論文摘要 本研究採內容分析法與訪談法並行的方式,以高雄市衛生局醫療爭議調處小組為對象,統計分析調處小組自民國七十八年至九十二年底所有調處案件檔案資料,共計一百六十二件;並完成訪談曾參與調處小組運作之成員,共計十位,以期對公部門醫療爭議調處機制有更多的認識。 由檔案資料初步統計結果發現:在總案件數中,以傷害案件最多,約佔61﹪;申請調處對象以病患家屬最多,約佔33.3﹪,自行提出申訴約30.6﹪,而第三者介入則有25﹪;申請調處原因以醫療不當及手術不當最多,分別約為25.9﹪及19.5﹪;病患基本資料以女性高於男性,年齡層以青壯年居多;醫師科別以外科最多,約佔30.6﹪,其次的婦產科則為21.9﹪;另在醫院層級部份,醫學中心偏高,約佔25.7﹪;調處結果則以不成立最多,約佔61﹪。 訪談部分發現,受訪者認為醫療爭議的成因包含:社會結構變遷、未預見的結果、不和諧的醫病關係。而尋求調處小組協助的原因可能為:不知如何處理及不希望進入訴訟。在對調處小組的期待部分,則可能為希望調處小組能協助鑑定、判定過失與協助獲得金錢賠償。另在調處小組的功能方面為:增加溝通協調的機會與提供專業的協助。而調處小組在執行上所面臨的問題則可能有:律師對醫療專業了解不足、醫醫相護仍在、參與協調者皆為兼職及第三者介入增加調處複雜度等。調處小組成員的角色功能為:律師擔任主持人與提供法律諮詢、醫師公會代表提供醫學專業諮詢、承辦人員提供行政資源與協助、有力第三者可協助促進醫病雙方溝通等,但有力第三者的介入對調處結果的影響,仍是形式意義大於實質意義,甚至可能增加調處的複雜度。而影響調處成敗的關鍵因素可能為:調處的金額、醫病雙方的認知差距、醫療機構的態度及調處成員的影響等。研究者認為未來應由制度面、醫院、衛生局等共同努力,以預防醫療爭議的發生。 關鍵詞:醫療爭議、調處、醫事審議委員會
Abstract In order to understand the mediating mechanism of medical dispute, the study data was collected by the content analysis and deep interviews from the Kaohsiung Bureau of Health. The 162 mediating data records from 1989’to 2003’was to be analyzed. The deep interview samples consisted of 10 medical dispute mediating committee members. The results of initial statistic include:the total number of cases is 162, and injured cases make up about 61﹪. Among these cases, about 33.3﹪patients’ family members apply for mediating, 30.6﹪by themselves, 25﹪by third party. The reasons why people apply for mediating was improper behavior:medical treatment and surgical operation. For the patients’ background, females out number the males, and the ages was centralized between 20 to 60. About 30.6﹪ of surgical department and 21.9﹪ of obstetrics and gynecology departments more often face medical malpractice. Medical centers also face medical dispute more often. About 61﹪ of these cases failed. To interview the committee members, some findings include:the reason why medical dispute coming, the reason why people seeking for mediation patient’s expect to the mediation committee, the function of the committee, practical problems of the committee, the function of the committee members and the key factors for mediation. We need to make efforts in the social system, hospital and Bureau of Health to prevent medical dispute. Key words:medical dispute, mediation, medical review board