家庭暴力驗傷診斷書品質之介入性研究

The Interventional Study of the Medical Certificates' Quality Improvement of Domestic Violence

黃志中(Joh-Jong Huang) ； 謝靜雯(Ching-Wen Hsieh) ； 周煌智(Huang-Chih Chou) ； 吳慈恩(Grace Tsyr-En Wu) ； 陳筱萍(Sheau-Ping Chen) ； 張淳茜(Chun-Chien Chan)

《亞洲家庭暴力與性侵害期刊》 1卷1期 (2005/12) Pp. 27-48

https://doi.org/10.29804/AJDVSO.200512.0002

摘要

目的：過去研究報告指出家庭暴力驗傷診斷書之內容品質普遍不佳，由於驗傷診斷書是家暴被害人用來舉證其家庭暴力傷害之待證事件的重要文書證據，診斷書之內容品質關係著法院訴訟之審理和被害人之權益甚鉅。
材料與方法：為提升家庭暴力驗傷診斷書之書寫品質，本研究設計前瞻式之介人性研究，收集民國92年9、10、11月份申請家暴被害人醫療補助費用所檢具之診斷書。而於民國93年7、8月期間，由高雄市衛生局針對市內家庭暴力防治指定醫院進行年度實地考察並由衛生局指導各醫院舉辦在職訓練。介入後之資料乃收集民國93年9、10、11月期間申請醫療補助費用所檢具之診斷書。
結果：本研究收集之家庭暴力驗傷診斷書共計有介入前184份，介入後121份。全部患者均為成年女性，平均年齡為38.21±9.97歲，而介入前與介入後之患者年齡及開立診斷書之醫院屬性並無統計上的顯著差異。比較介入前後之診斷書所記載當事人基本資料、家庭暴力事件描述和臨床評估結果等項目之完整與否。結果顯示僅「診斷醫師姓名」(P=0.016)、「醫院用印」(P=0.000)、「施暴者」(P=0.015)、「暴力發生時間」(P=0.016)、「外傷之顏色狀況」(P=0.009)在統計上有顯著差異。改善部份之特色屬於行政程序有關之形式的正確性，以及與判斷暴力傷害狀態之描述的完整性二類較有關係。前者與作業疏失有關，而後者因侷限於暴力傷害的表象，缺乏暴力歷程內涵之描述的完整性。
結論：本研究所蒐集的家庭暴力驗傷診斷書其內容多數完整性不足，無論是對於家暴事件之紀載，或是臨床驗傷診療結果之描述，多數診斷書內容無法提供充分之資訊。但此一家暴驗傷診斷書品質不佳的情況並不因著衛生主管機構的積極介入而有有效改善，顯示醫療體系對於家庭暴力防治之態度缺乏積極，且未有將家庭暴力視為重要醫療議題之共識。

關鍵字

家庭暴力 ； 診斷書 ； 被害人 ； 醫療服務

並列摘要

Medical certificates are often used as legal evidences by domestic violence victims to apply the Protection Order. Yet in a few studies, the presentation of the certificates received critics and was highly demanded to be improved. This study was inspired by an interventional approach to the quality improvement of the medical certificates addressed at domestic violent events. In which, the intervention method was adopted in the medical document review of medical practice of domestic violence and the associated education under the annual hospital supervision. There were 184 copies of pre-intervention phase and 121 copies of post-intervention phase in this study. All were females' certificates and their mean age was 38.21± 9.97 years. Analysis of the pre- and post-intervention data revealed items of statistic significance as: 'doctor's signature' (P=0.016), 'stamp on the certificate' (P=0.000), 'identification of the abuser' (P=0.015), 'time of the violent event' (P=0.016), 'wound's color and state' (P=0.009). The results did not effectively improve the quality of domestic violent document and its' relevant medical evaluation. However, lack of commitment by the medical staffs might be the reason why there was no significant quality improvement of medical certificate of domestic violence post intervention.