綜合醫院醫療爭議案件之心理社會面向分析

Psychosocial Analysis of Medical Disputes Occurring in a General Hospital

廖士程(Shih-Cheng Liao) ； 李明濱(Ming-Been Lee) ； 王美華(Mei-Hwa Wang) ； 周玲玲(Lin-Lin Chou) ； 李源德(Yuan-Teh Lee) ； 謝博生(Bor-Shen Hsieh)

《Journal of Medical Education》 6卷4期 (2002/12) Pp. 434-440

https://doi.org/10.6145/jme.200212_6(4).0007

摘要

醫療爭議日漸增加，風險管理更加重要，與醫療爭議相關之社會心理因素之掌控是關鍵之一。本研究旨在廣泛蒐集綜合醫院中，尚未逕付司法程序之醫療爭議案件，以個案研究之方式，分析其中之心理社會面向因素，為未來醫病溝通與醫療爭議之相關醫學倫理研究與教育，奠立實証之基礎。本研究共蒐集醫療爭議案例31件，按醫療爭議性質分類，醫療結果包括死亡及重大傷殘者20件（64.5%），輕度失能10件（32.3%），非醫療行為相關爭議案件1件（3.2%）。根據醫療爭議溝通過程之對談互動及書面資料分析，本研究結果發現知情同意過程不足之個案有15件（48.4%），顯著醫病認知差異者19件（61.3%）；醫療爭議發生時，呈現知情同意不足問題之個案，其年齡顯著較知情同意充分者為高，知情同意內容充足與否，與醫病溝通過程中呈現之認知差異，以及是否為死亡或重大失能顯著相關。整體而言，本研究發現引發醫療爭議之核心因素包括：災難性結果、醫療過程之不確定性及風險、急性期之危機處理、急性期後之治療策略溝通等。而醫病溝通之良窳以及知情同意原則之是否落實，往往與醫療爭議之發生及事後處理之難易程度相關。

關鍵字

醫療爭議 ； 知情同意 ； 心理社會因素

並列摘要

The doctor-patient relationship has been previously proposed as the key factor in medical disputes especially during the era of managed care. The aim of the present study was to analyze the content and cause of such conflicts during the doctor-patient relationship in a general hospital and identify what psychosocial factors contributed to these events. All consultant doctor-patient conflicts（N=31） in a general hospital during the first quarter of 2000 were analyzed with respect to their medical outcome, the doctor-patient relationship, the adequacy of informed consent, and their documentation. The medical outcomes included death or a major disability(64.5%), a minor injury(32.3%), or an nuchanged condition(3.2%). Inadequate informed consent significantly correlated with breakdown in medical communication, death a major disability and age. This study finds that level of informed consent and the pattern of communication between physician and patient had a great impact on the doctor-patient relationship, and they thus may contributed significantly to medical disputes.

並列關鍵字

medical dispute ； informed consent ； psychosocial factors

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