Objective and subjective causes of medical errors. Errors in treatment tactics

Identify all possible ways of prevention medical errors and it is impossible to give uniform recommendations for all occasions. It is important to avoid diagnostic errors, as they lead to treatment errors. The diagnostic process requires constant improvement of general human and medical knowledge, development of medical thinking. These questions should be addressed in educational process, during practice, in the first years of production activity.

I.I. Benediktov identified three ways to prevent medical errors, which can also be extended to veterinary medicine doctors. This is the selection and training of personnel, the organization of the doctor’s work and his individual work on himself.

Work on the selection and training of a doctor of veterinary medicine should begin in school. If a person makes a mistake in choosing a profession, his activities will be of little use. Those involved in career counseling should speak frankly about the complexities of being a veterinary doctor. It is better when a person becomes disillusioned with this profession while still at school or in his first year than after graduation. When choosing a profession, the first place is given to its social prestige, financial support for the doctor, prospects for further career growth, etc.

It is possible that the development of genetics, biochemistry and other sciences will attract many capable people to veterinary medicine, and they will believe that they were born precisely for this profession. Indeed, at the time when Louis Pasteur, Robert Koch and others made their famous discoveries, the prestige of biological science was very high, and this attracted the most gifted people to it.

Of course, in your youth it is difficult to make the right choice of your future profession. It is important for the teacher to notice and support the young person’s interest in a certain branch of knowledge and thus reduce the randomness of choice.

In higher educational institution Not only the acquisition of knowledge, but also professional education is important. One should not gloss over reality, but present it as it really is. Young people, from their student years, will be prepared to overcome difficulties and solve complex issues.

Purposeful, well-organized work on the professional education of young people, the study of issues of medical ethics and deontology, and the personal example of senior comrades should strengthen young people’s love for their chosen profession. Raising a future doctor is an honorable task for the teaching staff of an educational institution.

During the training period, the personality of a veterinary medicine doctor is formed especially actively. I. I. Benediktov considers the following to be the main tasks of the university in this direction.

1. Education of general medical citizenship. In the process of mastering veterinary disciplines, a student must simultaneously receive moral and ethical education, starting from the first days of training. He should be helped to cultivate high human qualities that predetermine a cordial attitude towards others. After all, delicacy, goodwill, and humanity are great strengths for a doctor.

In the process of education, it is important to teach a specialist the correct behavior. It is errors in his behavior that sometimes cause significant harm to the entire veterinary medicine service.

2. Instilling basic knowledge in veterinary medicine. Moreover, it is necessary not only to teach the student to accumulate knowledge, but also to be able to creatively apply it in practical activities. And this can be achieved by teaching educational material through the prism of its critical assessment. If a future specialist not only hears about medical errors, but participates in their analysis, his knowledge is deeply absorbed.

Unfortunately, the issues of ethical and deontological education of veterinary doctors have not yet received adequate attention. And they should occupy an important place in student training, especially when studying clinical disciplines. It is necessary that these questions become a mandatory component of the entire system of educational work.

In the education of students, the power of the teacher’s personal example is of extraordinary importance. If he speaks sincerely and warns young people against medical errors that he himself once made due to lack of experience, his students will remember his words forever. In some educational institutions, following the example of M.I. Pirogova, S.S. Yudin and other scientists today, the best teachers teach students from their own mistakes.

At the same time, it is necessary to acquaint students with the complexities of the profession of veterinary medicine, without hiding from them either bitterness or failures. Teach a future specialist to overcome obstacles and find the right way out of difficult, seemingly hopeless situations. Brought up in an atmosphere of goodwill, after graduation, the doctor will strive to create the same conditions in his team.

Self-education of a doctor- this is the path to the conscious formation of character, the development of the best human qualities. It contributes to the development of the doctor’s personality, communication with people in the team, and forms the ability to distinguish the real, the true from the artificial, feigned.

The main goal of self-education for a doctor of veterinary medicine is to deeply master the profession, cultivate freedom, strong ethical principles, and the ability to think professionally. A university provides a foundation of knowledge or, figuratively speaking, forms a mental springboard, which later allows you to independently obtain the necessary knowledge.

The main directions of self-education of medical qualities, professional auto-training of a doctor are as follows.

1. Systematic acquaintance with the latest scientific and technical information, special literature, periodicals on issues of veterinary and humanitarian medicine.

2. Development of medical thinking, which is formed on the basis of information, knowledge, experience, in-depth analysis and successes and mistakes in practical work.

3. Mastery of research methods, mastery of skills in working with any diagnostic or therapeutic equipment and devices.

4. Education of a medical character, i.e. qualities necessary to fulfill a medical duty (confidence, observation, self-criticism, a sense of the new, etc.).

Confidence is the key to success as a doctor. But it is necessary to ensure that it does not turn into self-confidence. Therefore, it is important to always maintain a critical attitude towards your own thoughts and actions. Don’t be afraid to question the data obtained during animal research and subject it to multiple checks. This is the only way to achieve high professionalism.

Doctors are much more likely than other specialists to become somewhat skeptics. Over the years of work, they have repeatedly been disappointed with either a new drug or a new method, on which they had high hopes. Often the results of experimental and clinical studies do not coincide. Scientists limit themselves to studying the function of a single organ or the effect of a drug on a specific body system. A doctor of veterinary medicine must consider the body as a whole, see the interconnections of organs and systems and their disorders during illness. Therefore, only a practitioner can correctly assess the effect of a drug and foresee possible complications. It is not enough to know chemotherapy drugs; you also need to skillfully use them, which, unfortunately, is not taught much in educational institutions.

Therefore, for a doctor of veterinary medicine, the following features are most significant.

1. Maximum self-criticism. Only such a person is able to detect and quickly correct a wrong action or behavior. You need to be a strict judge of yourself.

2. Love for systematic and persistent work. The work of a doctor cannot be regulated by the working day; one should devote oneself completely to it. K.I. Scriabin wrote:

“I am sure that a person can be truly happy only when he loves his profession, is satisfied with his work and is devoted to it with all his soul, when he feels that it is necessary for society, and his work brings benefits to people.”

3. A sense of responsibility for the assigned task, observation. With the development of science, attempts are being made to replace some of the doctor’s functions with computers. But professional observation cannot be replaced by anything. Therefore, in the doctor’s self-education system, special attention must be paid to its improvement.

4. Medical memory is the ability to reproduce all the data about a patient when meeting him a few days later. It develops for every doctor through constant exercise. Without such memory, he will not be able to closely monitor the course of the disease in a given animal, compare the results of daily observations with previous ones, or correctly evaluate the effectiveness of treatment.

5. Speed ​​of reasoning. It is known that timely and correct diagnosis of the disease is the key to successful treatment. A young doctor often feels uncertain after examining an animal and cannot quickly make a diagnosis. Early independent work is important here. You shouldn’t work “under tutelage” for a long time; it’s better to think and act more independently.

6. A caring attitude towards a sick animal and a sensitive attitude towards its owner. You should develop a sense of humanity and master the rules of medical ethics.

Summarizing the above, it should be noted that self-improvement and constant scientific and practical training are the basis for the education of a specialist, which is laid in an educational institution and should continue in the daily work of a doctor through self-education.

Self-training is a constant process that cannot happen on its own. You need to have a plan that takes into account the level of knowledge of the doctor, the strengths and weaknesses of his training.

But self-preparation planning will do nothing if it is not supported by self-control. A novice doctor should accustom himself to systematically (perhaps weekly) sum up his work according to the following scheme: what have I learned and mastered new; what new methods have you mastered? what were the shortcomings and achievements in my work; Did I work enough this week? If not, then why is it important how the long-term self-training plan is carried out? If this process is under threat, then what adjustments should be made to it.

I. V. Davydovsky (1941), Yu. P. Edel (1957), N. I. Krakovsky and Yu. Ya. Gritsman (1967), B. M. Khromov (1972), G. devoted their works to studying the causes of errors. G. Karavanov and V. V. Korshunova (1974), M. R. Rokitsky (1977), A. I. Rybakov (1988), etc. I. V. Davydovsky considers medical errors to be a conscientious error of the doctor due to or imperfection of medical science , either a special course of the disease in a particular patient, or insufficient experience and knowledge of the doctor. He divides errors into subjective (inadequate examination, lack of knowledge, ease and wariness of judgment) and objective (imperfection of medical science, excessively narrow specialization, difficulty of research). When analyzing specific errors, unjustified subjectivity in assessing facts should be condemned; Objective reasons suggest that some errors are considered inevitable.

V. M. Smolyaninov (1970) identified two categories of causes of doctor errors. To the first, he attributed the imperfection of medical science, to the second, the doctor’s insufficient primary awareness of. state and prospects for the development of medical science and practice (defects medical training bordering on illiteracy or defects in medical culture); diagnostic and therapeutic standardization, turning into a healing template; use of outdated diagnostic and treatment methods; insufficient practical experience; special circumstances of providing assistance that require prompt decisions and actions; accidents. The result of errors is the lack of the expected diagnostic or therapeutic effect, harm to the patient’s health or death. The criterion that defines medical error is bona fide error.

Other classifications of the causes of errors are also known. I. I. Benediktov (1977) proposed a classification that provides for the causes of diagnostic errors of an objective, mixed and subjective nature. This classification includes factors that can lead to diagnostic errors. The most complete classification of medical errors is presented by M. R. Rokitsky (1977).

/. Diagnostic errors:

a) reviewed diagnosis (during examination, the doctor does not detect signs of disease in the patient, considering him healthy). For example, the dystrophic form of periodontitis is mistaken for senile involution of the alveolar bone;

b) partially reviewed diagnosis (the main diagnosis has been established, but the accompanying diagnosis has not been established). For example, a diagnosis of submandibular phlegmon has been established, but it has not been established that the patient has diabetes mellitus; V) misdiagnosis

. For example, a diagnosis of “radicular cyst” was made, and the patient had adamantinoma; d) partially erroneous diagnosis (the main diagnosis is correct, but there are errors in the diagnosis of complications and concomitant diseases

). For example, a diagnosis of “phlegmon of the pterygomaxillary space” was made, but it was discovered that it was complicated by phlegmon of the infratemporal and pterygopalatine spaces.

2.

Treatment and tactical errors:

a) when determining indications for emergency or emergency care. For example, if a diagnosis has been made of “incipient phlegmon of the submandibular region,” the doctor does not perform an autopsy, waiting until there are several such patients;

b) when choosing a treatment regimen (inpatient or outpatient). For example, for a salivary stone located in the salivary gland, surgery is performed on an outpatient basis; mistake - the operation should be done in a hospital; instrumental method research (rupture of Wharton's duct with the introduction of a probe wider than the diameter of the duct, or perforation of the bottom of the maxillary cavity with careless probing of the socket | Tzuba);

b) when performing access operations to the source. For example, when opening a cellulitis, a very small incision is made. It turns out to be a narrow, deep “well” in the form of a funnel, the outflow of pus is poor, and it is difficult to stop the bleeding.

Conditions that may cause errors to occur:

a) critical situations requiring emergency decisions or actions from the doctor. For example, after removing a tooth whose root is in a hemangioma, profuse bleeding begins, which is difficult to stop; or opening of phlegmon without blood tests in a patient with chronic leukemia, if this operation was not performed for health reasons. “Performing an operation is more or less a matter of technique, while abstaining from an operation is a skillful work of refined thought, strict self-criticism and subtle observation,” said Kulenkampf;

b) errors in the organization of medical services. Doctor overload; distracting him to perform tasks not related to patients; placement of therapists (dental treatment) and surgeons (tooth extraction) in the same office; the table is incorrectly equipped (various medications that are not needed for a given patient), which facilitates the administration of the wrong medication;

c) doctor fatigue. Heavy sleepless duty, long-term difficult surgery leading to decreased attention, etc.;

d) unhealthy moral climate in the institution. “Sitting,” nervousness, distrust, and slander undermine the doctor’s self-confidence and prevent him from giving strength, experience, and knowledge to the patient;

e) the lack of a systematic and fundamental analysis of medical errors creates an atmosphere of undemandingness, mutual forgiveness, hushing up errors, miscalculations and failures. All errors should be analyzed and discussed. The true benefit of studying mistakes will be all the more effective if the doctor who made it is the most picky. Analysis of mistakes should be carried out at all levels in a spirit of goodwill and comradely assistance.

One of the conditions leading to the occurrence of medical errors is the incorrect opinion in our society that medical care should be classified as a service sector. This deeply erroneous opinion devalues ​​the work of a doctor, simplifies his selfless work, and does not reflect its essence (protecting public health). The work of a doctor cannot be compared with the work of a hairdresser, tailor, salesman, etc.

The result of treatment largely depends on the patient’s attitude towards the doctor. It should be based on respect and trust, consisting in unquestioning compliance with the daily routine in the hospital, accurate and timely fulfillment of all doctor’s prescriptions, all possible assistance to the doctor in order to quickly defeat the disease. Often a patient comes to the doctor after studying his illness; he received information about it from friends, more often it is misinformation, because such a patient has no clinical thinking, if he is not a doctor himself. The patient argues with the doctor, lectures, writes complaints, considering the actions of his attending physician to be erroneous. Such a patient does not know and does not want to know that medicine is still far from perfect, that there are diseases that are difficult to treat.

As already noted, the quality of a doctor’s work depends on the working conditions - it is very difficult to work in a general office, where there is a moan, a scream, and the blood of a neighboring patient, which does not at all contribute to the doctor’s analytical thinking when collecting anamnesis, examining and making a diagnosis. Of course, all this negatively affects the patient.

According to I. T. Maltsev (1959), a young doctor, due to insufficient training and awareness, makes mistakes in 17.8% of cases; in 26% - as a result of an unsatisfactory examination of the patient.

According to Yu. P. Edel (1957), at an outpatient clinic, 37.5% of erroneous diagnoses are made due to limited time for examining the patient, 29.5% - due to the inexperience of the doctor, 10.5% - due to his negligence.

According to N.V. Maslenkova (1969), the frequency of erroneous diagnoses in all hospitals (dental patients) is 7.3%. Errors in diagnosis occurred most often when inflammatory diseases - 13,5

%; specific inflammatory diseases maxillofacial area-19.3%; for diseases of the salivary glands - 9%; for congenital malformations -2%; for injuries - 3.3%. Without a diagnosis, 13.3% of patients were sent to the hospital. Moreover, patients with injuries predominated - 3 1.7%, with odontogenic sinusitis - 23.8%, with congenital malformations - 26.5%, with diseases of the salivary glands - 22.4%,

Yu. I. Vernadsky and G. P. Vernadskaya (1984) divide the causes of errors encountered in the practice of dental surgeons into 4 groups.

The first group: the applicant’s unsuccessful choice of the profession of a dental surgeon; studying at a higher dental educational institution with an inactive, inexperienced or not very competent teacher; insufficient diligence when studying surgical dentistry at university and internship; poor organization of educational and research work of students at the university; rare or passive participation by a doctor in courses or in advanced training institutes; failure to attend meetings of scientific dental societies; lack or loss of interest in reading domestic or foreign scientific literature on surgical dentistry. All this leads to low professional competence and training, and inevitably gives rise to gross errors in work.

Second group: insufficient dental care

logical institutions with equipment that allows the use modern methods(biochemical, cytological, polarographic, potentiometry, thermal imaging, electromyography, radiometry, tomoradiography, etc.) diagnosis of diseases.

Third group: exposure (atypical course) of a number of diseases, which is especially dangerous if the doctor is overly self-confident or fears of revealing his ignorance to colleagues.

Fourth group: insufficiently thought-out planning of all the details of the upcoming operation; poor provision of the surgeon with the instruments and devices necessary for the operation; insufficient anesthetic support, etc.

A.I. Rybakov (1988) also divides errors in dentistry into 4 groups: 1.

Unexpected errors. The doctor acts correctly, but during the treatment unforeseen situations arise.

2.

Due to the negligence or negligence of a doctor (other health workers); arising during reception in unsuitable conditions (poor lighting, old equipment).

3.

Due to the doctor’s low professional training and inexperience. 4., be able to listen and observe the patient, analyze data; Sometimes consultations with doctors of other specialties, x-ray*nography, sialography, etc. are necessary. Naturally, the allotted time for a quality examination is not enough, and as a result, errors may occur. In conditions maxillofacial An inpatient dental surgeon discovers an error made by a clinic doctor when diagnosing, for example, phlegmon, especially in the temporal, infratemporal and pterygopalatine regions. According to G.I. Semenchenko (1964), inflammation of the submandibular region caused by salivary stone disease is often diagnosed as acute odontogenic osteomyelitis lower jaw; the same diagnosis is made with exacerbation of perihilar and follicular cysts and acute sinusitis; for intraosseous malignant tumors only on the basis acute pain teeth or teeth are also diagnosed with acute odontogenic osteomyelitis.

According to V. S. Kovalenko (1969), about 30% of patients with salivary stone disease were erroneously treated on an outpatient basis for tonsillitis, glossitis, submandibular phlegmon, phlegmon of the floor of the mouth, tuberculosis and cancer of the lymph nodes. The erroneous tactics of dentists in the treatment of jaw fractures is indicated by the fact that up to 92% of victims are admitted to the clinic without immobilization (Yu. I. Vernadsky, 1969). Of 467 patients with fractures of the lower jaw, only 233 (50.6%) had a correct diagnosis (P.V. Khodorovich, 1969). During reconstructive operations on the face, mistakes are made in planning surgical interventions due to incomplete examination and analysis of the patient’s existing defect; it is erroneous to restore an organ on the face without the support necessary for this purpose or “...cutting out a skin tape for the Filatov stem in the area of ​​the elbow bend” (N. M. Mikhalson, 1962), which can lead to wound healing secondary intention, scar formation and contracture of the forearm. “The main reason for many errors leading to reoperations is that the surgical activity of doctors has increased, and most dentists and surgeons still do not have deep knowledge of cheiloplasty and uranoplasty. Sutures on the lip are applied roughly, the mucous membrane is sewn between the skin edges membrane; an incision is not made in the vestibule of the mouth. A common mistake made by dentists is the irrational, untargeted, indiscriminate use of antibiotics, leading to the development of antibiotic-resistant strains of microorganisms, dysbacteriosis, and candidiasis. For error-free tactics when using medications, it is necessary to follow the basic principles of rational antibiotic therapy.

The negative consequences of a dentist’s activity may be associated with an accident, which is understood as an unfavorable outcome of a medical intervention caused by random circumstances that he could not foresee and prevent, for example, individual intolerance to an anesthetic (A.P. GrGomov, 1979). The forensic medical literature describes a case of death after smearing the gums with dicain before tooth extraction (I. A. Kontsevich, 1983). When examining the corpse, no changes were found that would explain the cause of death, nor were any impurities found in dicaine. Unfortunately, in dental practice there are accidents that cannot be foreseen. Let's look at some of them.

A 29-year-old patient had a tooth removed, after which she became very pale, her pupils dilated, her pulse became threadlike, and death occurred (G. Ya. Pekker, 1958). E. G. Klein and A. Ya. Krishtul (1969) describe 2 cases of death after tooth extraction: in a 20-year-old patient, death occurred from asphyxia caused by Quincke's edema, in a 43-year-old patient - from acute failure adrenal cortex.

Let us give an example of a medical error from our practice.

Patient N., 57 years old, in 1967 complained of swelling of the soft tissues of the face and discomfort in the lower jaw on the right. 3 months ago he had a partial removable dental prosthesis made for his lower jaw. Roots 65 | teeth were not removed before prosthetics. From the anamnesis it was found out: there was no heredity, he was practically healthy, but he often drank alcoholic beverages and smoked a lot. Upon examination, a slight asymmetry of the face was established due to swelling of the soft tissues in the area of ​​the right corner of the lower jaw. The mouth opens by 2.5-3 cm. Regional movable jaws The lymph nodes on the right they are slightly enlarged, painless on palpation, mobile, on the left they cannot be felt.

On the upper jaw, a complete removable dental prosthesis, made 4

years ago, on the bottom - a partial removable denture, made at the same time. On the right, part of the alveolar base rests on the mobile roots of 651 teeth. The mucous membrane around the roots is sharply hyperemic and ulcerated. The edges of the ulcer are smooth, not everted. Individual areas of ulcerated mucous membrane are pinched between the edges of the roots and the base of the prosthesis.

Diagnosis of chronic periodontitis of the roots 65 | teeth, decubital ulcer of the mucous membrane of the alveolar process.” The roots were easily removed under mandibular anesthesia (4 ml of 2% novocaine solution). The bleeding was significant and inadequate to the intervention. After tamponade with iodoform gauze, the bleeding did not stop; tamponade and suturing of the dental sockets with catgut were performed. During suturing, the tissues easily tore and spread, which led to increased bleeding. After the bleeding stopped, the patient was sent home with a warning to call an ambulance if bleeding resumed. The next day, the patient presented with a complaint of sharp pain and increasing swelling of the face on the right. Strong pain and significant facial asymmetry in the area of ​​the right angle of the lower jaw did not correspond to the severity of the intervention. A suspicion of a cancerous ulcer arose. With a diagnosis of “Susp* ulcus maligna,” the patient was sent to the Kiev Oncology Research Institute, where he was diagnosed with “cancer of the lower jaw, inoperable.” After the course radiation therapy the tumor has decreased in size. The patient was discharged home and was under the supervision of a doctor at the oncology clinic. However, after 3.5 months, tumor growth resumed and reappeared sharp pain. The patient at the oncology clinic managed to read the records in the history of his illness, with the help of “friends”-medical workers, decipher them and find out the true diagnosis. During the next attack of pain (morphine no longer helped), the patient committed suicide.

IN in this case Several mistakes were made. The first is diagnostic: the doctor was unable to distinguish a cancerous ulcer from a decubital ulcer due to honest misconception and the complexity of the course of the disease; the development of complicated caries and the presence of dental prostheses caused infringement of the oral mucosa. The second is organizational: the patient should not have

get his hands on a medical history from which he copied the diagnosis. The behavior of the medical personnel was deontologically unacceptable.

Here is an example of a mistake made by a young doctor whose self-confident actions led to the death of a patient.

Patient M., 80 years old, in 1981 turned to dental clinic Kyiv Medical Institute for chronic periodontitis_7_| tooth The tooth had to be removed. After anesthesia, an attempt was made to remove the tooth using forceps, but the tooth did not loosen. Considering age-related changes jaws, we suggested that the doctor use a fissure bur and drill to remove the vestibular wall of the alveolar process, cutting out and exposing the buccal roots, which should have facilitated tooth extraction. The doctor agreed with us, but continued to loosen the tooth with forceps and elevators. Due to the application of great forces, the 7th tooth was removed along with part of the alveolar process, the bottom of the maxillary cavity, and the tubercle of the upper jaw. Profuse bleeding began, which could not be stopped. The patient was urgently hospitalized in the maxillofacial department, where, despite the measures taken, he died.

The doctor did not know the specifics of tooth extraction in elderly and old age who have osteoporosis and osteosclerosis, inflexibility of the bone walls of the alveolar process, fusion of the roots of the tooth with the bone - synostosis, and used the wrong method of tooth extraction. If the methods recommended by experienced colleagues had been applied, the tragedy would not have occurred.

A doctor must have the courage to admit his mistakes. Their concealment is a consequence of a false idea of ​​the doctor’s authority or excessive pride.

Analysis and analysis of errors are of great importance educational value, but they must be carried out kindly. You cannot condemn a colleague who has made a mistake behind his back. At medical conferences, when analyzing errors, there should be impartiality, collegiality, and a businesslike atmosphere.

Analyzing the mistakes of dentists, we can conclude that they are based on insufficient professional training, lack of conditions for providing the necessary medical care at the proper level, formal, sometimes negligent attitude towards patients. Therefore, the prevention of medical errors should be aided by erudition and culture, constant self-study and self-education, high moral qualities, and professional honesty, which manifests itself in the awareness of a mistake.

IN medical practice There are often situations where, due to errors by medical workers, patients suffer serious injuries or even die. Most often, doctors describe such situations as an unintentional act. However, if it is determined that the cause of the tragedy was medical negligence or the carelessness of the physician, the mistake quickly turns into a criminal offense for which the doctor will be punished.

Features and classification of medical errors

The legislator has not yet given a clear definition of the concept of medical error. You can catch a glimpse of it in the “Fundamentals of the Legislation of the Russian Federation on Health Protection” and the Federal Law “On Compulsory Insurance of Patients in the Provision of Medical Care.” Wherein, criminal law does not contain any norms devoted to this concept at all.

Therefore, the wording of the definition can be very diverse. The most common interpretations of the concept of medical error according to the classification are:

• the inability of a health worker to use theoretical knowledge in the field of medicine in practice and leaving the patient without qualified assistance as a result of the inaction of the attending physician;
• misdiagnosis of the patient and incorrectly prescribed medical procedures due to the doctor’s misconception;
• medical error in the performance of one’s professional duties as a result of a mistake that does not have any basis in a crime;
• result professional activity a doctor who, due to some neglect, has committed an error in his professional field, but this is in no way related to inactivity or negligence.

Whatever interpretation the user chooses, the result will still be the same. Depending on the damage received, the patient can write a complaint against the doctor or go to court.

Due to an error, the patient’s health is exposed to unprecedented danger and can lead to death.

Medical error essentially refers to generic concepts, and therefore it is classified into the following crimes:

• Article 109 of the Criminal Code of the Russian Federation – causing death by negligence;
• Article 118 of the Criminal Code of the Russian Federation – causing harm to health of increased severity through negligence;
• Article 124 of the Criminal Code of the Russian Federation – inaction of medical staff and failure to provide timely assistance.

In Western Europe and the USA, there are regulations in the medical industry, and any mistake entails a violation of the approved rules. Consequently, the offender will be held accountable for his misconduct. In Russia, such judicial practice is not used, and therefore it can be incredibly difficult to prove that a doctor made a mistake due to negligence or other reasons. However, if it is established that the doctor had all the necessary knowledge and resources to provide timely assistance, but did not do this due to certain circumstances, then the negligence of the doctors will be recognized, for which he will be held liable.

In any situation, the law will first of all take the side of the victim, since medical error is considered a criminal violation. However, she has very a large number features, including:

1. Most often, the error occurs due to accidents and does not imply any bad intentions on the part of the medical staff. This alone makes it possible to commute the sentence of the attending physician if it is not established that his actions (inaction) are malicious.
2. The objective basis for the occurrence of an error may consist of a number of factors, including inattention, lack of experience and qualifications, and negligence. All of them can serve as a reason for mitigating the punishment.
3. Subjective reasons for doctors’ mistakes include ignoring approved rules, neglecting medications and negligence when conducting any examinations. Such reasons may lead to increased liability in legal proceedings.

In order to determine at what stage of working with the patient errors were made, they are usually classified into the following types:

• diagnostic, which occurs most often; at the stage of examining the patient, the doctor does not take into account the specifics of the human body and makes an incorrect diagnosis;
• organizational, related to the lack of material support for the medical institution, as well as an insufficient level of medical care;
• treatment and tactical errors, this type occurs on the basis of an erroneous diagnosis, and the medical measures taken may lead to a deterioration in the person’s health;
• deontological, associated with the unsatisfactory psychophysical state of the doctor, and his incorrect line of behavior with patients, their relatives and other medical staff;
• technical, they are associated with incorrect preparation of the patient’s medical record or extract;
• pharmaceuticals, which appear due to the fact that a specialist incorrectly determines indications and contraindications, and also does not pay attention to compatibility various groups medications.

If you want to delve even further into this topic and find out what it is medical secrecy then read about it.

Causes of medical errors

Medical error occurs in situations where a certain action or inaction of a health care professional caused a deterioration in the patient’s condition or death. If the error is determined to be directly related to neglect of job description or negligence, the physician will be disciplined.

The reasons that led to the appearance medical errors can be subjective or objective. The most a shining example The objective reason is the atypical behavior of the disease and its impact on human health. Thus, if a new strain of the virus has appeared that has not yet been sufficiently studied, and damage is caused as a result of treatment, the doctor will not be held liable, since the error here will be due to a lack of intent.

As for the subjective reason, the situation here will be somewhat different. Thus, an error may occur due to the doctor’s lack of experience, incorrect filling out of medical documentation, or inappropriate behavior.

Criminal liability will be established in accordance with the current legislative framework.

Characteristics of the crime

Since there is in principle no separate standard for doctors who have made a mistake in the professional sphere, negligent actions of medical staff are a priori considered as neglect of official duties, which are designed to regulate professional activities.

Acting as an official, a doctor can commit a crime in situations where the patient has died or his health condition has deteriorated sharply. In view of this, the crime will consist of various factors:

1. Objectivity. It is expressed in the presence of certain duties and instructions that the doctor neglected due to negligence, inattention to detail or underestimation of the seriousness of the disease. However, if the disease exhibits atypical characteristics, then the cause-and-effect relationship will be uncertain, and the medical staff will be exempt from punishment.
2. Subjectivity, expressed by the presence of a medical employee whose actions led to the appearance negative consequences for the patient's health, or death.
3. Damage, which consists in recording an event (deterioration in health or death) that is directly dependent on the prescribed treatment procedures and the chosen treatment method.

If all three factors are present, then the doctor’s crime will be classified under Article 293 of the Criminal Code of the Russian Federation, and a certain type of punishment will be established for the negligence of doctors. Qualified medical malpractice attorneys can help you achieve justice.

Liability for medical malpractice

Liability for medical malpractice can be of three types:

1. Disciplinary. In this situation, the error was identified by an internal investigation and a thorough analysis of the doctor’s actions. If the harm caused is minor, the violator will be fined, sent for retraining, deprived of positions or transferred to another place of work. A reprimand will also appear in the doctor’s work record.
2. Civil law. If the doctor's actions cause harm to the patient, he may demand monetary compensation, including compensation for damages, the cost of all additional medications and care, moral compensation.
3. Criminal proceedings ordered in situations where the user received poor-quality medical services that resulted in serious harm to health or death. In situations where the damage is minor, it will be impossible to initiate criminal prosecution of the doctor. In addition, there will be a deprivation of the right to engage in medical practice in the foreseeable future for a certain period.

As an example of criminal proceedings on this topic, the following situations can be mentioned:

• an illegal abortion was carried out, due to which the woman received serious injuries or died, the offender will be punished under Part 3 of Article 123 of the Criminal Code of the Russian Federation;
• due to the doctor’s neglect, the patient was infected with HIV, in this situation the doctor will serve his sentence in prison for 5 years in accordance with the provisions of Part 4 of Article 122 of the Criminal Code of the Russian Federation;
• illegal medical and pharmaceutical assistance will be punished under Part 1 of Article 235 of the Criminal Code of the Russian Federation, if it involves fatal outcome, the case will be classified under Part 2 of Art. 235 of the Criminal Code of the Russian Federation, but it will be complex, and a good lawyer will be required;
• failure to provide assistance resulting in moderate or mild harm will be considered under Art. 124 of the Criminal Code of the Russian Federation, if the injuries are more serious, the medical worker will go under Part 2 of Article 124 of the Criminal Code of the Russian Federation;
• If a case of medical negligence and neglect of current standards is established, the person responsible will be convicted in accordance with Part 2 of Article 293 of the Criminal Code of the Russian Federation.

Please note that the injured party has the right to full compensation.

If criminal proceedings are initiated, the victim also has the right to file a lawsuit to receive compensation for the damage caused. This is stated in Art. 44 of the Code of Criminal Procedure of the Russian Federation, the legislator does not establish clear amounts of monetary compensation, therefore the level of damage in monetary terms must be assessed by the user independently.

It is worth saying that the amount of compensation will consist of material and moral damage. In the first case, this will include all costs for expensive treatment and the purchase of medications, as well as payment for additional care services. If the user is unable to work, this will also be taken into account. As for moral damages, the victim can request any amount, provided that its size is not greatly exaggerated.

Where to go and how to prove medical error

The law always protects the interests of the patient, so you should not be afraid to defend your point of view. In cases where there is a medical error that costs the victim his health or life, users will have to turn to such officials and authorities:

1. Administration of a medical institution. The management of the clinic will need to clarify the problem in detail and provide evidence. After an official investigation, if guilt is proven, the health worker will be subject to disciplinary action.
2. Insurance Company. If you have insurance, the victim or his representative will have to visit the insurers and explain the situation to them, and an examination will be initiated, which will show whether the medical staff is really to blame for the current situation. If the applicant's version is confirmed, fines will be imposed on the doctor and the clinic.
3. Courts. A claim must be sent here, which will carefully describe the situation and the applicant’s requirements. In addition, the user will have to take care of collecting evidence base. Based on the claim, legal proceedings will be opened, and if everything is confirmed, the plaintiff will receive compensation.
4. Prosecutor's office. This is where you need to contact if the user intends to initiate a criminal case. Please note that the proceedings will be long and will entail serious consequences for the offender.

The concept of medical errors, their classification.

As in any other complex mental activity, in the diagnostic process incorrect hypotheses are possible (and making a diagnosis is the formulation of hypotheses that are either confirmed or rejected in the future), diagnostic errors are possible.

In this chapter, the definition and essence of the very concept of “medical errors” will be analyzed, their classification will be given, the causes of medical errors, in particular diagnostic errors, will be considered, and their significance in the course and outcome of diseases will be shown.

Unfavorable outcomes of diseases and injuries (deterioration of health, disability, even death) are due to various reasons.

The first place should be given to the severity of the disease itself (malignant neoplasms, myocardial infarction, other forms of acute and exacerbation of chronic coronary heart disease and many others) or injuries (incompatible with life or life-threatening injuries, accompanied by severe shock, bleeding and other complications , III-IV degree burns of significant surfaces of the body, etc.), poisoning with various substances, including drugs, as well as various extreme conditions (mechanical asphyxia, exposure to extreme temperatures, electricity, high or low atmospheric pressure) and etc.

Late appeal for medical help, self-medication and treatment from healers, criminal abortions also often lead to severe consequences for people's health and life.

A certain place among the adverse outcomes of diseases and injuries is occupied by the consequences of medical interventions, late or erroneous diagnosis of a disease or injury. This may result from:

1. Illegal (criminal) intentional actions of medical workers: illegal abortion, failure to provide medical care to a patient, violation of rules specifically issued to combat epidemics, illegal distribution or sale of potent or narcotic substances and some others.

2. Illegal (criminal) careless actions of medical workers that caused significant harm to the life or health of the patient (negligence in the form of failure to perform or dishonest performance of their official duties; grave consequences as a result of gross violations of diagnostic or therapeutic techniques, failure to comply with instructions or instructions, for example, transfusion of blood of a different group due to violations of instructions on determining blood group), when the doctor or paramedical worker had the necessary capabilities to take correct actions to prevent the development of complications and associated consequences.

Criminal liability in these cases occurs if a direct causal connection is established between the action (inaction) medical worker and the grave consequences that ensued.

3. Medical errors.

4. Accidents in medical practice. Not a single person, even with the most conscientious performance of his duties, in any profession or specialty, is free from erroneous actions and judgments.

This was recognized by V.I. Lenin, who wrote:

“The smart one is not the one who doesn’t make mistakes. There are no such people and there cannot be. Smart is the one who makes mistakes that are not very significant and who knows how to correct them easily and quickly.” (V.I. Lenin - Childhood disease of “leftism” in communism. Collected works, ed. 4, vol. 31, Leningrad, Politizdat, 1952, p. 19.)

But the doctor’s mistakes in his diagnostic and therapeutic work (and preventive, if it concerns a sanitary doctor) are significantly different from the mistakes of a representative of any other specialty. Suppose the architect or builder made a mistake when designing or building the house. Their mistake, although serious, can be calculated in rubles, and, ultimately, the loss can be covered in one way or another. Another thing is a doctor’s mistake. The famous Hungarian obstetrician-gynecologist Ignaz Emmelweis (1818–1865) wrote that with a bad lawyer, the client risks losing money or freedom, and with a bad doctor, the patient risks losing his life.

Naturally, the issue of medical errors worries not only the doctors themselves, but also all people, our entire public.

When analyzing medical errors, it is necessary to define them. It should be noted right away that lawyers do not have the concept of “medical error” at all, because error is not a legal category at all, since it does not contain signs of a crime or misdemeanor, that is, socially dangerous acts in the form of action or inaction that caused a significant (crime) or minor (misdemeanor) harm to the legally protected rights and interests of an individual, in particular health or life. This concept was developed by doctors, and it should be noted that at different times and by different researchers, different content was put into this concept.

Currently, the following definition is generally accepted: a medical error is a conscientious error of a doctor in his judgments and actions, if there are no elements of negligence or medical ignorance.

I.V. Davydovsky et al. (Davydovsky I.V. et al. Medical errors. Great Medical Encyclopedia. M., Sov.encyclopedia, 1976, vol. 4, pp. 442–444.) give the same essentially definition, but in slightly different words: “...a doctor’s mistake in the performance of his professional duties, which is the result of an honest mistake and does not contain a crime or signs of misconduct.”

Consequently, the main content of this concept is error (incorrectness in actions or judgments), as a consequence of an honest mistake. If we talk, for example, about diagnostic errors, this means that the doctor, having questioned and examined the patient in detail using methods available under certain conditions, nevertheless made a mistake in the diagnosis, mistaking one disease for another: in the presence of symptoms “ acute abdomen“considered that they indicate appendicitis, but in fact the patient developed renal colic.

Questions to consider: Are medical errors inevitable? What medical errors occur in medical practice? What are their reasons? What is the difference between medical errors and illegal actions of a doctor (crimes and misdemeanors)? What is liability for medical errors?

Are medical errors inevitable? Practice shows that medical errors have always occurred, since ancient times, and they are unlikely to be avoided in the foreseeable future.

The reason for this is that the doctor deals with the most complex and perfect creation of nature - with man. The very complex physiological, and even more so, pathological processes occurring in the human body have not yet been fully studied. The nature of even the same type clinical manifestations pathological processes (for example, pneumonia) are far from clear; the course of these changes depends on many factors both within the body and outside it.

The diagnostic process can be compared to solving a multifactorial mathematical problem, an equation with many unknowns, and there is no single algorithm for solving such a problem. The formation and substantiation of a clinical diagnosis is based on the doctor’s knowledge of the etiology, pathogenesis, clinical and pathomorphological manifestations of diseases and pathological processes, the ability to correctly interpret the results of laboratory and other studies, the ability to fully collect an anamnesis of the disease, as well as taking into account the individual characteristics of the patient’s body and related characteristics the course of his disease. To this we can add that in some cases the doctor has little time (and sometimes does not have enough opportunities) to examine the patient and analyze the data obtained, and the decision must be made immediately. The doctor will have to decide for himself whether the diagnostic process is over or should continue. But in fact, this process continues throughout the observation of the patient: the doctor is constantly looking for either confirmation of his diagnosis hypothesis, or rejects it and puts forward a new one.

Hippocrates also wrote: “Life is short, the path of art is long, opportunity is fleeting, judgment is difficult. Human needs compel us to decide and act.”

With the development of medical science, the improvement of existing ones and the emergence of new objective methods for establishing and recording processes occurring in the human body, both normally and in pathology, the number of errors, in particular diagnostic ones, is decreasing and will continue to decrease. At the same time, the number of errors (and their quality) due to insufficient qualifications of the doctor can be reduced only with a significant increase in the quality of training of doctors in medical universities, improving the organization of postgraduate training of a doctor and, especially, with the purposeful independent work of each doctor to improve their professional theoretical knowledge and practical skills. Naturally, the latter will largely depend on the personal, moral and ethical qualities of the doctor, his sense of responsibility for the assigned work.

There are different types of mistakes. Sometimes they are allowed during preventive measures. Indeed, in practice there are known cases of violation of the vaccination schedule of animals, as a result of which cases, for example, erysipelas in pigs periodically appear on farms. True, due to the lack of specific means of prevention (vaccines and serums), there may be cases (which are observed) of the occurrence of diseases and not through the fault of the doctor. But still, in people’s minds, any disease is somehow connected with a doctor.

Errors are possible even when disinfecting premises. This is evidenced by the recent spread of pulp ulcers in bulls and cows under industrial housing. Reinforced concrete sections of slatted floors contain excess amounts of lime, which dissolves when the room humidity is high. Such “trifles” are often not paid attention to and caustic soda is used for disinfection. And the excess alkali led to the formation of deep ulcers on the finger, which later became infected, resulting in the development of a purulent-necrotic process.

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

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

Errors in diagnosing diseases:

1. Missed diagnosis. Sometimes a doctor, when examining a sick animal, does not find any signs of illness, although it has stopped taking food. The disease is just beginning to develop, and it is still difficult to recognize it. But the presence of a painful condition requires the doctor to conduct a detailed examination of the animal and carry out the so-called preventive, preventive treatment. Every disease occurs in two stages. At the first, pathochemical stage, clinical signs are uncharacteristic, but behind them the doctor can and should foresee the development of a particular disease. The doctor sometimes simply waits for characteristic clinical signs to appear without taking measures to prevent them.

2. Incomplete diagnosis. Sometimes the doctor correctly diagnoses the animal’s underlying disease, but does not pay attention to any complications or other signs that accompany the underlying disease. Treatment in this case will be incomplete.

3. Misdiagnosis. In such cases, the animal body bears the burden of not only a disease not recognized by the doctor, but also incorrectly prescribed medications.

Errors in treatment tactics:

1. Error in choosing the timing of treatment. There are a number of diseases for which an animal needs urgent help. This is intestinal prolapse due to penetrating wounds, strangulated hernia, acute tympany of various origins, poisoning and many others. Treatment for such diseases cannot be delayed; it is urgent.

2. Errors in determining the main directions of treatment. They are usually the result of an incomplete diagnosis.

3. Inadequate treatment ( neglect of certain methods or areas of treatment, as well as complications of the underlying disease).

4. Incorrect treatment(unreasonable use of various medications, treatment methods, surgery without justifying its necessity, etc.).

Medicinal and technical errors:

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

2. Errors in treatment technique(incorrect insertion of a magnetic probe, improper suturing of the intestines or scar during surgical treatment, improper obstetric care during a difficult birth in a cow, etc.

3. Organizational errors: they are often admitted by veterinary medicine specialists when planning and carrying out measures to eliminate or prevent a contagious disease in farms or populated areas.

4. Errors in doctor behavior. They deserve the most serious attention. Envy, petty joy when a colleague makes a mistake - all this creates a very unfavorable climate in the team and negatively affects the results of its work. Unacceptable “criticism” of his predecessor, who allegedly incorrectly diagnosed the disease or carried out treatment. Doctors, and especially young ones, striving for a kind of self-affirmation, often disdainfully treat their younger colleagues, paramedics, whose work is so necessary for the doctor to successfully complete his tasks.

Errors are most often a consequence of the doctor’s vicious opinion, and not his negligence. Some of them depend on an insufficient level of knowledge and little experience, others on imperfect research methods, and others are explained by the presence of rare clinical signs of the disease.

But one cannot confuse a medical error with the negligent actions of a doctor who could have foreseen possible consequences of his actions and was obliged to prevent them. There are also errors caused by the doctor’s dishonest performance of his official duties. For this, the perpetrators are held accountable in accordance with existing laws.

In medical practice, drug errors are discussed at conferences and on the pages of journals. Almost no attention is paid to mistakes made by veterinary medicine specialists. As a rule, conferences and seminars are based on positive examples, not mistakes. But in veterinary medicine, it is customary to perform a mandatory autopsy on the corpses of dead animals in order to compare clinical and pathological diagnoses. For a conscientious doctor, this is a school for improving business skills, one of the means of preventing medication errors, and a way to improve medical work. In such cases, he learns to make a pathogenetic diagnosis and develop methods of pathogenetic treatment of sick animals for the future.

I.I. Benediktov divides medication errors into objective, subjective and mixed. According to this classification, mistakes made by veterinary doctors can also be considered.

Objective errors in medical practice are quite common and account for 30-40% of their total number (Gilyarevsky 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 veterinary medicine specialists, the imperfections of some diagnostic methods, as well as as a result of underestimation in recent years medicinal work this figure will be somewhat higher.

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

1. The intensification and industrialization of livestock farming has dramatically changed the conditions for feeding and keeping animals. If the effect of insufficient feeding on the body has been known for a long time, then veterinarians are not sufficiently aware of the issue of excess feeding, and especially protein, when diets are unbalanced in mineral and vitamin components. Namely, such feeding (as well as insufficient feeding) under certain conditions can cause a number of diseases. After all, the adaptive capabilities of an animal organism are not limitless, and when they are violated, pathological changes appear that lead to various diseases.

Keeping livestock on a slatted floor is considered the most economical, hygienic, but not physiological: under such conditions, a uniform load over the entire plane of the hooves is impossible. And this leads to overload of certain areas of the skin base, to uncoordinated work of individual muscles and tendons, which cannot but affect the health of the animals. Physical inactivity, provided for by beef production technology, also disrupts physiological processes in the body. All this leads to the appearance of animal diseases, complex in etiology, tissue changes complex in nature, covering various systems of the animal body. These changes are still difficult to diagnose due to insufficient knowledge about this or that disease. It is no coincidence that the expressions “diseases of high productivity”, etc., have appeared in the literature of recent years.

Let's give an example. Recently, special beef production farms have begun to register a disease that manifests itself as necrosis of the Achilles tendon in bulls. Veterinary specialists, taking into account the literature data, of course diagnosed it as a disorder of vitamin and mineral metabolism. However, the treatment did not always give the desired results. 1 Only in recent years has it been established that this is a multifactorial disease that proceeds according to the principle of collagenosis. In this case, the doctor simply could not make the correct diagnosis without knowing the scientifically based mechanism of the disease.

The specialization of animal husbandry has contributed to the emergence of many poorly understood diseases. And known diseases in new conditions of feeding and keeping animals often manifest themselves atypically, which also leads to errors in diagnosis. To eliminate such errors, close cooperation between scientific and practical veterinary medicine is necessary.

2. Objective diagnostic errors are often made by a young doctor due to the inability to systematically examine the animal, as a result of which they are incorrectly assessed individual symptoms diseases and on this basis an incorrect diagnosis is made.

There are many such examples that can be given. This includes massive tympany of lambs in May due to intestinal blockage with monies (and the doctor did not check scatological studies, although antifermentation drugs did not give the desired results), atony of the proventriculus, the cause of which the doctor did not discover, but treated the symptom. There are cases when a doctor mistook anaerobic phlegmon in the neck area for emkar, and therefore argued for the need to slaughter the animal and take appropriate special measures to prevent the spread of the disease, although the animals had previously been vaccinated against emkar.

Consequently, for a novice doctor, diagnostic errors are often due to poor training, insufficient knowledge of clinical methods research.

In the actions of a doctor who treats animals, four stages can be distinguished: acquaintance with the anamnesis, clinical and laboratory examination, development of diagnosis and treatment. The most important is the medical history. It makes it possible to make a correct diagnosis in more than 50% of cases, clinical trial– in 30%, and laboratory – only in 20%. Therefore, due attention should be paid to anamnestic data. Of course, if the doctor knows the disease, the history will be short and aimed at identifying the cause of the disease. If the clinical picture is unclear, the anamnesis must be detailed so that, based on its data, the doctor can determine preliminary diagnosis, which is confirmed or changed during examination of the animal. Moreover, each time the specialist pays special attention to the objective clinical picture and should not fall under the “hypnosis” of the previous diagnosis.

A detailed clinical examination allows us to make a pathogenetic diagnosis or diagnosis of a disease in an animal. This is an important stage, since based on the diagnosis, the doctor prescribes pathogenetic treatment, and, therefore, he should not make mistakes.

Thus, the diagnostic process consists of anamnesis, examination of a sick animal, analysis of the results of the study, determination of the diagnosis and elaboration of treatment methods. Underestimation of any of these components (as well as overestimation) can cause a diagnostic error. Therefore, every veterinary doctor should attach special importance to the diagnostic process: after all, diagnostic errors lead to treatment errors.

It happens that in the first years of their professional activity, young doctors often try to simply “guess” the diagnosis, without taking into account some, in their opinion, unimportant symptoms. A superficial, incomplete examination of the animal is the cause of diagnostic and therapeutic errors. Thus, during a rectal examination of cows on the farm, the doctor diagnosed one of them with 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 compaction of the cervix and body of the uterus, fluctuation and simultaneous enlargement of both horns. And only later, when the animal showed general signs of the disease, pyometra was diagnosed after a more detailed study. Such a mistake can be attributed to the doctor’s self-confidence and lack of experience.

Often, a veterinary doctor makes a diagnosis without seeing the animal, based on the owner’s description of its condition or when examining the animal from a distance. This is where intuition, which is mastered by experienced specialists, comes into play. Observation makes it possible to form a preliminary idea of ​​the diagnosis, which is further confirmed or rejected by clinical and laboratory tests. The ability to instantly diagnose a disease comes from solid knowledge and years of experience. Moreover, this experience includes both our own achievements and the achievements of science, technology and production. A doctor must develop intuition, which is based on professional training, observation, and the ability to analyze the experience of colleagues and his own.

3. The activities of a doctor of veterinary medicine are inextricably linked with science. Therefore, the diagnosis is not guessed, but justified. And intuition, not supported by knowledge and experience, often fails. Examples can be given. When examining the horse, the young doctor diagnosed lymphatic extravasation in the abdominal wall. But his friend, noting a significant inflammatory reaction at the site of injury, suggested refraining from introducing a solution of iodine with formaldehyde into the cavity, which is customary in such cases. And after a course of anti-inflammatory therapy, the animal was diagnosed with an abdominal hernia. Consequently, the intuition of a more experienced doctor helped prevent an error that could have become irreparable.

In another case, an experienced doctor diagnosed an animal with eye cancer based solely on the presence of small warts on the eyelids. His young colleagues did not agree with this diagnosis and subjected the cow to surgical treatment. And after 10-12 days the neoplasm spread to eyeball and periorbita, i.e. surgical intervention provoked a relapse, which eventually led to the culling of the animal. This case again confirms that intuition is an advantage of an experienced specialist.

4. One of the reasons for objective diagnostic errors is the insufficient technical equipment of veterinary medical institutions, as well as the inability of many veterinary medicine specialists to use at least those devices that are available. Electrocardiography, oscillography and a number of other diagnostic methods are still practically not used. And electronic computers, which can reduce the number of diagnostic errors by 20-25% (Cherepanov L.S. et al.) in veterinary medicine, are still a distant future.

5. Among the factors that can cause an objective error, it should be noted the volume of work and the scope of responsibilities of a veterinary medicine doctor. It is known that the main job of a specialist, especially in farm conditions, is the prevention of contagious and non-contagious animal diseases. In addition to performing official duties, a doctor often has to engage in other social activities. Due to lack of time, diagnosis and treatment of sick animals is carried out by doctors in a hurry, often in the afternoon. And in medicine it has been proven that the diagnosis during a cursory and inattentive examination of the patient is erroneous in 37.5% of cases (Edel Yu. P., 1957). Apparently, in the practice of veterinary medicine this indicator will not be the lowest.

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

1. It is known that a doctor with a strong balanced and mobile type of nervous system (sanguine) is more able to work, sociable, deeply analyzes the results of research, and is seasoned in difficult situations that arise when diagnosing and providing assistance to an animal. In the practice of such a doctor, errors caused by a complex drug situation are rare. And vice versa, with the same level of knowledge, a doctor with an unbalanced type (choleric) makes more mistakes (Benediktov I.I., Karavanov G.G.).

Conceit, superficiality and other negative character traits are closely related to the type of nervous system and can also cause medication errors. They are caused by the so-called excessive spontaneous activity of the doctor, especially in the absence of experience, responsibility, and a sense of self-control. There are specialists in veterinary medicine who masterfully master surgical techniques, but lack clinical thinking. They are the ones who make a lot of mistakes.

Let's give an example. A doctor who was fond of surgical treatment, having diagnosed traumatic reticuloperitonitis, operated on a highly productive cow with signs of atony. Without finding a foreign body in the mesh, he successfully completed the operation and prescribed a gentle diet for several days. And two days later the cow died from sepsis, which developed as a result of purulent endometritis. Thus, due to the self-confidence of the doctor, who aimed himself at an erroneous diagnosis, a gross diagnostic and tactical error was made. Persistent atony in this case was one of the symptoms of intoxication of the body and the onset of the septic process. And the doctor didn’t even think of measuring my body temperature, at least before the operation.

The doctor’s activities are reflected in the mood – the emotional tone of a person, which depends on the state of health, psychological compatibility with others, and individual characteristics. A self-controlled doctor is able to regulate his emotional state and makes fewer mistakes. A depressed mood interferes with the doctor’s internal composure, reduces mental activity and the possibility of critical assessment, and this can lead to a subjective error.

2. A doctor’s activity is also influenced by the type of his memory. It can be mobile, emotional, figurative (visual), auditory, verbal-logical. A person can naturally have one, two or even three types of memory, and can also purposefully develop them in himself. The verbal-logical and figurative types should be recognized as professionally necessary for a doctor of veterinary medicine, because they expand the diagnostic capabilities of a specialist. After all, mistakes in diagnosis are more often made when the symptoms of a particular disease differ from the classic ones described in the textbook. The development of atypical symptoms is associated with the action of certain factors, as mentioned earlier. In such cases, a thoughtful analysis of the research results, the relationship of the symptoms of the disease with environmental conditions and medical history data is necessary. Otherwise, a diagnostic error will be made, followed by a practical error, which can lead to the death of the animal.

In one of the farms, massive post-castration complications occurred in rams. Having diagnosed them as post-castration inflammatory edema, the doctor prescribed antimicrobial and anti-inflammatory therapy. This treatment turned out to be ineffective, and the animals began to die due, as was established by a pathological study, to anaerobic sepsis.

As is known, characteristic feature anaerobic infection is crepitant tissue swelling. But the doctor did not find any crepitus when examining the animals. But at the same time, he did not take into account the peculiarities of inflammation in sheep (fibrinous), the anatomical structure of the scrotum, unsanitary conditions content during the post-castration period, as well as the fact that anaerobic microorganisms constantly multiply in the proventriculus of ruminants and are excreted in the feces. Once in a wound covered with fibrin, they develop and exhibit a pathogenic effect, inhibiting the inflammatory reaction with their toxins. This promotes their absorption into the blood and intoxication of the body. Due to an error in diagnosis, the doctor prescribed anti-inflammatory drugs, which accelerated the development of anaerobic sepsis. He also did not remember that for malignant edema, which was later established using laboratory tests, crepitus is uncharacteristic. A timely correct diagnosis would have minimized losses. But insufficient logical thinking caused the mistake.

3. Professional impulse plays an important role in the practical activities of a veterinary doctor. This is a constant readiness cultivated in oneself to fulfill one’s medicinal duty every day. And if these qualities are not sufficiently developed or are absent at all, professional passion cannot be expected.

The doctor decided to test the Meliksetyan probe. But due to lack of experience, he was unable to insert a magnet into the proventriculus of a cow and went to consult a more experienced comrade on this case. During this time, the owner took his cow home. But the doctor, having decided to master the technique of introducing it, went to the slaughter station, where he began to practice it in detail on pre-slaughter animals. If he had not been persistent, after the first failure he could have completely abandoned this diagnostic method.

A person does not always fulfill his duties with satisfaction. The reason for this may be fatigue or certain life circumstances. Work devoid of professional inspiration creates the soil on which diagnostic and practical errors multiply.

4. Veterinary medicine specialists make many mistakes due to inept, incorrect, and routine use of medicinal substances. It is known that disorders of the gastrointestinal tract in animals in one case act as a disease, and in another as a symptom, a protective reaction aimed at removing some toxins from the body. Unfortunately, many in such cases, without understanding, use drugs that inhibit the secretory and motor functions of the gastrointestinal tract. And this leads to further absorption of toxic substances and intoxication (if it was a symptom of poisoning).

Veterinary medicine specialists must be well aware of both the positive and negative properties of the substances they use. According to the Indian doctor Sushruta, medicine is in the hands knowledgeable person They are likened to the drink of immortality and life, and in the hands of the ignorant they are like fire and sword.

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

Some drugs sometimes interfere with the treatment process, change the course of the disease and make it difficult to diagnose. Thus, in cases of unclear diagnosis, antibiotics are often unjustifiably used. After them, the animal’s condition may improve. But at the same time, the cause of the disease remains undiscovered and not eliminated, and its clinical signs change under the influence of antibiotics. This makes it difficult to correctly classify the disease, make a pathogenetic diagnosis, and, consequently, carry out adequate treatment for the disease.

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

In addition, each drug, in addition to the main one, also exhibits side effects, especially pronounced if it is prescribed incorrectly. Nature often has to solve double problems: to fight the disease itself and, additionally, with the consequences of using drugs. Therefore, experienced doctors sometimes stop pharmaceutical drugs, allowing the body to mobilize all its strength and heal naturally. No one has ever cured a dog with rabies. But if she gets sick and runs away from home in a timely manner, she often returns after a few months, exhausted but healthy.

It is necessary to use drugs skillfully. I remember a case when a doctor mistakenly prepared and administered to a horse not 0.1, but a 1% solution of carbocholine, thus increasing the dose 10 times. Seeing the effect of the drug, he was so confused that he did not even think of removing it with atropine, and the horse died.

It is known that if calcium chloride, chloral hydrate, or some organic paints get under the skin during careless intravenous administration, necrotic processes develop in the places where they enter. The administration of such solutions requires the doctor to be careful and vigilant. And if by chance these substances get under the skin, their concentration should be immediately reduced by local administration of a solution of novocaine or at least distilled or digested water. And calcium chloride is well neutralized by sodium sulfate.

Many veterinarians make mistakes in their work. But sometimes it is not the mistake itself that is dangerous, but its silence, the attempt to hide it from the owner of the animal and one’s fellow professionals. A doctor who made a mistake causes harm to the patient, and if he concealed it, to hundreds of patients: after all, he did not warn his colleagues about the consequences of his mistake and ways to prevent complications.

That is why it is advisable in the educational process to make a detailed analysis of the mistakes made, to provide scientific justification for methods that exclude their repetition.

5. Medical errors may not be enough developed ability to clinical thinking, the doctor’s reluctance to see and evaluate subtle, but too important for correct diagnosis signs of the disease. And this is the result of a lack of knowledge, sporadic work with specialized literature, and uncritical use of one’s own and one’s comrades’ experience.

Such mistakes are often made by veterinary doctors in the first years of their practice. This is not even explained by a lack of knowledge, but by a lack of focus. According to experienced, qualified specialists, the trouble with most doctors is not that they don’t know enough, but that they don’t see enough.

6. There is an opinion that the skill of a doctor depends entirely on practical training. But the training of a specialist includes a constant combination of theoretical, scientific, clinical and experimental knowledge obtained through the study of specialized literature, personal observations and daily analysis of clinical material. Certainly, practical training should not be neglected; it often helps to avoid many mistakes. A veterinary doctor not only prescribes treatment, but also often carries it out on his own, so he is not immune from mistakes. Typical example:

While treating a horse with signs of colic, the doctor mistakenly injected a solution through a probe not into the stomach, but into the trachea, as a result of which the animal died from asphyxia. And although the animal was coughing and worried, the doctor, lacking practical experience and developed clinical thinking, did not notice the error in a timely manner and did not react to it.

7. I. I. Benediktov considers one of the reasons for the diagnostic error to be the lack of self-criticism, the inability to critically evaluate one’s judgment and actions. Self-criticism, of course, is acquired by experience, but the doctor himself must develop this character trait.

Self-criticism is associated with attitude towards work: as a rule, this trait is well developed in a conscientious specialist. If a doctor does not critically analyze his actions and the data obtained from animal research, he will often make diagnostic errors.

Mixed errors are associated with objective factors, but the degree of their manifestation depends on the subjective properties of the doctor. This group includes:

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

One day, a heifer was brought to the surgical clinic from a farm, sick with inflammation of the knee joint. Upon detailed examination, in addition to signs of purulent arthritis, sepsis was diagnosed. The farm doctor did not see any signs of it, apparently due to long-term antibiotic therapy. But he should have foreseen septic phenomena and could have saved the animal with timely surgical intervention.

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

3. The cause of the error may also be the serious condition of the animal, which did not allow, due to the forced recumbent position, to carry out the necessary additional research. Many people are familiar with diseases such as postpartum eclampsia and postpartum paresis. Their clinical signs are not always characteristic, and additional studies may not be possible.

4. An incorrect medical history can also cause an error, especially in the practice of a young doctor. Modern methods Keeping animals in specialized farms excludes individual observations of animals, so one cannot count on an always objective anamnesis obtained from service personnel. In addition, there are cases when, due to human fault, an animal gets sick or dies, and then the doctor may be given incorrect anamnestic data. In such cases, to prove the anamnesis wrong, he can only rely on his knowledge and experience.

5. The cause of a diagnostic error is sometimes a diagnosis based on intuition, which does not always coincide with reality. Such a diagnosis often arises as a hypothesis or as an attempt to define a disease without thorough examination. Thus, many doctors unreasonably diagnose eye diseases in old dogs as cataracts, and in bitches all neoplasms of milk bags are considered malignant (without histological examinations). An experienced doctor can make a diagnosis by intuition, supplementing it with a deep and comprehensive analysis of the symptoms obtained during the examination of a sick animal.

6. Medication error can also be caused by preoccupation with common diagnoses or medications. Thus, many veterinary medicine specialists today diagnose ordinary D-hypovitaminosis in calves as collagenosis - a new disease, less studied.

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

7. The cause of the error can also be the so-called “suggested” diagnosis. Often young specialists take the opinion of a more experienced colleague on faith. And if an authoritative doctor made the diagnosis correctly, then his young colleague makes a new mistake, treating not a sick animal, but a disease. However, it does not take into account changes in the body during the treatment process, and a previously established diagnosis after a certain time may not correspond to the actual condition of the sick animal.

There are cases when the owner of an animal goes to a doctor with a ready-made diagnosis and the doctor, without seeing the patient, prescribes treatment.

8. The cause of a diagnostic error can also be an overestimation of laboratory tests. Their performance depends on many factors. In addition, they are often carried out by laboratory assistants who do not have any data about the animal, and, like every person, can make mistakes. Laboratory findings must be analyzed, properly evaluated, and compared with clinical data. Laboratory data are auxiliary, and the main thing in the diagnostic process should be clinical research.

In practice, there are cases when an error in laboratory research brucellosis caused the culling of high-value cows. It’s no coincidence that recently the tuberculin test verified by microbiological and pathological studies.

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

Taking into account the above, it can be argued that any error is subjective. But the factors that lead to it may be objective. WITH further development science, optimization of feeding and keeping conditions for 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 medication errors should be resolved in a comprehensive manner: by improving the system of training and retraining of veterinary medicine personnel, organizing veterinary medicine services in general and medicinal and preventive work in animal husbandry in particular.

Unfortunately, doctor mistakes are still inevitable, especially in the first years of his work. In many ways, this stage is characterized by a natural feeling of self-doubt in one’s abilities and knowledge. As experience is gained, as a result of self-education and self-education, such feelings gradually disappear, which reduces the number of errors in work. But mistakes are made not only by novice doctors, but also by experienced specialists who have forgotten about the need constant increase your qualifications.

The work of a veterinary medicine doctor is so complex that it is simply impossible to exclude errors. Therefore, demanding absolutely error-free actions from specialists means not taking reality into account. But still, every veterinary doctor should strive to ensure that the number of errors decreases over the years.

Errors should be distinguished by the nature and degree of their negative consequences. You should be more tolerant of random errors caused by lack of experience, overwork and other objective reasons. No one immediately becomes an experienced specialist; experience comes through the process of painstaking work on oneself.

It is often argued that doctors value their “uniform honor” too much and do not want to admit their mistakes. There is nothing bad about this, because every doctor of veterinary medicine should value his professional honor, no matter where and in what position he works. And you don’t have to admit your mistake publicly. People who are not familiar with the specifics of a doctor’s work are unable to correctly perceive this error. Of course, doctors make mistakes, but most often they correct their mistakes on their own or with the help of a colleague. But publicly acknowledging them or pointing out who made the mistake is completely unnecessary and unethical. This is tantamount to a ban on practicing medicine. After all, a doctor without the trust of livestock breeders, without authority, is not a doctor.

Therefore, in a group of non-specialists it is not customary to talk about errors. But among colleagues, the specialist’s wrong steps, if necessary, are criticized. And while the doctor remains a doctor, all his mistakes and professional mistakes are discussed only with colleagues.

This is especially true for young specialists who, despite being conscientious workers, still make mistakes more often due to lack of experience. Colleagues of the older generation should believe in them, believe that soon this doctor, through his conscientious work, will gain experience and authority among his colleagues and will make fewer mistakes. Let someone criticize you for his mistakes, throw a reproach in your direction, but do not let him insult a young colleague, take him under your protection - and you will not be mistaken: trust doubles human strength and abilities.

Professional mistakes should be discussed among colleagues to avoid their possible repetition by others. The ability to identify someone else’s mistake and point it out to a colleague requires not only thorough professional knowledge, but also compliance with relevant ethical principles. In order not to offend a young specialist by criticizing him, it is advisable to observe certain standards of behavior. So, it’s better to have this conversation in private. At the same time, first reassure your colleague, referring to the fact that it was not easy to cope with the assigned task and in such a situation, most doctors made one or another mistake, and therefore you should not be ashamed of them. Advise on how best to do it and ask to complete the task again. If you yourself do not know well how to do this work, then it is better not to resort to criticism at all. Before pointing out mistakes, praise the employee for the work he did flawlessly. In some cases, it is better to postpone talking about mistakes until another time, when the person can take your critical comments calmly.

In humanitarian and veterinary medicine, the expressions “the right to make mistakes”, “learn from mistakes” and the like are common. It looks like errors should exist like tutorial. In fact, this statement is flawed. A mistake is an evil, a defect in the work of a doctor. And anyone who tries to justify this evil by claiming that medication errors are inevitable is in a position of ethical capitulation, which is immoral and unworthy of the high title of doctor. Sometimes he makes mistakes, but no one gave him the right to do so. Therefore, you should take as many lessons as possible from your mistakes, thereby enriching both your own practice and the general experience of veterinary medicine.

A doctor is an ordinary person, like specialists in other fields, and his responsibility for professional errors should have objective moral and ethical criteria. If ignorance of something is not a crime, then lack of professional knowledge in general is another matter: a doctor who does not know the basic fundamentals of anatomy, physiology, and clinics should not be allowed to work.

It is necessary to distinguish between accidental and deliberate errors made due to the irresponsibility or frivolity of the doctor. The latter borders on a professional crime, for which one should be held accountable in accordance with the law.

Consequently, a doctor can make a mistake, and it is important to correct the mistake in time, and even more important - to anticipate it and prevent it. Sometimes he seems to have everything he needs to work successfully, but still makes diagnostic and practical errors. In some cases, they are due to the characteristics of his character or physical condition, and other objective factors. Among the latter, significant ones are the insufficient scientific developments on many issues of practical veterinary medicine, the imperfection of our knowledge, the peculiarities of the course of the disease, the complexity of diagnosis, insufficient equipment of the workplace, etc.

But still, every specialist should strive to gradually reduce the number of errors, so that the mistakes made become a lesson for both him and his colleagues.