醫療從業人員在醫療爭議調處暨訴訟階段需求探究

研究背景與目的近年醫療糾紛案件大幅地增加，但未有就醫療人員在承受醫療爭議調處和訴訟階段之心理影響及在醫療爭議期間所需之服務為何。故此，本研究之目的在於瞭解醫療從業人員在醫療爭議的不同階段（含調處及訴訟）所獲得之協助重要性和其自身所期望之協助，另在醫療爭議事件發生後，其心理影響為何？是否有可能造成防衛性醫療？研究方法本研究為前瞻性之量化研究，以自行研發之問卷及引用翻譯國外醫療糾紛壓力癥候群（Medical Malpractice Stress Syndrom）問卷，經2回合之德菲法（Delphi method）討論後，始申請人體試驗核准。研究對象為臺灣地區南郭某醫學中心之醫師、護理師及醫技人員。收案期間自民國101年11月1日起，至同年12月8日止。共計發出600份問卷，回收291份問卷，有效問卷286份。統計分析方法為獨立樣本t檢定、Mann-Whitney無母數檢定及因素分析。研究結果問卷經德菲法討論後，其各構面前測之Cronbach’s α俱達0.748以上，最高則為0.996。而在286份有效問卷中，共有76人曾有醫療爭議調處經驗（醫師53人、護理及醫技23人），其中更有24人有訴訟經驗（醫師18人、護理及醫技6人），而實際因爭議調處不成始進入訴訟者，僅有3人。不同職務之醫療從業人員，在醫療爭議發生後，其心理影響及協助之需求亦有所差異，醫師在醫療爭議事件發生後，認為判斷力的下降會影響工作者，平均為3.9分，而護理及醫技人員則為4.4分；會增加不必要的檢查者，平均有3.8分，而護理及醫技人員則為3.4分；而醫療爭議經驗之有無，更會使醫院事先預防措施與事後協助團隊之需求出現明顯之差異。有訴訟經驗者，在全院性的醫療糾紛與倫理教學之重要性得分分別為3.9及3.5分，與無訴訟經驗者相較，則出現顯著性的低落。結論與建議醫療糾紛對於醫療從業人員之心理影響極為嚴重，而且可能會導致不必要之醫療行為增加，致使醫療成本提升，並浪費醫療資源，而且也可能造成生理疾病。然，在法治國憲法保障公民之訴訟權情況下，醫療團隊無得禁止民眾行使訴訟權之情形下，建議依本研究之結果，建立醫療糾紛因應團隊，以給予從業人員在不同之醫療爭議階段不同之協助，進而避免醫療機構與醫療從業人員不致因醫療糾紛而蒙受巨大損失。

關鍵字

醫療糾紛；需求；協助；心理；財務

並列摘要

Background Although the medical malpractice mediation and litigation cases have a significant increasing in recent years, there is no research for the mental infulence and the different requirs in mediation or litigation stages of medical professions. So, that the prupose of this research is to investgating the importance of service that the medical professions already have in mediation or litigation stage, and what kind of service that the medical professions already need. Besides, after the medical malpractice mediation or litigation, the mental influence and defensive medicine of medical professions are also considering in this research. Methods This is a prospective and quantitave study. This study has developed a original questionnaire as a part of whole questionnaire and also translated Medical Malpractice Stress Syndrom questionnaire into Chinese as another part of whole questionnaire. After 2 rounds of Delphi method discussion and 1 round pretest, the whole questionnaire has been developed. The questionnaire was sent to 600 medical professions (doctors, nurses and medical personnels) in a medical center in the sounthern of Taiwan during Nov. 1st 2012 to Dec. 8th 2012. After the table has been complited, we have used the t-test, M-W test and factor analysis for analisit the raw data. Results The cronbach’s α value of all item frame surfaces has reached to 0.748, so that the questionnaire have a standard Reliability and Validity. Of all 286 valid questionnaires, 76 reported having medical malpractice mediation experience and 24 of 76 having the litgation experience after the negotiation in the mediation have been failed. During the medical malpractice (either mediation or litigation stage) different medical professions has different demands among mental support and assistance. Physicians thinks that the judgment would be decreased in average 3.9 points and meical personnels also thinks that the judgment would be decreased in average 4.4 points (p-value < 0.05). So, that the importance of precautions and assistances are also different from medical professions who had been experienced medical malpractice or not. Conclusion and Recommandations The influence of medical malpractices would bring significant amount of mental pressure to medical personnel and this would raise the number of cases of unnecessary medical treatments. The worst outcome is to increase the medical expense, to waste medical resources and to cause mental illness of medical personnel. As the Constitute protects every citizen's jurdical rights, no medical ground could prevent from jurdical involvement with patients. Hence, this dissertation suggests that it is necessary to found a medical malpractice response team to help medical personnel in different periods of medical law cases. This would ultimately decrease the damage from medical malpractice jurdical cases.