THE FACTORS
INFLUENCING QUALITY OF RENDERING OF THE EMERGENCY MEDICAL SERVICE AT THE
PRE-HOSPITAL STAGE
As.professor
DubitskiyA.A.
Medical
University Astana, Kazakhstan
Medical errors, their
frequency, character and the reasons, being an object of research of a medical
erologiya, long time serve as object of the analysis and studying from heads of
establishments of health care, experts of insurance companies, and is more rare
than psychologists [1].
At the review of literature it
was revealed that questions of medical errors in the conditions of a hospital
and policlinics at the moment are most fully studied. The reason of the medical
mistakes arising at a stage of rendering of an emergency medical service in the
conditions of threefold deficiency: time, information and resources, and also
stressful kind of work, - it is studied a little and insufficiently shined in
domestic literature [2].
Studying of a role of the
reasons of emergence of mistakes showed that 13,8 % are the share of a share of
subjective mistakes from their total number. For emergence of subjective
mistakes professional and psychological factors (change of a place of work, a
profile of work, a position) and difficult character of the doctor have the
greatest value [3].
The great value is given to
characterologic features of the identity of the doctor, directly connected with
its professional suitability for work in specific conditions of an emergency
medical service, including so-called professional deformation of the identity
of the doctor.
So, for
example, in the early nineties in the city of Astana a peculiar experiment was
made. During the winter period, in a flu epidemic the group of
doctors-therapists of hospitals and the policlinics which earlier weren't
working for station of an emergency medical service was directed on work on
station of ambulance. Each of them, despite solid length of service and
specially carried out preliminary instructing in ambulance, allowed a number of
the tactical and diagnostic mistakes surpassing in frequency of occurrence and
those weights at constantly working at station of an emergency medical service
of doctors.
Thus,
attempts to use at station of ambulance of doctors of other specialties without
preliminary psychological preparation and training terminated unsuccessfully.
In this
regard the working hypothesis was put forward: the combination of certain
qualities of the identity of the doctor can affect acceptance of the incorrect
decision by it and lead to mistake emergence.
Within
check of correctness of this hypothesis the techniques which are most suitable
for psychological research in the conditions of deficiency of time at the
doctor were used:
1) on
ability to listen;
2) on
adequacy of self-image;
3) on
behavior strategy in conflict situations;
4) on
level of subjective control;
5)
versatile questionnaire of the personality.
Research
was carried out at casually chosen doctors of linear brigades and brigades of
intensive therapy of station of an emergency medical service of Astana.
As a
result of research qualities of the identity of the doctor, influencing
emergence of medical errors came to light:
1) low
level of audition (inability to listen and adequately to apprehend verbal
information);
2)
inadequate assessment of and the possibilities;
3) lack
of flexibility in performance of social installations and overcoming of
psychological barriers;
4)
inability to choose individual tactics of rendering of emergency medical care;
5)
tendency to risk, carelessness, preference of own decisions to the established
algorithms of actions. Aggression in relation to people around;
6) an
inadequate choice of strategy of behavior in permission of conflict situations.
The
combination of these qualities of the identity of the doctor promotes adoption
of the incorrect decision and can lead to emergence of a medical error that
confirms the hypothesis put forward by us.
The
obtained data allow to draw the following conclusions:
1) At
employment to a position of the doctor, the medical assistant of a mobile team
of ambulance carrying out a complex assessment of personal qualities by means
of specially picked up techniques (tests) the expert – the psychologist is
expedient;
2)
Carrying out psychological consultation on assistance in the solution of
personal, professional and household psychological problems as in usual, and,
especially, in crisis situations, and also trainings on psychocorrection is
important.
3) It
is necessary to include questions of medical, social psychology and
conflictology in programs of preparation of the medical personnel of an
emergency medical service.
Acquisition
of knowledge in the field of psychology gives additional possibilities for the
prevention of medical errors at the exit personnel of an emergency medical
service.
Literature.
1.
Meshchersky L.A. Social assessment of quality of the organization of an
emergency medical service. – Novosibirsk, 2004.
2.
Nemytova L.L. Psychological preparation of the personnel of an emergency
medical service//Emergency medical service.-2003. - N. 3. – P. 42-43.
3.
Dubitsky A.A. Portrait of the emergency doctor of the XXI century. – Astana медициналык magazines. – 2011. - N. 5. – P. 16-18.