如何化解醫療爭議及提升病人安全──醫改會的觀點

The View of the Taiwan Healthcare Reform Foundation on Enhancing Patient Safety and Resolving Healthcare Disputes

台灣醫療改革基金會（以下簡稱醫改會）自2001年成立以來即提供醫糾病家電話諮詢服務，15年間已累積協助超過6千件醫糾案件。根據醫改會調查發現，病家處理醫糾的四大困境為關鍵證據取得難、諮詢鑑定沒管道、溝通調處不管用及專業資訊不對等。此外，儘管各界積極倡導與推動院內關懷或衛生局調處，仍有八成三醫糾病家表示醫院未進行院內關懷，僅四分之一選擇衛生局調處，並導致七成左右醫療爭議最後是不了了之。另方面，高達98％的醫糾病家期待立法增列由政府或公正第三方提供專業醫療諮詢與鑑定，有近七成的縣市衛生局建議應由中央或委託團體先做簡易鑑定或病歷審查。因此，醫改會呼籲盡快建立裁判外紛爭解決模式（Alternative Dispute Resolution，ADR），並以新通過的生產事故救濟條例為基礎，建立不責難的事件根本原因分析（Root Cause Analysis，RCA）及公開透明的醫療事故除錯學習機制調查報告，透過學習避免再錯，以提升病人安全並有效化解過往醫病雙輸的醫糾困境。

Since its inception in 2001, the Taiwan Healthcare Reform Foundation (THRF) has provided advice by telephone to patients and their families involved in medical disputes, with more than 6,000 consultations over the years. According to a survey conducted by the THRF, the four main obstacles that patients often meet in medical disputes are “difficulty in gathering critical evidence, lack of access to consultations and investigations, ineffectiveness of the mediation, and professional information asymmetry”. In addition, although in-hospital mediation and mediation by the Department of Health are actively being advocated and promoted, 83% of the patients still indicated that in-hospital mediation was not carried out and only 25% had chosen mediation by the Department of Health. This has led to 71% of medical disputes ending without a resolution. On the other hand, 98% of the patients are anticipating the introduction of new legislation that will seek to provide professional medical consultations or investigations by either the Government or an impartial third party. Moreover, 68% of the county health bureaus recommend that summary investigations or medical record reviews should be conducted by the central authority or commissioned organizations. Therefore, the THRF strongly advocates the establishment of an Alternative Dispute Resolution (ADR) model and a Root Cause Analysis (RCA) for no blame events based on the newly adopted Obstetric Incident Relief Act, as well as open and transparent reporting of the medical incident correction and learning mechanism. Through learning how to avoid repeating past mistakes, patient safety can be enhanced and the no-win plight of medical disputes in the past can be resolved.