急診醫師過勞

Burnout among Emergency Physicians

以往醫療系統，並無規劃專責之科別提供急性病症或創傷病患之處置服務。以往醫院之急診處，多以內、外、兒科醫師輪值看診。美國在1970年代就在醫學院內設有「急診醫學科」，將急診醫療專科化，為第23個政府認證的專料。我國衛生署在1997年認定急診醫學專科醫師成為第21個主專料。急診專科醫師制度建立後，急診的壓力逐漸由急診專科醫師來承擔。各國急診醫師都有高比率的過勞情形，過勞比率是所有科別醫師中最高的。各國研究發現急診醫師過勞的因素中，最重要的就是工作時間長與病人病情危急，其次是行政上與其他醫療團隊的溝通問題。我國急診醫師過勞問題的主要因素為急診專科醫師人力不足，以致臨床工作太重。另外健保制度的不健全也導致急重症病人缺乏足夠的各科醫師處理。希望政府、民眾與醫界共同努力改進，重視急重症病人的照護壓力，改善急診專科醫師執業環境，增加急診專科醫師的人數以改善急診醫師過勞的問題。

In the past, patients with emergency conditions were managed by internists, surgeons, pediatrics or other specialists. However these specialists were only responsible for their special fields and would not offer total care. In 1970s, Emergency Medicine became a special division of the medical schools in the United States, and Emergency Physician became the 23rd government-certificated specialist of the United States in 1989. In Taiwan, the Emergency Physician became the 21st government-certificated specialist in 1997. After the establishment of emergency medicine specialist, emergency physicians have gradually taken full responsibility of taking total care of emergency patients. Because of the unique characteristics in their working environment, emergency physicians have high burnout rate all around the world, and the burnout rate is usually the highest among all medical specialists. The factors associated with the high burnout rate in emergency physicians are: large workload in emergency department, critical condition of emergency patients, poor support from the authorities and other specialists, and poor support from society. The main factor associated with burnout in Taiwan is high pressure from clinical workload due to lack of adequate number of emergency physicians. Our National Health Insurance does not reimburse critical patient care adequately. Therefore, the physicians are reluctant to join the specialists who manage critical patients. We hope our government authorities and the whole country would make effort to resolve these serious problems by increasing the number of emergency physicians, reducing the workload of treating critical patients, and improving the working environment in emergency medicine.