醫療糾紛與醫師特性分析

Physicians’ Characteristics and Medicolegal Issues

本研究以問卷調查方式，藉以了解醫師的主觀醫療糾紛經驗，分別針對醫師之性別、年齡、執業科別、執業區域、執業場所、以及是否擁有專科醫師證書等特性進行分析，以瞭解醫師的特性與醫療糾紛的發生以及解決模式之間的關係。在醫療糾紛的盛行率分析部分，我們發現有醫療糾紛經驗的男醫師比率高於女醫師（37.2％ vs. 26.1％， P=0.049），有專科醫師執照者高於無專科醫師執照者（39.2％ vs. 17.2％，P=0.0001），在醫院執業的醫師發生糾紛的比率均高於在診所執業的醫師。在單變數邏輯迴歸分析中，我們發現男性、35-54 歲的醫師、以及高風險科別（婦產科、麻醉科、以及外科），發生醫療糾紛的機會較高，在多變數分析中，則發現只有年齡介於35-54 歲（OR=1.51， P=0.022）以及高風險科別的醫師 （OR=4.15，P<0.0001），為獨立的危險因子。在醫療糾紛的解決模式上，我們則發現在南部區域執業的醫師，病方撤回或者放棄的機會較高，而進入司法訴訟的機會最低（P=0.006），同時其與病方達到和解或者調解的速度也顯著較快（P=0.016），如果進入司法訴訟，其訴訟的速度也最快（P=0.007）。年齡層介於35-54 歲的醫師，其平均和解或調解金額則顯著偏高（P=0.043）；高風險科別的醫師在醫療糾紛發生後，病方提起訴訟的機會較大（OR=1.97， P=0.033）。我們發現容易發生醫療糾紛的高風險族群，與1991 年的實證研究結果幾乎完全相同，如何改善這些高風險族群醫師所面對的醫療糾紛風險，將是一個非常重要的問題。

The present study was a nationwide survey to investigate whether physicians’ characteristics correlated with occurrence and resolution of medical malpractice. We found higher prevalence of malpractice experience was associated with male physicians (male vs. female: 37.2% vs. 26.1%, P=0.049), physicians with specialty credentials (with vs. without credentials: 39.2% vs. 17.2%, P=0.0001), and physicians practice in hospital. On univariable analysis, male physicians, physician between 35-54 years of age, and physicians of high risk specialties had significantly higher risk of malpractice experience. On multivariable analysis, only age and specialty were correlated with risk of malpractice experience. We also found physicians who practiced in southern district had less chance to encounter legal actions (P=0.006), shorter duration to solve in the cases not entering litigation (P=0.016), or even the cases brought to the courts (P=0.007). Physicians between 35-54 years of age paid significantly higher compensation (P=0.043). Physicians in high risk specialties (Ob/Gyn, Anesthesiologists and surgeons) had significantly higher chance to encounter a lawsuit (OR=1.97, P=0.033).