醫學中心住院醫師之醫病溝通訓練成效

Efficacy of a Physician-patient Communication Training Program for Residents in a Medical Center

廖士程(Shih-Cheng Liao) ； 李明濱(Ming-Been Lee) ； 李宇宙(Yue-Jue Lee) ； 楊培銘(Pei-Ming Yang) ； 李源德(Yuan-Teh Lee) ； 謝博生(Bor-Shen Hsieh)

《Journal of Medical Education》 4卷3期 (2000/09) Pp. 294-306

https://doi.org/10.6145/jme.200009_4(3).0004

摘要

醫病溝通是醫學倫理教育中之基礎項目，良好之醫病溝通，也是預防病處理醫療爭議及醫療糾紛之重要因素。本研究以醫病溝通研習營實施前及實施後，測量學員相關經驗及瞭解程度，爲日後醫學人文教育提供建言及參考。研究樣本為59名參加某醫學中心主辦「住院醫師醫病互動與對應研習會」之第二年住院醫師，以不計名之方式，藉由結構性自填問卷，針對醫病互動相關議題實施測量及分析。本研究指出：有89.8%與會住院醫師，曾擔心會面臨醫療糾紛，而有74.6%曾有與病患溝通困難之經驗。擔心醫療糾紛之原因，以家屬及病人之態度(66.1%)以及治療或處置過程發生不良反應(61.0%)等爲多，而溝通困難常發生於預後溝通(71.2%)及治療方式溝通(61.0%)等部分，且各醫病溝通之相關變項，與畢業之校別無顯著相關，故不論醫學院教育背景如何，在醫學生畢業進入臨床工作後，仍有必要實施與醫病溝通及醫療糾紛處理與預防相關之繼續教育，以加强住院醫師處理醫病關係問題之能力。在知情同意及醫療糾紛預防方法的瞭解程度上，兩項之前後測均呈現顯著進步，顯示本次研習營之教學成效。然而就本次會後學員之自評結果而言，「增進醫病關係之幫助」與「知情同意的暸解程度」，兩變項間並無顯著相關。故在教學上應在個案研討前先施以概念性之提示，使學員熟悉病人自主之概念以及知情同意之實施步驟，使其更熟悉知情同意之具體意義，進而在醫病關係中，促使病患及家屬確認醫療之不確定性以及預防醫療糾紛。未來除持續辦理此類在職訓練外，針對醫護人員之大規模醫病溝通困難調查，建立特殊訓練模式、實施本土化之醫學人文訓練及醫療爭議之相關實證研究，是努力之方向。

關鍵字

醫病溝通 ； 醫療糾紛 ； 在職訓練

並列摘要

Physician-patient communication is the basic component in the contemporary medical-ethic education program. The quality and effectiveness of physician-patient communication would also appear to be the main factor in preventing and managing medical disputes between physician and patient, and even reducing the risk of medical malpractice suits. In Taiwan, however, little research focusing upon training programs in this area has been conducted. The present study is intended to explore the common difficulties experienced in physician-patient communication amongst medical residents in a general hospital and also, to examine the effect of a one-day continuous medical education program focused upon the management of medical disputes, informed consent, the necessary skills for effective physician-patient communication, and case-based discussion regarding medical disputes. A total of 59 second-year medical residents were recruited into this study, at a time when they were not onduty. A structured questionnaire pertaining to the (resident-perceived) main issues of effective physician-patient communication mechanisms, and a self-assessment of the resident's knowledge and ability as regards physician-patient communication and medical disputation was given to the resident both before, and after, the symposium. An analysis of the questionnaire revealed 89.8%of the trainees had, at some stage, been worried about being litigated against during their previous medical practice, the main reasons for their concern being the negative attitude of patients or families (66.1%), and the adverse outcome of previous treatment protocols (61.0%). Also, it was revealed that 74.6% of the trainees admitted to having previously experienced some difficulties along physician-patient communication channels, the major problems typically arising during conveyancing of patient's prognosis (71.2%) and intended treatment program (61.0%). The resident's previous medical college back ground prior to their commencing residency appeared to be un-related to the resident's self-assessed degree of ability as regards physician-patient communication, but there appeared to arise some differences between the responses of residents deriving from different departments. The extent of residents' knowledge regarding informed consent and their intended approach to preventing malpractice suits was significantly enhanced subsequent to their participation in this symposium, but the inter-correlation between residents in each cross-section was low.
In conclusion, no matter the medical college education background of residents, continuous medical education focusing upon the physician-patient communication structure appears warranted in the future. Specific training programs that adequately address the requirements of physicians from specific and different disciplines also appear necessary. The concept and implementation of optimal informed consent and its relationship with the prevention of potential future medical malpractice litigation should be emphasized in any desirable medical training program. In the future, we suggest that, as part of normal on-going medical education programs for resident medical staff, the following should be conducted: a large-scaled survey of the difficulties experienced in physician-patient communication procedures among stall grades of residents, and a medical outcome study pertaining to the effect of psychosocial training, and the efficacy of intensive training in physician-patient communication practices as regards the prevention of potential malpractice litigation.

並列關鍵字

physician-patient communication ； medical dispute ； continuous medical education