3 years;
• in prison for 3 years.

Additionally, the doctor can deprive the right to engage in medical practice for 3 years.

For the death of a patient who caused by negligence, a doctor threatens prison up to 3 years.

For infection with HIV infection, the health worker faces the punishment under Art. 122 of the Criminal Code in the form:

• forced work up to 5 years;
• imprisonment for 5 years.

The court also has the right to deprive the doctor the opportunity to work in medical institutions for 3 years.

Remember that prove the medical error is problematic. And it is better to enlist the support of an experienced lawyer in advance to punish the unfair health worker for non-professionalism.