內科醫師過勞

Burnout among Internal Medicine Physicians

內科對於即將來臨高齡社會不可或缺。然而近五年來內科住院醫師招募人仍然短缺。美國Medscape在2013年與2015調查，發現全美主治醫師自覺過勞的比率持續攀升，且急診料和一般內科主治醫師的自覺過勞比例最高。美國已於2003年開始規定住院醫師工時，台灣衛福部亦仿效美國在2013年公告住院醫師勞動權益保障參考指引，但限制工時是否是最佳的解決方案？隨著醫療服務項目的擴增，導致醫師必須在更短的時間內完成應該要完成的工作，這種「工作壓縮」會造成更多的醫療錯誤與醫師健康問題。因此，合理的工時設計必須根據工作量，要達到合理的工作負荷，醫院應該提供足夠的支持與支援系統、加強電子化病歷與流程管理、減少重複工作、降低行政文書，運用彈性排班來處理工作量與過勞問題。最後，學術界應該將醫師工作量列入重要研究議題，以實證醫學向衛生當局提出政策建議。

Internal medicine is a core specialty in medical care, with increasing demands in the aging society. Nevertheless, the insufficiency of internal medicine resident recruitment persisted without improvement in recent 5 years. The physician life style report from Medscape in 2013 and 2015 revealed an increasing trend of burnout sensation during these years, especially for emergency and general internal medicine specialties. Although the ACGME in the US launched a resident work hour restriction in 2003 and the Ministry of Health and Welfare in Taiwan proposed a similar work hour restriction for resident in 2013, the effectiveness for burnout is frequently debated. As medical demand and care facility grow, physicians nowadays should deliver more care in a shorter time, which inevitably cause ＂work compression＂. Work compression may threaten both patient safety and physicians' health. Therefore, a reasonable work hour should be in accordance with workload. For internal medicine physicians, patient severity, co-morbid complexity and treatment goal all contribute to workload. Besides, communication and education to patient and family take a lot of time but are often neglected. Standard operation, pathway, guideline and quality indicators are all likely to generate extra workload for physicians. To achieve reasonable workload, hospital managers should provide sufficient backup system and surplus manpower, reinforce intelligence technology system for medical record and process, reduce duplication and handwriting, and adapt professional division and flexible work schedule to alleviate physician fatigue and burnout. Finally, research on physician workload should be a valuable issue academically, and the evidence can become important advice to the government.