醫師部落格潛在的醫病關係、法律與相關議題

Physician Blogs in Taiwan: The Potential Physician-Patient Relationship, Legal and Related Issues

背景及目的：隨著網路分享工具之成熟，已有越來越多的醫療專業者應用部落格輔助有關的醫療活動，側重網路醫學發展的期刊文獻雖陸續對醫師部落格活動有所著墨，惟尚未見系統化觀察與分析醫師部落格網際活動在醫病互動、醫療倫理及法律的影響。本研究之目的為瞭解醫師應用部落格於醫療相關活動之現況，並分析醫師部落格中公開瀏覽的內容資料，探討涉及的醫病關係、法律與醫療倫理議題。方法：本研究採內容分析法，以「醫師部落格」為關鍵字搜尋提供部落格功能之常用入口網站，擷取內容分析所需之文本資料，取樣原則須符合部落格設立者為醫師身份且內容與醫藥衛生課題有關；篩選後共取得120筆資料。結果：120個醫師部落格中81.7%有註明科別，其中以整形外科(14.2%)、婦產科(10%)、皮膚科(9.2%)、中醫(9.2%)佔有較高比例。多數部落格設立者會公開真實姓名(75.8%)及張貼照片(60%)。多數醫師部落格應用於提供醫療資訊分享(98.3%)、留言版線上諮詢(55%)、主動張貼診所訊息廣告(41.7%)，少數應用於醫學教學(14.2%)；在醫療資訊分享的活動中，依次為提供RSS訂閱(83.3%)、轉載醫藥相關新聞(60.8%)、提供臨床案例解說(35.8%)及提供醫療健康相關網站(30%)。而各類別項目間關聯分析結果，張貼醫療相關廣告與公開真實姓名(φ=0.2)及電話(φ=0.5)呈正相關；張貼醫師照片與使用RSS功能(φ=0.2)、臨床案例解說(φ=0.2)及轉載新聞(φ=0.2)呈正相關；提供醫學教學功能與提供臨床案例解說呈正相關(φ=0.2)、與張貼廣告呈負相關(φ=-0.2)。由部落格公開的回應內容歸納部落格訪客為兩類：第一類訪客具有既存的醫病關係（原臨床就診病人），第二類訪客則未有既存的醫病關係，但在部落格的醫病諮詢互動下，有兩種發展成醫病關係之模式，包括：對話內容涉及直接診斷而構成醫病關係，以及促成訪客成為就診病人形成的醫病關係；而在線上諮詢涉及通訊診察者，易有法律上的顧慮。此外，樣本中涉及替減肥商品背書之部落格，則僅有一例。結論：建議醫師在應用部落格於專業的知識分享或諮詢服務時，應注意到自身的專業立場並以提供實證資料為優先，回應醫療相關問題時，應提醒部落格訪客該回應內容僅做參考，無法取代醫療現場之診治。

Background: With the advance of internet technology, more than ever is there increasing number of journal articles reported the use of Internet Blog in promoting medical care services. However, none of the literature critically discussed physician blogging behavior from the point of medical ethics and laws. The current study was designed to assess physician blog contents and its management behavior then to discuss its ethics, laws and moral implications. Method: The current study used the method of ”Content Analysis” to analyze collected data. For this purpose, ”physician blog” was used as the keyword to search related data through the web portal. All data collected meet the criteria of physician managed blogs and their content must be related to medical care services. Results: We identified a total of 120 physician blogs. Among these blogs, 81.7% made clear indication of a medical specialty, with 14.2% in plastic surgery, 10% in gynecology, 9.2% in dermatology, and 9.2% in Chinese medicine. Most physician bloggers posted their names (75.8%) and personal photos (60%). A total of 98.3% of the analyzed blogs provided medical information, 55% provided on-line consultation, 41.7% provided clinic information, and 14.2% provided medical education. In the area of medical information, 83.3% provided RSS subscription services, 60.8% cited medical news from mass media, 35.8% illustrated clinical cases, and 30% provided other health-related websites. A test of categorical correlation found that posting of medical advertisements was positively related to posting of the blogger's name (ø=0.2) and telephone number (ø=0.5). In addition, posting of a personal photo was related to the use of RSS (φ=0.2), clinical case illustration (ø=0.2), and posting medical news which were cited from mass media (ø=0.2). Providing medical education services was positively associated with illustration of clinical cases (ø=0.2) and negatively associated with posting advertisements (ø=-0.2). There were two types of blog visitors: those who were patients of the blogger, and those who were forming a physician-patient relationship by blogging. We found only one case of apparent law violation, in which a blog was used to promote weight reducing drugs and foods. Conclusions: Physician bloggers should only provide advice that is supported by evidence-based medicine and should only share information that is within their medical specialties. Physician bloggers should warn visitors that all advice provided is only for references and should not replace an actual visit to the clinic.