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ویرایش: [1 ed.] نویسندگان: Kevin Barraclough, Jenny du Toit, Jeremy Budd, Joseph E. Raine, Kate Williams, Jonathan Bonser سری: AVE - Avoiding Errors Series ISBN (شابک) : 9780470673577, 0470673575 ناشر: Wiley-Blackwell سال نشر: 2013 تعداد صفحات: [200] زبان: English فرمت فایل : PDF (درصورت درخواست کاربر به PDF، EPUB یا AZW3 تبدیل می شود) حجم فایل: 11 Mb
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توجه داشته باشید کتاب اجتناب از خطا در تمرین عمومی نسخه زبان اصلی می باشد و کتاب ترجمه شده به فارسی نمی باشد. وبسایت اینترنشنال لایبرری ارائه دهنده کتاب های زبان اصلی می باشد و هیچ گونه کتاب ترجمه شده یا نوشته شده به فارسی را ارائه نمی دهد.
برخی از مهم ترین و بهترین درس ها در حرفه یک پزشک از اشتباهات آموخته می شود. با این حال، آگاهی از علل رایج خطاهای پزشکی و ایجاد رفتارهای مثبت می تواند خطر اشتباهات و دادخواهی را کاهش دهد. برای پزشکان، کارآموزان و پزشکان عمومی سال پایه نوشته شده است، و بر خلاف هر عنوان دیگر مدیریت بالینی موجود، اجتناب از خطاها در طب عمومی رایج ترین خطاهایی را که احتمالاً در یک محیط سرپایی رخ می دهد را شناسایی و توضیح می دهد - به طوری که شما آنها را مرتکب نشوید. بخش اول در این راهنمای کاملاً جدید، علل خطاها را در عمل عمومی مورد بحث قرار می دهد. دومین و بزرگترین بخش شامل سناریوهای موردی است و شامل نظرات متخصص و حقوقی و همچنین نکات و استراتژیهای آموزشی بالینی است که به شما کمک میکند تا در طول حرفه خود در تمرین ایمنتر شرکت کنید. بخش آخر نحوه برخورد با شکایات و عواقب بالقوه پزشکی-حقوقی بعدی را مورد بحث قرار میدهد که به کاهش اضطراب شما هنگام برخورد با عواقب یک خطا کمک میکند. اجتناب از اشتباهات در تمرین عمومی که در طول سالهای پایه، آموزش تخصصی و برای مشاوران ارزشمند است، راهنمای عالی برای کمک به مقابله با چالش های حرفه ای و عاطفی زندگی به عنوان پزشک عمومی است. مرور "تجربه من به عنوان یک شاهد متخصص در موارد سهل انگاری بالینی، رئیس هیئت MPTS، مشاور پزشکی در یک تحقیق عمومی و به عنوان یک گزارشگر مستقل گاهی اوقات سفارش شده در مورد حوادث نامطلوب به من می گوید که این کتاب ها بسیار عالی هستند، برای همه پزشکان ارزشمند هستند، نه فقط برای کسانی که در سطح عالی هستند. - تخصص های ریسک؛ و تمام مدیران NHS که در حفظ یا بهبود کیفیت مراقبت نقش دارند. خلاصههای پرونده، به تنهایی، منبع مفیدی برای آموزش کارآموزان پزشکی در مورد مواردی هستند که ممکن است اشتباه کنند و چگونه با آن برخورد کنند.» (هاروی مارکوویچ، مجله ریسک بالینی) «این یک تمرین فوقالعاده در مهارتهای تفکر انتقادی است، یعنی توانایی تفکر از طریق تشخیصهای متفاوت و پیامدهای بلندمدت فراتر از واقعیتهای ساده ارائهشده. این کتاب ارزش یادگیری زیادی برای پزشکان جوان و میانسال دارد تا به آنها کمک کند تا مهارت های تشخیصی خود را تقویت کنند. (Doody's، 5 ژوئیه 2013) "این کتاب عالی 182 صفحه ای برای پزشکان عمومی در سال های اولیه طراحی شده است. منبع بسیار مفیدی برای همه کسانی است که در آموزش و راهنمایی کسانی که در عمل عمومی فعالیت می کنند، و فکر می کنم خواندن آن برای همه مدیران طب اجباری باشد. آنقدر مملو از اطلاعات، مفاهیم و مطالعات موردی است که به زبان انگلیسی مناسب نوشته شده است که به سختی می توانم آن را کنار بگذارم. بخش اول رزومه ای از قانون مربوط به تخلف از وظیفه پزشکی از جمله آزمون بولام را ارائه می دهد. علت، خسارت و محدودیت های زمانی برای دعوا مورد بحث قرار می گیرد. پروتکلها، دستورالعملها و ارتباطات در نظر گرفته میشوند و به دنبال آن جذابیت قلبی برای درس گرفتن از خرابیهای سیستم وجود دارد. این چیزی است که من می خواهم مدیران تمرین بخوانند. بخش بعدی به چگونگی دستیابی به تشخیص اولیه و سپس اصلاح میپردازد. اجتناب از گمراه شدن توسط برداشت های اولیه با آزمایش در برابر تشخیص افتراقی، حذف تشخیص هایی که نباید فراموش شوند، در نظر گرفتن حقایق نامناسب، و بازبینی پیگیری همه کمک می کند. در صورتی که بیماری مسیر مورد انتظار را دنبال نکند میتواند وضعیت را بازیابی کند و ثبت آن میتواند شهرت را نجات دهد. ارتباطات به عنوان هسته عمل ایمن شناخته می شود. من مفهوم ساده "از خود بپرسید که آیا یک همکار می تواند از یادداشت های شما جزئیات اساسی مشاوره را بیابد" را دوست دارم. سپس گوشت واقعی کتاب را دنبال می کند. این شامل چهل مورد بالینی اخیر است که هر کدام یک اتفاق ناگوار خاص را نشان می دهد. این چهل مورد، 95 درصد از علل شکایت از پزشکان عمومی را نشان می دهد. هر کدام یک مورد را در چند جمله به خوبی انتخاب شده توصیف میکنند و از خواننده میپرسند که چه فکر میکنند و ممکن است بعداً چه کار کنند. به عنوان مثال، یک تشخیص افتراقی انجام دهید یا معاینات ساده دیگری را انجام دهید. سپس یک نظر متخصص در مورد اینکه چه عملکرد خوبی شامل می شود داده می شود. به دنبال آن یک نظر حقوقی در مورد پرونده، از جمله محدوده احتمالی خسارت یا تسویه حساب، دنبال می شود. برخی از مبالغ خسته کننده است! هر مورد فقط دو صفحه را شامل می شود. این کتاب با پرسشها و دادگاههای مختلفی که ممکن است با آنها روبرو شود و توصیههای عملی برای رسیدگی به آنها به پایان میرسد. من صمیمانه امیدوارم که سایر پزشکان و مدیران تمرین این کتاب کوچک را مانند من برانگیزاننده بیابند.» (دانیل هاینز، FRCGP، MFFLM.)
Some of the most important and best lessons in a doctor’s career are learnt from mistakes. However, an awareness of the common causes of medical errors and developing positive behaviours can reduce the risk of mistakes and litigation. Written for Foundation Year doctors, trainees and general practitioners, and unlike any other clinical management title available, Avoiding Errors in General Practice identifies and explains the most common errors likely to occur in an outpatient setting - so that you won’t make them. The first section in this brand new guide discusses the causes of errors in general practice. The second and largest section consists of case scenarios and includes expert and legal comment as well as clinical teaching points and strategies to help you engage in safer practice throughout your career. The final section discusses how to deal with complaints and the subsequent potential medico-legal consequences, helping to reduce your anxiety when dealing with the consequences of an error. Invaluable during the Foundation Years, Specialty Training and for Consultants, Avoiding Errors in General Practice is the perfect guide to help tackle the professional and emotional challenges of life as a GP. Review “My experience as an expert witness in clinical negligence cases, MPTS Panel chairman, medical adviser to a Public Inquiry and as a sometimes commissioned independent reporter on adverse incidents tells me that these are excellent books, valuable for all clinicians, not just those in high-risk specialties; and all NHS managers involved in maintaining or improving the quality of care. The case vignettes, alone, are useful source material for teaching medical trainees on what can go wrong and how to deal with it when it does.” (Harvey Marcovitch, Clinical Risk journal) “This is a tremendous exercise in critical thinking skills, i.e. the ability to think through differential diagnoses and longer-term consequences beyond the simple facts presented. This book has great learning value for young and midcareer clinicians to help them hone their diagnostic skills.” (Doody’s, 5 July 2013) "This excellent 182-page book is designed for general practitioners in their early years. It will be a very useful source for all involved in teaching and mentoring those in general practice, and should, I think, be compulsory reading for all practice managers. It is so packed with information, concepts and case studies written in decent English that I found it difficult to put down. The first section gives a resume of the law concerning breach of medical duty, including the Bolam test. Causation, damages and time limits for litigation are discussed. Protocols, guidelines and communications are considered followed by a heart felt appeal to learn from system failures. This is what I want practice managers to read. The next section looks at how an initial diagnosis is reached, and then refined. Avoiding being misled by first impressions by testing against a differential diagnosis, excluding diagnoses that must not be missed, considering non-fitting facts, and follow up review all help. Making arrangements to review the case if the illness does not follow the expected course can retrieve the situation, and a record of this can save a reputation. Communication is recognised as the core of safe practice. I like the simple concept “Ask yourself whether a colleague could work out from your notes the essential details of the consultation.” Then follows the real meat of the book. This consists of forty recent clinical cases, each demonstrating a particular mishap. These forty cases bring up 95% of causes of complaints against general practitioners. Each describes a case in a few well-chosen sentences, and asks the reader what they think, and might do next. For example, make a differential diagnosis, or perform further simple examinations. An expert opinion is then given on what good practice would involve. This is followed by a legal opinion of the case, including the likely range of damages or settlement. Some of the sums are unnerving! Each case takes up just two pages. The book ends with the various enquiries and courts that may be faced, and practical advice on addressing them. I sincerely hope that other practitioners and practice managers will find this little book as thought provoking as I have." (Daniel Haines, FRCGP, MFFLM.)
Avoiding Errors in General Practice Contents Contributors Preface Abbreviations Introduction PART 1 Section 1: The legal structure of negligence A few words about error Medical negligence Negligence Has there been a breach of duty? Causation Damages The limitation period Jurisdictions Learning from system failures – the vincristine example Failure to follow protocols or guidelines Inadequate communication Reference Section 2: Causes of diagnostic errors in general practice and how they can be avoided How do general practitioners reach diagnoses? Initiation of the diagnosis Refinement Defining the final ‘diagnosis’ Where do errors occur in diagnosis? How can we minimize the risks of these errors? References and further reading Section 3: Bayesian reasoning and avoiding diagnostic errors References and further reading Section 4: A potpourri of advice on avoiding errors History and examination The telephone consultation Communication problems When lack of knowledge plays a part The unexpectedly abnormal result The standard of notes Drug errors or prescribing errors Consent Confidentiality Data Protection Act, 1998 Disclosure without consent Caldicott Guardians Conditions that are ‘frequent flyers’ in negligence cases Safety netting References and further reading PART 2 Clinical cases Introduction Case 1 A man with iron deficiency What would you have done with the results? What would you do now? What is your differential diagnosis? Expert opinion Legal comment References and further reading Case 2 When is a headache abrupt? What would you have done? What would you do now? What is your differential diagnosis? Do you think their claim will succeed? Expert opinion Legal comment References and further reading Case 3 A woman with chest pain What other information would you obtain? What would be your differential diagnosis and how would you discriminate between them? Do you think her claim will succeed? Expert opinion Legal comment References and further reading Case 4 A dizzy man What would you do now? What would be your differential diagnosis and how would you discriminate between them? Do you think his claim will succeed? Expert opinion Legal comment References and further reading Case 5 Rectal bleeding in a pregnant woman If you had been her GP what would you have done? Would you have done anything differently? Expert opinion Legal comment References and further reading Case 6 A pulled calf muscle What are the clinical features that you would consider discriminatory when assessing a possible DVT? What would you do now? Do you think her claim will succeed? Expert opinion Legal comment References and further reading Case 7 A woman with hemiplegic migraine What would you do now? What would be your differential diagnosis and how would you discriminate between them? Do you think his claim will succeed? Expert opinion Legal comment References and further reading Online resources Case 8 Irritable bowel syndrome after sickness in Goa What would be your differential diagnosis? What would you have done differently? Expert opinion Legal comment References and further reading Case 9 A young man with back pain Do you think his claim will succeed? Expert opinion Should Dr Mitchell have insisted on admission? Should Dr Murphy have sought admission? Legal comment References and further reading Case 10 Irregular intermenstrual bleeding in a woman on the pill What would you do? Would you have done anything differently? Expert opinion Legal comment References and further reading Case 11 A boy with a limp What is the differential diagnosis and what would you do now? Do you agree with the diagnosis? Would you have managed the case differently? Do you think his claim will succeed? Expert opinion Legal comment References and further reading Case 12 A runner with a cough What would you do now? What would be your differential diagnosis and how would you discriminate between them? Do you think her claim will succeed? Expert opinion Legal comment Further reading Case 13 A woman with classical migraine What would you do now? What bits of information would you want to elicit? What would be your differential diagnosis and how would you discriminate between them? Do you think her claim will succeed? Expert comment Legal comment Further reading Case 14 A young woman with diarrhoea and vomiting Why was the diagnosis of appendicitis missed? Expert comment Legal comment References and further reading Case 15 Ill-fitting dentures in an elderly man What would you do now? What would be your differential diagnosis and how would you discriminate between them? Do you think his claim will succeed? Expert comment Legal comment References and further reading Case 16 Back pain in a middle-aged woman What would you do now? Are any particular features on examination likely to be helpful? What would be your differential diagnosis and how would you discriminate between them? Do you think her claim will succeed? Expert comment Legal comment References and further reading Case 17 Cellulitis in a man’s foot Would you have done anything differently? Would this result have reassured you? Expert opinion Legal comment References and further reading Case 18 A flare-up of ulcerative colitis What would you do now? What would be your differential diagnosis and how would you discriminate between them? Do you think her claim will succeed? Expert comment Legal comment References Case 19 A woman with a skin lump on her leg Do you think a claim against Dr Welch will succeed? Expert comment Legal comment References and further reading Case 20 A woman with microscopic haematuria What would you do now? What would be your differential diagnosis and how would you discriminate between them? Do you think her claim will succeed? Expert comment Legal comment References Case 21 A limping young girl What would you do now? Do you think her claim will succeed? Expert comment Legal comment References and further reading Case 22 A builder tripping over his feet What would be your differential diagnosis and how would you discriminate between them? Do you think his claim will succeed? Expert comment Legal comment References and further reading Case 23 An anxious young woman with hyperventilation What would you do now? What would be your differential diagnosis and how would you discriminate between them? Do you think her claim will succeed? Expert comment What went wrong in this case? Legal comment Further reading and references Case 24 A slightly raised AST in an Asian woman What would you do now? What would be your differential diagnosis and how would you discriminate between them? Do you think her claim will succeed? Expert comment Legal comment References and further reading Case 25 Cough and fever in a 42-year-old accountant Would you have done anything else? Do you think his claim will succeed? Expert comment Legal comment References Case 26 Lost prescription: Benzodiazepine addiction What options were open to the GP? Should she speak to the police? Expert comment Legal comment Further reading Case 27 A febrile baby What features would you have specifically noted? Would you have done anything differently? Do you think his claim will succeed? Expert comment Legal comment Further reading and references Case 28 A limping elderly woman after a fall Would you have done anything differently? Do you think her claim will succeed? Expert comment Legal comment References and further reading Case 29 Indigestion in a stressed executive What would you do now? What would be your differential diagnosis have been and how would you discriminate between them? Do you think his claim will succeed? Expert comment Legal comment References and further reading Case 30 A hoped-for pregnancy What would you do now? What would be your differential diagnosis and what would you do? Do you think her claim will succeed? Expert comment Legal comment References and further reading Case 31 A breast lump that disappears What would you do now? Do you think her claim will succeed? Expert comment Legal comment References Case 32 Fever and cough after an ankle fusion Would you have done anything differently? Do you think the claim will succeed? Expert comment Legal comment References Case 33 Urinary problem in a welder What would you do now? Do you think his claim will succeed? Expert comment Legal comment References Case 34 A hypertensive 38-year-old woman What would you do now? Expert comment Legal comment References Case 35 A swollen lip in a 56-year-old man What would you do now? What would be your differential diagnosis and how would you discriminate between them? Do you think his claim will succeed? Expert comment Legal comment Reference Case 36 A woman with fatigue and weight gain What would you do now? Would you have done the same? Expert comment Legal comment References Case 37 A woman told off for ignoring her friends What would you do now? What would be your differential diagnosis and how would you discriminate between them? Would you have done anything else? Do you think the claim will succeed? Expert comment Legal comment Further reading and references Case 38 A man with a headache: Swine flu or meningitis? What would you do now? Was it reasonable to diagnosis swine flu and authorize Tamiflu? What would be your differential diagnosis and how would you discriminate between them? Can Dr Craig be criticized for his initial diagnosis of flu? Headache is relatively common with influenza. How does one avoid admitting everyone with flu? Expert comment Legal comment References and further reading Case 39 A woman suffering dizziness Was there anything else you would have checked? What would be your differential diagnosis and what would you have done? Do you think her claim will succeed? Expert comment Legal comment References and further reading Case 40 A middle-aged man with an ankle injury What other information would you obtain in a case such as this? Do you think a claim against the GP will succeed? Expert comment Legal comment Further reading PART 3 Investigating and dealing with errors 1 Introduction 2 How errors and their recurrence are prevented in primary care Guidelines and protocols Audit Appraisals Complaints management Significant Event Analysis 3 The role of the Primary Care Trusts Performers’ Lists 4 Other investigations National Clinical Assessment Service (NCAS) Partnership issues arising from errors The Care Quality Commission 5 Legal advice – where to get it and how to pay Medical Defence Organizations 6 External inquiries The Health Service Ombudsman Negligence claims and the litigation process Coroner’s Court Fatal Accident Inquiries Criminal matters Public inquiry General Medical Council in practice An example from general practice The GMC in future 7 The role of the doctor Witness statements Formal requirements Content Presenting oral evidence 8 Emotional repercussions 9 Conclusion Reference Index