醫師經歷醫療糾紛後之身心與社會調適過程

The Process of Physical/Psychological and Social Adaptatio after Physicians Experienced Medical Malpractice

李佳穎(Chia-Ying Li)

指導教授 ： 陳端容

國立臺灣大學/公共衛生學院/健康政策與管理研究所/碩士(2013年)

https://doi.org/10.6342/NTU.2013.10370

摘要

背景：目前國內醫療糾紛的案件有逐年增加的現象，當醫療服務發生過失或糾紛時，醫師須面臨很大的壓力和責任承擔，醫療刑責的追訴不外乎是過程中的勞心傷財和心理壓力，冗長的訴訟過程讓許多醫療工作者身心俱疲。許多研究指出醫師經歷醫療糾紛後有負面的影響，這些負面情緒的影響往往在事件發生過後仍持續了一段時間，醫師常需要花很長的時間去調適與適應，所受到的心理壓力是外人難以想像的。為了確保醫師能持續提供高品質的醫療照護，及當糾紛發生後如何適切的提供支持與幫助，深入了解醫療糾紛對醫師的影響是必要的。
目的：了解醫師經歷醫療糾紛的經驗，及醫療糾紛事件對醫師造成的影響。探討醫師在面臨醫療糾紛時的調適過程，分析醫師內在身心調適及外在的社會適應，並探討主要的影響因素，期望可以提供政府或相關單位做參考。
方法：本研究採質性研究之深度訪談方式，針對經歷過醫療糾紛事件的醫師為蒐集對象，利用滾雪球抽樣以選取符合研究條件之個案。資料蒐集期間自2012年11月至2013年3 月，共有18 位受訪者。使用半結構式訪談為研究者事先建立訪談大綱，訪談過程中依情況做彈性調整。資料分析運用歸納整理的方式，彙整出受訪醫師對研究主題最主要的表達意見，另外採用QCA質性比較分析方法(Qualitative Comparative Analysis)，對資料內容作深入的系統性分析，以擬似量性分析結果的精簡等式呈現資料之間的關係。
研究結果：(一)法院的情境對醫師而言是很大的心理壓力，少數醫師亦認為訴訟過程過於冗長且耗時，若病人及家屬因此有較不理性的回應，對醫師造成的壓力更為明顯，尤其診所醫師在遭遇不遵循法律既有的解決途徑等不理性的抗爭時，常飽受身心煎熬。(二)醫療糾紛造成醫師的影響可分為身心影響、醫療行為改變及降低職業熱忱，身心負面的影響佔了大部分，且負面情緒都維持了一段長時間，醫師在醫療行為上多會採取防禦性醫療，而降低醫師職業熱忱的影響最為明顯，特別是在醫療糾紛事件對醫師沒有正面影響，且事件嚴重度高有造成病人死亡，或醫師對此事件感受到不公平。(三)醫師經歷醫療糾紛後常需要一段時間來恢復與調適，調適過程分為內在的身心調適與外在的社會適應，在身心調適方面，多數醫師會採取向他人傾訴的方式以尋求協助，也有醫師會有自我調適的行為；在社會適應方面，多數醫師在發生醫療糾紛後是需要社會支持的，也有醫師因當時的負面輿論、媒體報導或主管不支持等因素而造成負面影響。(四)醫師在經歷醫療糾紛事件後的恢復過程現象是有跡可循的，可將其用五個階段來分別呈現，依序為：(1)混亂&思考發生原因，(2)受事件影響，(3) 調適，(4)態度轉變，(5)繼續前進。

關鍵字

醫療糾紛 ； 醫師 ； 質性比較分析方法(QCA)

並列摘要

Background：Medical malpractice cases increased year by year. Physicians are under a lot of pressure and accountability when errors or disputes occur in medical services. Many studies have pointed out negative impacts on physicians experiencing medical malpractice events. Physicians need a long time to adapt and adjust the pressure that is difficult for outsiders to imagine. Therefore, in order to ensure that medical providers can continue to provide high-quality medical care, and how to provide appropriate support when disputes occur, it’s necessary to understand the influence on physicians experiencing medical malpractice events.
Objectives：To understand the experience of physicians experiencing medical malpractice and the influence on physicians. To explore the adaptation process of physicians encountering medical malpractice events, and to analyze physicians’ psychological adjustment and social adaptation.
Methods：This qualitative study adopted in-depth interview and Snowball Sampling. There were eighteen physicians who experienced medical malpractice participating in semistructured interview. Data were collected from November 2012 to March 2013. Data analysis summarized the views expressed by physicians, using Qualitative Comparative Analysis (QCA) method to present the interrelationship between several pieces of information.
Results：(1) Court room scenarios are stressful for physicians. Some physicians also think that the litigation process is too lengthy and time-consuming. If patients and their families have irrational responses to physicians, physicians will have more obvious stress, especially clinic physicians. (2) The impact of physicians experiencing medical malpractice events can be divided into negative psychological influence, medical behavior change and reduced enthusiasm. Negative emotions last for a long period of time. Physicians in medical practice are more likely to take on defensive medicine, and the most obvious influence to physicians is reduced enthusiasm, especially when those cases have no positive impact on physicians; for instance, those involving patients’ death, or causing unfair feeling to physicians. (3) Physicians often require a period of time to recover and adapt after experiencing medical disputes. Most physicians will seek help by talking their feelings to others. Some physicians have inner-adaptated ability, but most of them are in need of social support. (4) Physicians experiencing medical malpractice process have a predictable recovery trajectory. The process has five stages as follows: (1) confusing & thinking, (2) influence, (3) adaptation, (4) changing in attitude, and (5) moving on.

並列關鍵字

Medical malpractice ； Physicians ； Qualitative Comparative Analysis(QCA)

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