What is medical mediation. How to resolve a conflict between a doctor and a patient in an environmentally friendly way without resorting to litigation.
Medical mediator on conflicts between doctors and patients
Alesya Khomich, medical mediator, a professional negotiator who helps people resolve disputes without going to court or higher authorities, told how it works. Portal "Healthy People" publishes real stories and advice from an expert.
Who can contact a mediator
“As a rule, I am approached by representatives of the administrations of healthcare institutions where the conflict occurred,” says Alesya Khomich. – Patients apply less often: people just don’t know much about mediation yet and at first they may not even trust us. We have to explain to them that we are subordinate to the Ministry of Justice, and not to the Ministry of Health, that we are a neutral party, and not in "collision with doctors."
– In mediation, you can resolve the conflict on the spot, here and now, by concluding a mediation agreement. This is important for patients, because time plays against them – if there is a defect, a medical error, it must be quickly eliminated. And people are often emotional, not fully understanding, in the heat of the moment they want to go to court or write to the Ministry of Health, thinking that they will quickly achieve justice. I, as a lawyer with experience, explain to them that in practice the situation is quite different. When applying, for example, to the Ministry of Health, the department will appoint an inspection, create a commission that will draw up a certificate on the complaint. A person can go to court with this certificate. The court will appoint an expert. It is carried out without a patient, only on the basis of documents.
The procedure is long and expensive. It is paid by the party that requests the appointment of an examination. The outcome of the examination depends on how the questions are formulated, who is included in the expert commission. That is, one cannot do without competent legal assistance, and these services are also expensive. Even if the patient wins a certain amount of compensation in court, he will receive the money at best in six months. And if he does not prove the guilt of doctors, he can still be charged the costs incurred by the healthcare organization for legal costs, expertise, and a lawyer.
When contacting a consumer protection society, it is also not so simple. Lawyers of societies, as a rule, very rarely deal with medical cases. When you tell all this, people, as a rule, choose the option to solve everything on the spot.
If time is important for patients, then reputation is important for medical organizations. They often agree to mediation to maintain confidentiality. In a mediation agreement, as a rule, the parties stipulate that all information on the case is closed, that if the patient is satisfied with the options for solving the problem, he cannot apply to the Ministry of Health, law enforcement and judicial authorities, or the media.Thus, organizations can save the image and avoid checks.
What options for resolving disputes are possible
– Options offer the parties themselves. It may be a refund for the service for the service that did not satisfy the patient. Rarely, but it happens that people also want compensation for moral damage. This is possible outside the court if the sides of each other agree on the amount (according to the Consumer Protection Act). I had a mediation when the separation of paid services of the state dental polyclinic, the orthopedic doctor under the formulation of prostheses was treated with their acid, which fell on the patient's oral mucosa and, as a result, the patient received the strongest burner. This is a direct harm to health, a person subsequently made a plastic surgery to eliminate the scar from the burn.
If he appealed to law enforcement agencies, could and initiate a criminal case. In mediation, we agreed that the clinic pays the patient in the amount of the cost of work, and the orthopedist already as an individual pays 200 rubles of moral compensation. The patient, in turn, wrote that he had no complaints about either to the institution.
A good way to resolve the conflict is to eliminate a medical error. After all, the doctor never realizes does not harm the patient, but he is also a person and may be mistaken. If he is to blame, then interested to eliminate the error and will do everything possible for this. Patients usually understand it. Also, people go to negotiations faster when they are offered a commission inspection, arrange a consultation with a higher-level specialist, an expert from another institution is invited – for them it is a sign that they do not hide anything here, but, on the contrary, trying to help.
If people lose confidence in the clinic, in which there was a conflict, and they want to take place in another institution, there are also options. Passing the treatment elsewhere, patients can provide in the "guilty" organization of checks and treatment plan, and the institution will pay them. It happens that a tripartite agreement is concluded when an organization that eliminates defects and errors, directly exposes an invoice to the institution where the conflict has happened.
In private clinics, options for discounts, bonuses are possible. I had a mediation when a person was preparing for implantation, and the doctor, when removing the old protester, cut her gum. The parties came to the fact that the clinic provides a 50% discount on implantation, and also describes in detail about the treatment plan, methodology for installing implants and all information about the implants themselves. The latter was necessary to calm the patient that he was not deceived, a cheap implant will not be quenched. I've been watching all the documentation for the product with him, studied the treatment plan and installation method.
Can government agencies use the services of the mediator
– Private medical centers, and government health care facilities can also be applied to the mediator.The state clinic can pay the costs of compensation for damage from the budget of the institution, referring to the article of Art. 937 of the Civil Code of the Republic of Belarus, according to which the harm caused by an employee of the organization is compensated by the organization. Some kind of moral compensation can be paid from an off-budget fund, or it can be done personally by a doctor who has made a mistake. The state clinic can also pay for the services of a mediator from extrabudgetary funds.
How much is it
– Usually, in mediation, the parties share the costs in half, but in medical disputes, the health organization more often pays for the services of a mediator. Each mediator sets their own prices for the session. My whole mediation costs about 300 rubles, for example. For state institutions, I hold the first meeting free of charge to talk about mediation and its possibilities. Usually the whole dispute is resolved in 1-2 meetings.
What causes conflicts? Practical cases
“The patient had her front teeth done and, in her opinion, the enamel was too polished, because of which they became thin and brittle,” the mediator gives an example. – Although, in fact, due to malocclusion, such changes were on all teeth. A whole council was assembled for her to explain this. But the woman balked. Then the manager turned to me.
I spoke to the woman in private. It turned out that she had been treated by this doctor for 10 years. But on that ill-fated day, the doctor did not pay due attention to her – she briefly said hello, did not smile, did not tell what she would do. Often our doctors miss these moments, do not attach importance to communication. I asked the patient for a moment to put herself in the place of a doctor: maybe she was tired – there were a lot of patients, maybe she was silent in order to concentrate on treatment. That was enough to calm the woman down. Then I had to persuade the doctor, who also had a professional offense. Doctors have their own “crown”: “we are professionals, and we are in charge here,” and if a person starts complaining, it means that he is inadequate or wants to make money on them. These are stereotypes, because of which conflicts flare up. When we start talking, everything becomes clear.
As a result, they agreed that the doctor would once again examine the patient and eliminate minor flaws in my presence. It was a pre-mediation, that is, it did not even require the signing of a mediation agreement, the conflict was resolved. At the request of the patient, I sat next to her and served as a "translator". Doctors have a professional language that is not always clear to patients. This is also a serious conflict.
There was a curious case in the state clinic, – Alesya Khomich continues. – They changed the chairs in the corridors: instead of leatherette they put iron chairs with holes. A 75-year-old woman came to the reception, got treated, and then went out and wrote in the book of complaints: she waited a long time for an appointment in a cold chair, the holes in the chairs blew, I caught a cold, compensate me for the money for the treatment of a cold. I met with the complainant.Grandma talked to me for 4 hours and told all his life: from birth to the moment when she was caught up, sitting on a cold chair. A person just needed to talk – she is lonely, even there are no cats at home. And then she sat down in a corridor for a long time, was not to talk with anyone, then the doctor quickly put the seal, the words did not say, so he fed. I myself explained to her that I was repaired, changed the chairs, but the doctor did not even affect the quality of treatment. And she recalled the complaint. Moreover, then he wrote a gratitude to the head physician, the doctor and nurse, who spoke so long with her. I do not know why she decided that I was a nurse.
This does not mean that we need to speak with everyone for 4 hours. You just need to be attentive to such moments of communication. My sister is a dentist, worked in the state clinic, is now engaged in private practice. So she took themselves as a rule: the patient who comes first, she does not treat, and the hour of reception time talks to him, makes a full inspection, sends to the picture and gives full consultation. So created Thread therapeutic cooperation. When it is, even if any nuances arise, even if the doctor doesn't do something like that, the patient will perceive it more calmly, because confidence and human contact are established.
When mediation does not work
– Mediation does not always help, "explains the expert. – There are patients with a moving psyche, and agreements will not lead to anything: today will sign a media agreement, and tomorrow will change the decision. Or if the goal is not to solve the problem with health, and extort money. Mediative Agreement is a voluntary document, it does not have the power of the executive list. Therefore, it is so important that both sides really wanted to solve the problem. If I see that one of the parties will not fulfill its agreements, then stop the mediation procedure. In this case, the dispute is best solved through court or otherwise.