臺灣地區中醫與西醫醫療糾紛的差異

THE DIFFERENCE OF MEDICAL MALPRACTICE DISPUTES BETWEEN TRADITIONAL CHINESE MEDICINE AND WESTERN MEDICINE IN TAIWAN DISTRICT

陳榮基與謝啟瑞在衛生署八十年度委託的研究計畫中指出，有44 % 的西醫師，在其執業生涯中曾遭遇過醫療糾紛，而醫療糾紛發生率較高的醫師，主要具有下列特性：（1 ）年紀大，（2 ）男性，（3 ）執業科別為骨科、婦產科、外科與麻醉科，（4 ）高所得，（5 ）以檢覈考試取得資格，並具有專科醫師證書。該調查為研究醫療糾紛此一議題，提供了實證的經驗。但是，在執業的中醫師族群中，醫療糾紛發生的頻率及特性如何？與西醫有那些差異？一直乏人去研究。本研究就是要針對中醫醫療糾紛之現況，進行實證調查。主要利用問卷之方式，蒐集目前台灣地區執業中醫師實際發生醫療糾紛的資料，以瞭解在中醫界醫療糾紛的發生率、發生的原因及型態，進而與西醫的醫療糾紛作比較。本研究發出問卷共3,514 份，回收533 份（回收率15.17 % ），從回收的問卷發現，在執業的中醫師族群中，有15.4 % （82 /533 ）的中醫師，在其執業生涯中曾遭遇過醫療糾紛的經驗。醫療糾紛發生率較高的中醫師，主要具有下列特性：（1 ）年紀較輕，（2 ）男性，（3 ）執業科別以中醫傷科與內科為主，（4 ）收入較高，（5 ）以學士後中醫系及七年制中醫系畢業檢覈考試取得資格。本研究的結果與陳榮基及謝啟瑞有關西醫醫療糾紛問卷調查的差異，主要有下列三點：（1 ）中醫師醫療糾紛的發生率較低，（2 ）發生醫療糾紛的原因在中醫以治療相關（36.6 % ）、不良反應（31.7 % ）及不滿意（15.9 % ）為主；而西醫則以不良反應（19.5 % ）、不滿意（12.19 % ）及死因不明（11.5 % ）為主，（3 ）年齡方面，中醫年輕的較易發生醫療糾紛；西醫則年紀大者較易發生。Chen and Hsieh’s study in 1991 had shownd that approximately 44 % of Western-style physicians have had medical malpractice (MM) disputes in their practices. Those who are in the following categories usually experience higher MM dispute rate than those who are otherwise: (1) old age; (2) male (3) practicing orthopaedics, obs-gyn, surgery, and anesthesiology; (4) high income; (5) receiving MD license through application system rather than formal examination; and (6) having certificate in specialty. This investigation has provided valuable information for us to understand the reality of medical malpractice disputes in Taiwan. It, however, focused on MM disputes between patient and physician in the Western medicine context. Little is known about MM disputes in TCM. This study is to investigate the actuality of MM disputes of TCM in Taiwan. There are approximately 3,514 registered Chinese medicine doctors in Taiwan. A comprehensive survey is conducted to investigate the frequency and severity of MM in TCM so as to understand the type of possible medical injuries and features of MM claims in the Chinese medicine context. A total of 3,514 questionares were sent out to all the registered Chinese Medicine doctors in Taiwan and 533 of them responded (responding rate 15.17 %). Analysing the replying results had found that about 15.4 % (82/533) of Chinese Medicine doctors have had MM disputes in their practice. Those who are (1) young, (2) male, (3) practicing Traumatology and Internal Medicine, (4) high income, and (5) receiving their licenses through formal examination system are more likely to have MM disputes. Compared with what have found in Chen and Hsieh’s study, this paper finds three differences in MM disputes between Western Medicine and Chinese Medicine: (1) the frequency of MM is much lower in Chinese Medicine context; (2) causes of MM disputes in Chinese Medicine are mainly treatment-related (36.6 %)、adverse reaction (31.7 %) and dissatisfaction of results (15.9 %), while in Western Medicine are mainly adverse reaction (19.5 %), dissatisfaction of results (12.19 %), and unknown death (1.5 %); (3) MM disputes are more likely to happen in young practitioners for Chinese Medicine and in old physicians for Western Medicine.