病人安全，也要醫師安全：從醫療事故預防及爭議處理法第35條出發

Patient Safety, but also Physician Safety: Starting from Article 35 of the Medical Incidence Prevention and Dispute Resolution Act

病人安全問題通常不是健康照護提供者（醫事人員，通常是醫師）的錯誤，大多數的事件是因為系統的疏失。減少這些錯誤再度發生的唯一方法是醫事人員說出他們的疏失，自發性地報告過錯，進而公開討論，使其他醫事人員從中學習，而不再犯同樣的錯誤。然而，保護通報者是健全通報系統的主要力量，尤其是法律上的免責，更是鼓勵通報者通報的原動力。醫療事故預防及爭議處理法第四章（第33條至第37條）著重於病人安全管理制度。在病人安全方面，立法已經相當完善。但是在醫事人員免責方面則有改進的空間。為促使醫療機構內部人員勇於通報，應將資料「去連結」，並將去連結概念導入本法第33條第3項的病人安全事件通報資料、第34條第1項的醫療機構就重大醫療事故提出的改善方案及第34條第3項的第1項重大醫療事故通報及改善方案。專案調查（本法第35條第1項及第2項）報告之內容應該去連結，以保護醫療事故當事人，以利專案小組調查時發現事實真相、共同學習。為保持去連結，專案調查時，應由熟知案情之醫療機構醫療事故關懷小組人員出席說明，而發生醫療事故之當事人不得出席。如果修法曠日廢時，先將「去連結」概念加入施行細則也是快速可行的方式，只是法律位階較低。至於醫療爭議案件真相的尋求可回到傳統訴訟程序，法院或檢察官認有必要進行醫療爭議鑑定時，仍可透過傳統鑑定程序，送請衛福部醫事審議委員會進行鑑定。醫療過失行為之出發點是善意且惡性較金融犯罪或是組織犯罪為輕，但因醫療行為之不確定性，導致醫療爭議事件調查較為困難，無相關人員配合之狀況下，難以得知真相。為鼓勵醫療事故醫事人員主動通報、積極配合調查或提供資料以助釐清真相，且鼓勵其自新亦可收發現系統錯誤之效，進而減少大量可以避免的醫療錯誤，減少許多病人傷亡及大量醫療資源耗損，其成效遠勝於金融犯罪或是組織犯罪之窩裡反績效，自「得減輕或免除其刑」。一個健全的社會應承認「人會犯錯」，勇於面對醫事人員出發點是善意的錯誤，乃是建立醫療錯誤通報系統及專案調查成敗的關鍵，進而促進廣大病人的安全。從而，醫師安全，病人就安全！

Patient safety issues are usually not the fault of health care providers (medical personnels, usually physicians), most incidents are due to system failures. The only way to reduce the recurrence of these mistakes is for medical staff to speak out their mistakes, voluntarily report mistakes, and then discuss themselves openly so that other medical staffs can learn from them and do not make the same mistakes again. However, the protection of these informants is the main force for a sound reporting system, especially the legal disclaim, which is the driving force behind encouraging to report informants Chapter IV (Articles 33 to 37) of the Medical Incidence Prevention and Dispute Resolution Act focuses on the patient safety management system. When it comes to patient safety, the legislation is fairly well established. However, there is room for improvement in terms of disclaim for medical personnel. In order to encourage the internal personnel of medical institutions to report bravely, the data should be“delinked”, and the concept of de-identification should be introduced into the notification data of patient safety incidents in item 3 of Article 33 of this Act, and the medical institutions in item 1 of article 34 of this Act. The improvement plan proposed in Item 3 of Article 34 should also be delinked. The contents of the special case investigation (items 1 and 2 of Article 35 of this Act) should be delinked to protect the parties involved in the medical incidence, so that the special case team can discover the truth and learn more during the investigation. In order to keep de-identification, during the special case investigation, personnel from the medical incidence care team of the medical institution who are familiar with the case should attend and explain, and the parties involved in the medical accident should not be present. If it takes a long time to amend the law, there is also a faster and feasible way to add the concept of de-identification to the implementation rules, but the legal status is lower. As for the truth-seeking of medical dispute cases, you can go back to traditional litigation procedures. When the court or prosecutor finds it necessary to carry out medical dispute appraisal, you can still go through the traditional appraisal procedure and send it to the Medical Review Committee of the Ministry of Health and Welfare for appraisal. The starting point of medical negligence is benign and less malignant, but because of the uncertainty of medical performance, it is difficult to investigate medical disputes, and it is difficult to know the truth without the cooperation of relevant medical personnel. In order to encourage the medical staff of medical dispute to actively report, actively cooperate with the investigation or provide information to help clarify the truth, and encourage them to rehabilitate and discover system errors, their criminal liability may be reduced or exempted. A sound society should recognize that“people make mistakes”, and bravely face medical staff's unintentional mistakes, which is the key to the success of establishing a medical error reporting system and ad hoc investigation, thereby promoting the safety of patients. Thus, a safe doctor keep patients safe!