Доказательства вреда: опыт пациентов и медицинские стандарты в судебных решениях

Журнал исследований социальной политики. 2022.

Бороздина Е. А., Ельницкий Е. С.

The standardization of medical work and the transition to patient-centred care are the main trends that characterize modern healthcare systems. Some studies suggest that patient-centred care is a component of evidence-based medicine, while others argue that these principles contradict each other. We studied the framework of the relationship between patient-centeredness and medical standardization set by Russian judicial practice: how the nuances of the patient's experience and adherence to the evidence-based medicine paradigm are interpreted in court proceedings, and what pragmatic consequences these interpretations have. We examine the normative ideas of medical practice and the position of the patient in the healthcare system, which can be acquired from the texts of court decisions. A unique representative database was created from the texts of 498 first instance court decisions on civil claims of patients against medical organizations, published in 2018. The study was conducted in accordance with a mixed methods strategy. To explore how standards of evidence-based medicine and attention to patient experience are interpreted and used in court decisions, we analysed the texts of fifty-two randomly selected documents. With the help of regression analysis of data from 498 decisions, the practical consequences of the interpretations presented in the texts were discovered. As a result, we show there are statistically significant relationships between variables that quantify the circumstances of the conflict between medical professionals and patients (the fact of the death of the victim, children among the victims, the number of doctors working with the victims), and the amounts requested by the plaintiffs and the court decision on the amount of compensation. With the help of a qualitative analysis, we demonstrate how the documents interpret (non-)compliance with medical standards and prove the significance of the harm caused to the victims.

Keywords: court decisions, неформальные правила, моральный вред, судебные решения, доказательная медицина, evidence-based medicine, patient- centered medicine, moral harm, informal rules, пациентоориентированность, healthcare