醫療糾紛處理及協商機制之研究-以某醫學中心為例

Researches of Negotiation Methods and Managements for Medical Treatment Dispute－A Case Study of V Hospital Center

向為平(Wei－Peng Shiang)

指導教授 ： 郭文忠 ； 徐學忍

元智大學/管理學院/管理研究所/碩士(2006年)

摘要

近年來醫療糾紛案件日漸增加，大多數爭議起因於醫病雙方之溝通不良。如能促進建立正面、積極的醫病互動機制，不但可以提升醫療品質及成效，更是消弭彼此緊張與對立、避免醫療糾紛甚或訴訟官司等爭議斧底抽薪的辦法。
本研究探討個案醫院之醫療糾紛處理機制，整理分析自2002年至2004年共五百餘件醫療爭議的相關個案，佐以其他醫院相關之醫療爭議糾紛案件，再證諸法院判例，歸納出六大類指標性醫療糾紛案例，其分別為：一、醫療疏失；二、司法訴訟問題；三、醫療意外；四、醫病關係不良；五、罕見不可抗力之意外；六、未善盡告知義務而引起爭議。究其成因與衍生歷程後，綜整出因應之預防方式與解決作法，主要建議如下：(1).主動關切、積極詢問 (2).建立多重參照、交互監控模式 (3).提升醫療專業品質，強化醫護敬業態度 (4).建立臨床路徑標準作業流程、加強教育訓練。(5).加強院內硬體安全設施，充足人員彈性配置。加強在職訓練。(6).建立視病猶親之價值觀（設身處地同理病人心情）、專業敬責之態度、與病人周圍利害關係人建立良性互動之關係 (7).充分說明、耐心溝通、建立對話、關懷協商、堅守立場 (8).善盡術前告知義務之履行 (9).建立無過失補償制度。
本論文亦嘗試建立醫療糾紛處理機制之建構，將之分為前置作業、預防階段及處理階段等三個流程。前置作業即常態研究作為，醫療糾紛處理單位平日即應針對時趨演變，持續進行計畫研擬；預防階段即醫療行為進行之時，防範醫療糾紛之作為與醫療行為實乃一體兩面、密不可分，旨在培養視病猶親、以病患為中心以及針對各項醫療行為皆善盡告知的責任與義務，促進良性之互動與信賴，並設立「初期預警通報系統」，務期避免重蹈覆轍的錯誤；處理階段所面對的乃是業已成案但尚未進入司法訴訟程序的醫療糾紛，可說是醫病雙方最後的溝通網絡，因此在處理的三個層級化流程與人員的編制上都分外綿密、慎重，分別為「關懷小組」介入、「醫事評估小組」研判以及「醫療糾紛委員會」鑑定。

關鍵字

醫療糾紛 ； 醫療醫療糾紛處理機制 ； 醫病關係

並列摘要

The cases of medical treatment disputes have been increasing in recent years, most of the arguments are due to bad communications between the parties of hospital and patients. If positive and aggressive interactions could be further facilitated between the parties, it will be the best way to improve medical treatment quality and efficiency as well as minimize the tensions and oppositions, even legal actions between the parties could be further avoided.
By case study of V hospital center for managing medical treatment disputes, summaries of 500 disputed cases from year 2002 to 2004, the disputed cases study from other hospitals and court judgments, there are 6 major medical treatment disputes concluded as follows: (1) medical treatment faults (2) legal issues (3) medical treatment accidents (4) bad relationships between the parties (5) force majeure (6) arguments without prior well-explained to patients. By finding the problems and root causes, here we come out the solutions and way for preventions, the suggestions are: (1) take care of patients actively and aggressively (2) set up multi-reference record and cross-monitor the status between the patients (3) enhance medical treatment quality and professional attitude (4) establish SOP for on the spot operation and enhance education training (5) improving hospital hardware for safety, providing sufficient manpower as well as enhancing on-job training (6) set up the value concepts of treating the patients as his family、professional and responsible attitude、good relationships and interactions with patients and his relatives (7) enough explanations、be patient for communications、dialogue and negotiation channels set-up、insist on the right position (8) strictly obey the obligation of well-informing required information to patients prior to operation (9) establish compensation system for the disputes without faults.
For the purpose of this research, it is also the intention to set up the system for managing disputed cases based on various stages by pre-operation、prevention and management. Pre-operation stage means regular researches, the institutions shall keep planning for managing problems occurred ；Prevention stage means trying to avoid any dispute while conducting medical treatments by fulfilling all the mandatory responsibilities and obligations；Management stage means for the disputed cases before legal actions, it could be the last chance for the parties’ communications. The operations for those three different levels consisting “the involvement of care team” 、” the judgment from medical evaluation team” and committee for medical treatment dispute” are extremely close to each others.

並列關鍵字

medical treatment dispute ； system for managing medical treatment dispute ； relationships between doctors and patients

參考文獻

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