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  • 學位論文

外科醫療疏失調查初探

An Investigation of Medical Errors for Surgery

指導教授 : 賴慶松
共同指導教授 : 翁慧卿(Hui-Ching Weng)

摘要


本研究主要是要探討外科醫師醫療疏失行為的概況,如今現在的社會型態的改變,使得病人意識逐漸的抬頭,外科醫師在執行業務時,造成醫療疏失行為的產生,而面臨到醫療糾紛,對於醫師本身的專業訓練也有相當的挑戰性,組織內部因素的影響以及醫病關係之間的種種因素,對於外科醫師都是不可忽視掉的小細節。 本研究抽樣對象以台、澎、金地區的外科醫師為主,共計發出210份問卷。回收卷數為187份,問卷回收率約89.05%。扣除填答不完整的問卷份,有效樣本數為185份。本研究結果顯示外科醫師認為醫療疏失行為病人因素分析最有可能者是:疾病或手術併發症或後遺症(n=145)。醫師個人相關因素分析最有可能者是:疲倦或超時工作(包含輪班造成生理時差)(n=103)。組織因素分析最有可能者是:人力不足或需同時處理多位病患問題(n=136)。 外科醫師醫療疏失行為相關類型,在診斷方面,年資在3年以下者,以未及時確診(n=69)最多。在術後照顧方面,年資在3年以下者,以手術傷口感染(n=80)最多。在用藥方面,年資在3年以下者,以選擇不適當的藥物或曾過敏之藥物(n=38)最多。從疏失中學習是病人安全的第一步,瞭解外科醫師發生醫療疏失行為的相關因素與類型,希望透過在職訓練及案例分享,改善外科醫師執業中,發生醫療疏失的機會與次數,讓民眾能夠獲得更安全、優質的就醫環境,因而恢復健康,提高醫療服務品質。

並列摘要


This study mainly discussed the patterns and fregnencies of surgeons’ malpractice. Due to the structural change of the modern social environment, patients’ awareness is gradually on the rise. During a surgeon’s practice, if wrongful medical behaviors occur; thus facing medical disputes, it’d become quite challenging to the surgeon’s professional training. Minor details of organizational factors and doctor-patient relationship and so forth are not to be ignored by the surgeons. Samples were drawn from surgeons in the Taiwan, Penghu island, and Kinmen (Quemoy) island areas. A total of 210 questionnaires were issued. The number of returned questionnaires was 187, which rendered 89.05% of recovery. Less incomplete questionnaires, valid sample number came to be 185. The outcome of this study demonstrated that surgeons themselves believe that the highly possible medical malpractice have three folds: Most malpractice related to the patient factors would be: disease/surgical complication or sequelae (n=145). The most surgeons related malpractice is likely due to fatigue and overwork (including biological lag resulting from shift rotating) (n=103). And malpractice related to organizational factors is most likely due to lack of man power; as a result, multiple patients would have to be treated all at the same time (n=136). Other types of surgeons’ malpractice, diagnosis wise, it is found that lack of seniority (under three-year experience), as well as failure to provide accurate diagnosis in time rank the highest (n=69). In terms of post-surgical care, lack of seniority (under three-year experience), as well as surgical wound infection rank the highest (n=80). When it comes to prescription, most malpractice would be related to lack of seniority (under three-year experience), inappropriate choice of medication, or allergy to medication (n=38). The first step toward patient safety is to learn from mistakes, and to understand the surgical malpractice relating factors and types. Hopefully, through continuous education/training and case studies, the practice of surgeons could be improved; hence, the chance and frequency of malpractice could be reduced.

並列關鍵字

medical negligence medical dispute surgeon

參考文獻


一、中文部分
台灣病人通報系統(2013)。病人通報流程。取自 2013/7 http://www.tpr.org.tw/
行政院衛生福利部(2013)。病人安全資訊網。病人安全解釋名詞2013公告版http://www.patientsafety.mohw.gov.tw/big5/content/Content.asp?cid=108
行政院衛生福利部。http://www.mohw.gov.tw
石崇良、侯勝茂、薛亞聖、鍾國彪、蘇喜、廖薰香(2005)。異常事件通報系統概況與通報障礙。台灣醫學9(1)。

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