醫療機構醫療爭議調處經驗之質性研究－－以台南地區為例

A Qualitative Study for the Negotiated Experiences of Medical Malpractice in the Hospital Situation

透過八所台南縣市地區教學醫院等級以上之醫院的資料，與醫療爭議經辦人員的訪談歷程資料，探究醫療爭議處理現況，並藉現行爭議處理之協商模式與因應策略的解析，研擬妥適處理與預防模式，提供相關醫療機構參酌，以減少對醫病雙方所可能造成的傷害。整合歸納出一「協商模式」，即醫療爭議的調處，涵括醫療機構、調處者（社會工作者）及病家代表等，須透過不斷溝通、協商，方能順利化解爭議事件危機，將傷害減至最低。協商過程中，參與的各方皆有因應策略與介入，善用談判、磋商技巧，以保障與爭取應有的權益。在當前法制尚未健全情況下，回歸以醫療機構為基礎的協商模式來調處醫病爭議應是難以避免的。

By collecting the secondary data of eight hospitals, which are above the grade of local teaching hospitals, in Tainan City and Tainan County and by gathering the interviews on record with the staff who transact medical malpractice from these eight hospitals, this research explores the current situation and transacting differences of medical malpractice in different medical institutions in Tainan City and Tainan County. Further, by analyzing the present negotiated models medical malpractice, this research also draws up appropriate negotiated and preventive models of medical malpractice as the reference for medical institutions to appropriately transact medical malpractice, so that the damage to both medical institutions and patients and their family could be lessened. The researcher induces a ”Negotiated Model”, which suggests that medical institution, negotiators who are social workers, and patient’s delegate have to constantly communicate with each other and compromise on conflicts in the process of negotiation, so that the risk caused by the dispute could be solved and the damage could be decreased to the slightest level. During the process of negotiating, each participant should have certain strategy and directing principle to negotiate and confer with skill, to ensure their legal right, and to strive for their benefit. Under the circumstances that the relative laws are not completed, it is necessary to take the medical institution as the basis to negotiate medical malpractice. The researcher supposes this ”Negotiated Model” is applicable to most medical institutions and also can be the reference to the hospitals which are not institutionalized. Meanwhile, according to the research purpose and outcome and reference, the researcher is interested in some issues and extends several relative topics, such as the negotiated experience models of medical malpractice, the practicable guidance for the social workers to interfere with medical malpractice, and the participation of the third participant, to explore and to make medical and academic circles to think highly of related works of medical malpractice negotiation. The researcher suggests medical institutions should adopt proper transacting and preventative models to conduct medical malpractice. In peace-time, the institutions should devote their time to operate the harmonic doctor-patient relationship, to construct a flawless appealing and complaining institution, to establish an organized system which has special manager to transact medical malpractice, to carefully plan the strategy and proposal for risk management, and to choose and train ideal staff to transact medical malpractice. The staff should be authorized proper authority and suitable position. Both the institution and the staff who practice medical treatment should think highly of their own right and responsibility, make the medical malpractice have proper disposal and prevent the case of medical malpractice from happening. Besides, the researcher also suggests the authorities and the legislature should widely adopt opinions from medical circle and other professionals to legislate appropriate laws to conduct medical malpractice. The laws should be credible and acceptable to decrease the case of medical lawsuit and to promote the harmony between medical practitioner and patient.