- 學位論文
獸醫溝通研究全球趨勢探索及台灣獸醫師、獸醫系學生和飼主對寵物醫療糾紛之風險因子分析
Exploring Global Trends in Veterinary Communication Research and Analyzing Risk Factors of Veterinary Medical Disputes among Veterinarians, Veterinary Students, and Clients in Taiwan
摘要
自世界動物衛生組織於2012年公布獸醫核心課程綱要，揭示執業獸醫師第一天的能力，希望促進獸醫師與飼主的關係以及有效溝通，以提升醫療成果。然而，失效的溝通會引發寵物醫療糾紛，想要提升溝通成效則需要理解彼此的想法，不僅可以讓雙方更容易建立關係，也提供獸醫系學生進入臨床執業前對於飼主的想法更為了解。此外，在探索觀點的過程中，更重要的是了解國際獸醫溝通教育的研究與全球標竿獸醫學院所開創的溝通課程，以及了解獸醫師與飼主認知的異同之後，提供可參考的具體內容。因此，本研究以文獻計量學的方法分析2000至2021年間獸醫教育的發展趨勢，結果顯示溝通相關的研究佔比逐年增加。此外，高引用的文章多聚焦在獸醫師與飼主對於互動關係與費用議題，文獻關鍵字分析提供了未來研究的架構，而學校與作者的分析，提供線索去了解該授課教師的背景與相關課程，給予台灣獸醫溝通教育未來可能的發展方向。接著，便針對台灣獸醫師、飼主與學生對於寵物醫療糾紛的觀點看法調查，採取線上問卷調查的方式，一方面是研究2014年與2022年的獸醫師與獸醫系學生對於誘發寵物醫療糾紛風險因素的看法比較、二方面是研究2022年獸醫師與飼主對於誘發與降低寵物醫療糾紛風險因素的認知分析。調查結果顯示，2022年受訪者(126位獸醫師與31位學生)對於風險認知較2014年(73位獸醫師與33位學生)顯著提高，這可能與近年來客訴醫糾事件激增，以及獸醫師繼續教育的執業規定有關。此外，獸醫師與學生在認為誘發醫療糾紛風險的因素上有顯著差異，2014年學生更重視醫療技術，而2022年獸醫師則是更重視於醫療費用所引發的風險。在2014年，獸醫師認為飼主觀點和醫療費用是兩大主要的誘發醫療糾紛的風險因子，學生則認為是飼主觀點與醫療技術。而2022年，獸醫師將互動態度與客訴管理列為主要兩大因素，其認知轉變可能來自於時間或者經驗的累積、或者是在2016-2021之間進行的六年執業獸醫師之繼續教育有關。其次，獸醫師對互動態度和飼主觀點的風險認知顯著高於飼主，而飼主則對客訴管理和醫療技術對於醫糾引發風險程度顯著更高。在降低糾紛的解法認知裡，所有獸醫都傾向於提供醫療費用估算並培養對飼主的同理心和同情心以降低醫療糾紛，而飼主則強調知情同意和提供更詳細的書面訊息的重要性。綜上所述，本研究證實了在獸醫師、獸醫學生與飼主之間對於引發寵物醫療糾紛的風險認知存在著差異，可能存在著臨床溝通的風險。其次，建議獸醫教育者應考慮到這些認知差異，在教學中加強互動態度、客訴管理等方面的教育，讓學生提早了解飼主在臨床互動過程在意的溝通重點、降低引發客訴醫糾的風險。最後，本研究根據文獻計量分析中，以獸醫溝通教育研究中最主要的學者與大學所開設的課程，對獸醫溝通教育的發展提供參考資料，對台灣未來的獸醫溝通教育發展提供可能的方向。
並列摘要
Since the release of the World Organization for Animal Health's Veterinary Core Curriculum in 2012, which outlines the required day-one competencies of practicing veterinarians, veterinary education has been emphasized to foster better relationships between veterinarians, clients (pet owners), and animals. However, ineffective communication can lead to veterinary medical disputes. To improve communication effectiveness, understanding each other's perspectives is crucial. This facilitates building better relationships between veterinarians and clients and provides veterinary students with insights into client perspectives before entering practice. In exploring these perspectives, it is essential to understand the research on international veterinary communication education and the communication courses offered by leading veterinary schools. This understanding and recognition of disparities in the perceptions of veterinarians and clients can offer valuable reference material for developing concrete content. Hence, this study employs bibliometric analysis to examine the development trends in veterinary education from 2000 to 2021. The results show a steady increase in research on communication-related topics. Highly cited articles mainly focus on the perceptions of veterinarians and clients concerning interaction dynamics and cost-related issues. Furthermore, keyword analysis provides an initial framework for future research, and analyzing universities and authors gives insights into instructors' backgrounds and relevant course outlines. These insights can guide the future development of veterinary communication education in Taiwan. Subsequently, the study investigates the perceptions of Taiwanese veterinarians, clients, and students regarding veterinary medical disputes. An online survey was conducted with 126 veterinarians and 31 veterinary students surveyed in 2022 and 73 veterinarians and 33 students surveyed in 2014. The findings indicate a significant increase in risk perceptions among respondents in 2022 compared to 2014, possibly due to a recent surge in medical malpractice complaints or the influence of veterinary continuing education. Moreover, differences between veterinarians and students were observed in their perceptions of risk factors, with students being more concerned about medical skills in 2014 and veterinarians showing greater perceptions of medical expenses in 2022. Furthermore, the results reveal that in 2022, veterinarians' risk perceptions of stakeholders' attitudes during interactions and clients' perspectives are higher than clients' perceptions, while clients rank complaint management and medical skills as more critical risk factors in veterinary medical disputes. The results also reveal variations in reducing veterinary medical dispute risk perceptions between veterinarians and clients, with veterinarians emphasizing interactive attitudes and complaint management. In contrast, clients focus on informed consent and detailed written information as essential in mitigating veterinary medical disputes. In conclusion, this study confirms disparities in risk perception among veterinarians, veterinary students, and clients, suggesting potential communication risks in clinical settings. Consequently, it recommends that veterinary educators address these perception differences by enhancing education on interactive attitudes, complaint management, and other related aspects, enabling students to understand the communication focal points of clients during clinical interactions and reduce the risk of complaints and malpractice disputes. Finally, based on the bibliometric analysis of veterinary communication education research, including leading scholars and courses offered by universities, this study provides valuable reference material for developing veterinary communication education in Taiwan, offering possible directions for the future.