從醫師經驗探討醫院的醫療糾紛處理制度

Preliminary study of hospital systems for malpractice dispute management based on physicians' experiences

目標：醫療糾紛是重要的社會議題，但目前探討醫師經驗的研究不多，也缺乏醫院態度與做法的相關資訊。本研究從醫師經驗探討醫院的醫療糾紛處理制度，並針對相關政策提出具體建議。方法：本研究採用深度訪談法，對象為18位在過去十年內曾有醫療糾紛經驗的受僱醫師。結果：目前院內制度對醫師當事人多提供法律方面和賠償金的協助，卻缺乏同事或主管關懷等實質的心理支持，並普遍存在羞恥與究責文化。對糾紛事件的回應則是大致了解事件經過，卻鮮少深入探究根本原因或提出預防措施。大多數的醫院態度相對被動，僅少數落實醫療糾紛的預防制度。結論：衛生主管機關應要求醫院定期舉辨醫療糾紛的教育訓練，加強醫護人員對於醫療糾紛的知識態度，並針對每個醫療糾紛進行根本原因分析，提出預防措施，且留存檔案作為相關政策依據。此外應要求醫院落實預防制度，主動介入協助通報的不良結果或病人抱怨，及早消弭潛在的醫療糾紛。 Objectives: This study explored the characteristics of hospitals' systems for malpractice dispute management. Suggestions are proposed for improving hospitals' policies in this field. Methods: Eighteen physicians who had experienced malpractice disputes in the past 10 years were interviewed. Results: Most physicians received legal and financial support from hospital systems for malpractice disputes, but emotional support from colleagues and supervisors was inadequate due to a prevalent culture of shame and liability in malpractice dispute contexts. Hospital systems were reported to examine dispute events to assure monetary compensation but not to discover root causes of events or to devise preventive strategies. Most hospitals were determined to be reactive, with few implementing policies to proactively prevent malpractice disputes. Conclusions: Government authorities handling health affairs should request that hospitals organize educational activities regularly to improve medical staff members' knowledge and attitudes regarding malpractice disputes. Each malpractice dispute requires root cause analysis and recording of results to guide future policies. For resolution of potential malpractice disputes, hospitals should implement preventive policies to enable early assistance when adverse outcomes or patient complaints occur.