بررسي تحليلي موارد شكايات از گروه چشم پزشكي ارجاعي به پزشكي قانوني استان تهران

Analytical investigation of ophthalmology complaints referred to legal medicine organization of tehran, Iran

امروزه با افزايش شكايت بيماران از عواقب اقدامات درماني، بررسي علت و انجام مداخلات موثر از اهميت شاياني برخوردار است. مطالعه حاضر با هدف بررسي تحليلي شكايت از متخصصين چشم پزشكي در استان تهران طراحي گرديد. روش بررسي در مطالعه مقطعي (توصيفي-تحليلي) مذكور كليه پروندههاي شكايت ارجاعي به اداره كميسيونهاي سازمان پزشكي قانوني استان تهران از فروردين 1396 تا اسفند 1398بررسي شد. اطلاعات جمعيتشناختي بيماران و پزشكان، نوع اقدامات درماني و عارضه گزارش شده، آراي نهايي كميسيون اول و در صورت اعتراض، نتايج نهايي كميسيونهاي تجديد نظر بررسي و ثبت گرديدند. از ﻣﯿﺎن 176 ﭘﺮوﻧﺪه ﺷﮑﺎﯾﺘﯽ ﺛﺒﺖ ﺷﺪه در 27 ﻣﻮرد )15/3%( ﻗﺼﻮر ﭘﺰﺷـﮏ ﻣﻌـﺎﻟﺞ ﮐـﻪ ﺷـﺎﯾﻊﺗﺮﯾﻦ آن از ﻧـﻮع ﺑﯽﻣﺒﺎﻻﺗﯽ )81/5%( ﺑﻮد، اﺣﺮاز ﮔﺮدﯾﺪ. ﻋﻤﺪهﺗﺮﯾﻦ ﺷﮑﺎﯾﺎت ﻣﺮﺑﻮط ﺑﻪ ﺟﺮاﺣـﯽ ﮐﺎﺗﺎراﮐـﺖ )55/1%( و ﻋﻤـﺪهﺗﺮﯾﻦ اﻗـﺪام درﻣﺎﻧﯽ ﻣﻨﺠﺮ ﺑﻪ ﻗﺼﻮر، ﭘﯿﻮﻧﺪ ﻗﺮﻧﯿﻪ )66/7%( ﺑﻮد. اﮔﺮﭼﻪ ﺑﯿﻤﺎران ﺑﯿﺸﺘﺮﯾﻦ اﻋﺘﺮاض را ﺑﻪ راي ﮐﻤﺴﯿﻮن اول ﻣﻄـﺮح ﮐـﺮده ﺑﻮدﻧﺪ، اﻣﺎ اﻋﺘﺮاض ﭘﺰﺷﮑﺎن ﺑﻪ اﯾﻦ راي ﺑﻪﺻﻮرت ﻣﻌﻨﺎداري ﻣﻮﺛﺮﺗﺮ ﺑﻮد )P<0/001(. نتيجه گيري با توجه به آمار رو به تزايد شكايات رشته چشم پزشكي و در عين حال ميزان اندك موارد منجر به قصور در مورد شايع ترين شكايت (كاهش بينايي)، لزوم برقراري ارتباط صحيح بين بيمار و پزشك و درك صحيح بيمار از اقدام درماني و عوارض احتمالي مي تواند دركاهش شكايات تاثير به سزايي داشته باشد. از طرفي با عنايت به اختلاف نظر در آراي كمسيون هاي متوالي، لزوم ايجاد وحدت رويه با استفاده از اطلاعات جديد و نتايج مبتني بر شواهد ضروري به نظر مي رسد.

Today, despite the efforts of the medical community and health staff, the rate of dissatisfaction and complaints among patients is increasing and this highlights the importance of evaluating its related factors. The aim of this study was to analytically investigate complaints against ophthalmologists which were referred to the Legal Medicine Organization of Iran in Tehran during 2017-2019. Methods In this cross-sectional (analytical-descriptive) study, the demographic data of patients and physicians including age, gender, marital status and academic degree, type of treatment measures leading to complaints, last decision of the medical commission, characteristics of protesting of patients and vote of revision commissions for all the complaints of ophthalmology were recorded and analyzed. Results During 3 years, 176 complaints were recorded in the field of ophthalmology. Of these, 90(51.1%) complaints were from medical interventions which took place in university or government hospitals and clinics. Also, 27(15.3%) cases of malpractice were reported, among which negligent was the most common type, with 22 cases (81.5%). The highest number of complaints was for cataract surgery and the most frequent treatments with malpractice of the physicians were cornea transplantation. Although the most protests to the first decision were from the patients, the effectiveness of physicians’ protest was significantly higher (P<0.001). Conclusion Nowadays, with advances in treatment methods and technologies in ophthalmology and enhancement in the knowledge of patients about their rights, their expectations from medical staff have changed. The findings of the present study suggest that due to the rise in the number of complaints in ophthalmological treatment while a decrease in malpractice rate, applying intervention actions such as good communication between physicians and patients and patient’s right perception of treatment and possible side effects can lead to less number of complaints. In addition, due to different opinions in consecutive commissions, utilizing a single approach based on new information and evidence seems necessary.