臺灣家庭醫學科醫院服務醫師之司法醫學事件判決－－回顧與分析

A Review and Analysis of Judicial Decrees regarding Medicolegal Issues for Hospital-service Family Medicine Physicians in Taiwan

背景：家庭醫學科為專業且專門醫學科學，訓練是以全人之照顧。家庭醫學科醫師在醫院服務，其範圍由臨床、保健、教育皆有涉及，在新經濟和醫療人權時代來臨時，應思考如何提升專科醫師訓練及工作的內容。方法：本文收集在我國法院對家庭醫學科醫院服務醫師的醫療爭議判決或交付審判之裁定，了解其內容，藉由司法觀點提供國內家庭醫學科醫院服務醫師改變訓練及工作之證據。結果：在司法院法學資料檢索系統中查詢全國各級法院，共有10個案例符合收錄條件，將這些案例分類，其中公文診斷書類為4例、醫療業務類4例、醫療行政類1例和身體檢查類1例。公文診斷書類4例之案由是不當得利的偽造文書，醫療業務類4例是業務過失致死為案由，在判決中司法是以照顧品質為評估疏失作依據，而非單純以科別作分別。醫療行政類是病人由藥局業者至醫院代掛號及領藥品而有涉及貪污罪可能，而身體檢查類是體檢結果診斷過失。結論：受於本國司法案件搜尋之限制，雖然本文只有10個案例，仍然可以提供往後訓練之參考。由本文分析得知，家庭醫學科醫院服務醫師在執行業務時，應注意醫療法規和醫事行政之規定；另外在專業上亦必須注意照顧品質之社會要求。最後希望透過本文，呼籲學界正視社會改變帶來之衝擊，往後收集更多案例分析，對將來發展提供更精確之資料。

Background: Family medicine is a professional specialty, and its training focuses on holistic health care. In hospital service, a family medicine physician is involved in clinical service, preventive medicine, and education. In the new era of economic and human medical rights, this specialty training and work content need to be reviewed. Methods: In order to provide credible evidence to support any alteration in training and work content for hospital-service family medicine physicians, we collected and reviewed the judicial decrees in cases related to this specialty in our country. These decrees reflect the viewpoint of the judicial system, and can help in understanding the shortcoming in current training and work content. Results: In the Judicial Database, there were 10 cases related to hospital-service family medicine physicians. There were 4 cases of forgery in the official document category, 4 cases of medical negligence causing death in the medical business category, 1 case of corruption in the medical management category, and 1 case of diagnostic negligence in the health examination category. Conclusions: Ethics and professional knowledge are two important topics for training courses and continuing medical education in family medicine. They should be emphasized in future programs.