醫療場域中專業協作的順從與反抗：呼吸治療的建制民族誌

Compliance and Resistance in Professional Medical Practices: An Institutional Ethnography of Respiratory Therapy

為改善呼吸器依賴患者佔用急性病房或加護病房的問題，以有效利用急性醫療之資源，解決加護病床急症患者一床難求的窘境，當時之行政院衛生署提出不同計畫來對不同病程提供分段照護措施，期待在健保的給付架構下，能有效率和合理分配醫療照護資源。然而，從呼吸治療個管師在建制體系內的醫療實作發現，病患最佳利益與相關建制系統間卻因此產生許多利益衝突的現象。本文擬透過建制民族誌，探索在呼吸治療照護的實作中，反映出醫療體制何種多元面貌的統治關係，並試圖指出相關的醫療協作如何產生階級差異化的再製。論文最後也將檢討方法論，指出建制民族誌可能的研究限制。

Taiwan’s Ministry of Health has implemented new policies regarding respiratory therapy for different illness stages in order to optimize efficiency in providing health care and increase the availability of ICU beds. Drawing upon participant observations and in-depth interviews, this article reveals otherwise obscured conflicts of interest between patient benefits and organizational demands in the professional practices of respiratory therapists. Specifically, from an institutional ethnography (IE) analysis, this article illuminates multiple dimensions of “ruling relations” in institutionalized respiratory therapy resulting in making and maintaining class inequalities for the socially disadvantaged. In critical dialogue with IE, this article concludes with methodological reflections and limitations in doing institutional ethnography.