道歉：一位醫師的訪談研究

A Study of A Physician’s Apologies

目的：台灣醫師面臨越來越多的醫療訴訟，本研究想探索道歉是否是一個有效減少醫療訴訟的方法。方法：本研究以訪談方式探索一位醫師的道歉經驗和其對醫師應否道歉的看法；受訪醫師認為道歉是減緩醫療疏失發生時醫病緊張的有效方法；受訪醫師除了口頭道歉及解釋，還會照顧病人的情緒，了解並協助分析問題、甚至協助解決問題。結果：由受訪醫師的四個案例歸納醫師會道歉的相關因子有「醫師個人因素」及「科別因素」兩項，「醫師個人因素」包括「認知因素」及「學習因素」，「科別因素」指「所屬科別的繼續教育有強調關心病人的方式」；而「認知因素」包括「醫師的角色就是要幫助病人」及「醫師可為所處的醫療體系統其他人的錯誤道歉」，「學習因素」指「醫師會不斷由自己及他人的錯誤經驗反省及學習」。醫師不會道歉的相關因子有「事件因素」、「醫師個人因素」及「科別因素」三項；「事件因素」包括「醫療上被質疑」及「擔心醫療訴訟」，「醫師個人因素」包括「年紀輕」及「經驗不足」，「科別因素」包括「所屬科別的醫病互動時間越短」，「所屬科別較不著重跟病人解釋病情或處理病人情緒之能力」，「所屬科別的性格養成中較強調完成醫療工作，較少重視關懷病人」。結論：醫師的養成及繼續教育應有處理醫療疏失的經驗傳承，而根據本研究，有效的道歉亦可能是一個解決之道，值得進一步探討。

Purposes: Physicians in Taiwan have increasingly faced malpractice lawsuits. The purpose of this study was to examine if physicians’ apologies to patients were an effective way to reduce medical lawsuits when unanticipated outcomes occurred due to malpractice. Methods: A physician was interviewed to determine his experiences with apologies to patients and his views on those apologies. Based on four cases provided by the interviewee, the results were analyzed in terms of apology vs non-apology. Results: There were two factors associated with apology: personal, and departmental and three with non-apology: incidental, personal, and departmental. Conclusions: It was concluded that physicians’ apologies may be an effective way to smooth tensions between physicians and patients. In addition, physicians’ apologies and explanations of patients’ medical conditions could ease patients’ emotional responses and further help resolve tensions. The study also recommended that medical malpractice be addressed in physicians’ professional training and continuing education.