從病患申訴案件探討醫病關係-以某醫學中心為例

Exploring the Relationship between the Medical Practitioner and the Patient from the Perspective of Complaints Filed by the Patient – Case Study on One Medical Center in the Nort

劉英蘭(Ing-lan Liou)

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

本研究旨在分析某醫學中心93年度病患申訴之『社會服務室醫病關係個案記錄』，經由統計分析，整理出病人最常見的醫病抱怨型態、問題、對象..等，再針對首要被申訴之原因「態度不良」及對象「醫師」兩項指標性的醫病關係，進行醫療行為、認知及醫師、病人個人因素等問題深入探討，以了解目前影響醫師與病人溝通之原因。除了以病人申訴資料外，本研究更進一步設計及發放『影響醫師與病人溝通原因的重要性與困難性問卷調查表』，由醫師觀點為基礎，深入探討醫師在醫療上認知的重要程度及相對於實際執行時之間具有的困難度。
本研究主要獲得如下發現: 1. 申訴人申訴管道大多採用最便捷的電話申訴，就申訴病患就醫種類而言，以門診、急診及住院病患為最大的三宗，尤其門診更是遠遠領先其他就醫種類。2. 醫師為最常被申訴之對象，護士次之。主訴問題為醫療『態度及溝通不良』最多，最常發生之時間為7月份。3. 就醫種類來探討主訴問題分析方面，在門診部分態度不良為首要原因，佔了30%；住院部份為醫療疏失，佔了20%；急診部份態度不良之比例更高，佔了42%。4. 就醫師個人因素方面，”病人太多”及” 私人因素影響情緒”是影響醫師與病人溝通的最主要因素。對醫師的調查中發現 5. 在對「病人因素」的關係中，病人家屬過多，反覆詢問病情是醫師們普遍認為常發生的問題。6. 在調查醫師們的認知上面發現，清楚說明病況未來發展與危險性”是最為重要的。
醫師與病人之間能有良好互動，必須要籍由順暢的溝通，而醫師如何在短短的時間內使病人感受到親切與醫療專業，除了專業醫療技術的加強，在養成教育上還需學習如何與病人溝通，以達成醫病之間的良性互動，減少負面的醫病關係產生。

關鍵字

醫病關係 ； 申訴 ； 門診 ； 醫師 ； 醫病溝通

並列摘要

The research objective is to find out causes that presently impact the communications between the medical practitioner and the patient. The complaint cases filed by patients and recorded by the Social Service Section of one medical center are analyzed and a statistical report is attained. The statistics shows the most commonly filed complaints from the patients, issues, complained subjects and so on. Of issues listed on the top of complaints are “poor attitude” and “medical practitioners” as the most complained subjects. The two issues are earmarked to indicate how the medical practitioner-patient relationship goes. Through the two indicators, more issues such as medical behaviors, perceptions, and personal factors of the medical practitioner and the patient are further examined. Apart from the filed complaints from the patient, the research has also designed a questionnaire based on the medical practitioner’s viewpoints to survey the significance and difficulty exposed by the causes that have impacted communications between the medical practitioner and the patient. Through the questionnaire survey, the medical practitioner’s perception of medical treatment’s importance as opposed to the difficulty exposed in their medical practices is further explored and understood.

The primary finds through the research are as follows:
1. The complainant makes complaints mostly through phone call. Most complainants are from the three groups: outpatients, patients for emergency care and inpatients. Among the three, outpatients outnumber the other two.
2. Medical practitioners are the most complained subjects and nurses come next. Most complaints are poor attitudes and communications. July is the month that receives most complaints.
3. On the analysis of most complaints filed out of the above three groups, poor attitudes displayed top the complaint list from the outpatient viewpoints, accounting for 30%. Medical negligence accounts for 20%, from the inpatient group. From the emergency care group, poor attitudes even take a higher share of complaints, 42% to be exact.
4. Considering the medical practitioner’s personal factors, the dominating ones that affect the communications between medical practitioners and patients are too many patients to treat and emotional factors.
5. From the survey on medical practitioners, their concerns on issues are actually more related to the patient’s family and too many repetitive questions raised by them on the patient’s illness conditions
6. On the surveyed perceptions of medical practitioners, to state clearly the prospect and the danger of the illness is the uppermost.
To attain a positive interaction between the medical practitioner and the patient, it takes a good and smooth communication. How the medical practitioner enables the patient to sense his medical professionalism and makes the patient feel respected in a short time? Besides the strengthening of medical professionalism and expertise, the medical practitioners need to further their communication skills with the patients to achieve a sensible and smooth interaction and reduce negative impacts on their relationships.

並列關鍵字

Medical Practitioner-patient Relationship ； Complaints ； Outpatient Call ； Medical Practitioner ； Communications between the Medical Practitioner and the Patient

參考文獻

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