台灣醫師對過勞相關疾病的態度與看法-網路問卷調查

背景　在東亞國家，過勞是常見的現象，過重的工作負荷及過度工作壓力導致的相關疾病病，已成為職業健康政策的重要議題。台灣近年來過勞導致傷病的個案頻傳，政府參考日本經驗，分別在1991年和2008年頒佈「職業引起之腦心血管疾病」及「職業引起之精神疾病職業病認定指引」。然而，過勞職業病的認定充滿爭議而認定率並不高。在職業病認定過程中扮演重要守門員角色的醫師，對過勞職災問題抱持何種態度？有何因素會影響醫師的認定，在台灣少有研究探討此議題。研究方法　本研究採用線上匿名問卷調查，利用兩個題組（工作引發腦中風與重鬱症）案例，探討醫師的傾向病因、有效預防方法以及認定狀況；分析醫師的人口學變項以及工作特性與是否認定為職業病的相關性。亦調查醫師的自評健康狀況以及疲勞程度。研究結果　總計有163位執業中的西醫師被納入本研究。研究結果發現，受訪醫師對於工作相關因素為兩題組案例之致病因有高度認同; 超過90%的受訪醫師分別在兩題組認可「工時過長」、「工作場所的霸凌」為可能致病因;重鬱症題組的致病因素則呈現較多樣化。有48.5%受訪醫師認定案例題組之腦中風為工作相關因素引起;而35%受訪醫師認定案例題組之重鬱症為工作壓力相關。進一步迴歸分析發現醫師的人口學變項(如性別、年齡、有無管理職、執業地方)等與認定腦中風無關; 醫師具備職業醫學訓練背景會降低重鬱症的認定(OR=0.39, p=0.023)而本身的疲勞程度會增加認定重鬱症為職業相關(OR=1.019, p=0.044)。此外，大部分受訪醫師認為台灣醫師的過勞問題是嚴重的，增加醫師的薪水較可以預防醫師過勞問題。而定期接受健康檢查以及心理諮商則被醫師族群認為可以減少一般工作者因職業引起的中風與重鬱症。結論在醫師的觀點中，重鬱症的成因較腦心血管疾病更為多重病因，可能會造成醫師在認定工作壓力是否造成精神疾病上的困難，為改善此狀況，指引中對於致病因相關的規範似有調整的必要性。另外，相關專科的訓練會影響醫師是否認定為職業病，建議未來可增加此方面的研究。提高薪資、定期接受健康檢查或心理諮商、降低工時以及修改相關法律可能可以改善過勞職業病問題。

關鍵字

醫師；過勞；致病信念；職業病認定；職災補償

並列摘要

Background Overwork is a prevalent phenomenon in East-Asian countries. Overwork or work stress induced diseases become important occupational health issue. In Taiwan, overwork related problems increased and aroused public attention. Government referred to Japan’s policy experience, promulgated “work-induced cerebro-cardiovascular disease recognition guideline” and “work stress related mental illness recognition guideline” in 1991 and 2008. However, it remained controversial in the recognition and low compensation rate of the above two diseases were noted in Taiwan. Physicians’ play gatekeepers role in occupational diseases. It is worth investigating the attitudes and causal beliefs toward overwork diseases among Taiwanese physicians, and further discussion about factors which might impact on physicians’ recognition. Methods An online questionnaire survey was conducted by using two vignettes to explore the causal beliefs and recognition. Physicians’ sociodemographic and work characteristics were collected. The association between the above characteristics and recognition as work-related diseases was examined. Physicians’ self-rated health condition, burnout scale, and opinion about effective methods to prevent overwork problem were also examined. Results A total of 163 physicians participated in this research. Over than 90% of physicians agreed that “working too long” or “bully at workplace” are possible causes of cerebrovascular disease(CVD) and major depressive disorder(MDD). More diverse etiology was shown in MDD. 48.5% participants recognized CVD as overwork-related disease, and 35% of physicians recognized MDD as overwork-related disease. No demographic factors, including age, sex, management position, occupational training were significantly related to recognition of CVD. However, occupational training decreased the recognition of MDD (OR=0.39, p=0.023) while high burnout level increased the recognition of MDD (OR=1.019, p=0.044). Most physicians agreed with that overwork condition is severe in Taiwan’s physicians. Raising up physicians’ salary is the most effective method to improve physicians’ overwork problems while “ask workers to receive regular health check-up” and “receive mental consultation” were most effective ways to improve workers’ overwork CVD and MDD. Conclusion MDD is a more multi-etiology disease than CVD which may increase physicians’ difficulty in recognition of overwork diseases. In order to reduce physicians’ obstacles in recognition, some revision of the guideline should be done. Related specialty training may also impact on physicians’ recognition. Raise up income, receive health check-up or consultation, reduce working hours, and amend labor protection law may help in overwork diseases.