歷史宿命或時代使命？台灣社會工作專業介入醫療爭議事件之分析

A Destiny or a Mission? Analysis of Social Work Intervention in Medical Dispute in Taiwan

本文嘗試從台灣醫療體制改革和醫院內外醫療爭議處理機制變遷的社會脈絡中，分析社會工作專業者介入處理醫療爭議事件的現況、態度，以及困境，並思索社會工作專業者在醫療爭議領域發展的空間與可行性。本研究結合量化與質化研究方法，一方面，針對任職醫學中心和區域醫院之社會工作者（不含精神科），以郵寄問卷方式進行普查；另一方面，針對5名在醫院處理醫療爭議、具社會工作專業背景的人員，進行深度訪談。本研究發現有三：第一，多數醫務社會工作部門參與處理醫療爭議事件，社會工作者對介入醫療爭議事件亦持正面態度；第二，社會工作專業者在醫療爭議領域中扮演醫病溝通橋樑、在職教育講師、案例統計分析，以及人員考核的間接評估者等角色，協助化解和預防醫療爭議，有助提升社工專業地位；第三，當社會工作者會需介入賠償談判時，會感受較大壓力，但此壓力隨著醫院醫療爭議處理機制的制度化與角色分工，降低社工介入此議題的衝突、壓力，以及倫理爭議。本研究建議有二：第一，提供多元且實務取向的訓練課程，培養社工處理醫療爭議事件的敏感度和專業能力；第二，建立以修復性正義為基礎的醫療爭議處理機制，促成醫、病，以及台灣社群三贏的局面。

This study attempts to analyze social workers' roles, attitudes, and difficulties when they intervene in medical disputes under the context of health care system reforms and medical dispute resolving mechanisms inside and outside the hospitals in Taiwan, and then speculates upon the development and possibilities of the social workers' involvement in the field of medical dispute.Both quantitative and qualitative methods were used. In one hand, this study conducted a general survey by mailing questionnaires to the social workers in social work departments (psychiatry departments not included) of those medical centers and regional hospitals in Taiwan. On the other hand, in-depth interview was applied where five interviewees, who were highly experienced all played important roles in the dealing process of medical disputes in hospitals.There are three major findings including: first, most medical social work departments in Taiwan indeed have intervened in handling medical disputes, and the medical social workers held positive attitudes toward their intervention roles in medical disputes. Second, the social workers have been playing several important roles including the mediator between the doctors and patients, the instructor of on-the-job training, the analyzer of medical dispute cases, and indirect evaluator of employees performance. These roles may help to prevent more medical disputes from reoccurrence, and have improved the medical procedures and professional position of social work. Third, the involvement in compensation negotiation during the medical disputes handling process have brought pressures to medical social workers; however, following the increasingly systematic structure of the medical dispute resolution mechanisms in hospitals, there has been clearer division of collaboration among various roles. Thus, the conflicts, pressures, and moral controversies of social workers' roles regarding this issue have been alleviated to some degree.This study concluded with two suggestions. First, the social work professional association or the academics should offer courses to improve social workers' professional ability in dealing with the roles conflicts and ethical dilemma while dealing with the medical disputes. Second, the conflict resolution system as well as the communication mechanism of open disclosure should be built-up and based on restorative justice so as to achieve a 'win/win/win' situation among the doctors, patients, and community.