病人及大眾對於醫師主動揭露醫療錯誤之看法－對實證文獻之回顧

Views of Patients and the Public Regarding Physician Disclosure of Medical Errors-A Review of Empirical Literature

邱淑媞(Shu-Ti Chiou)

《台灣公共衛生雜誌》 26卷5期 (2007/10) Pp. 339-352

https://doi.org/10.6288/TJPH2007-26-05-01

摘要

主動揭露是處理醫療錯誤的重要環節，許多先進國家皆明訂醫師有主動揭露醫療錯誤之倫理義務，美國更列入醫院評鑑基準中。國內近年亦開始關注此一議題，但醫界仍存有相當疑慮。為瞭解病人、家屬或社會對醫師主動揭露醫療錯誤之看法以及釐清主動揭露與醫療訴訟或糾紛之間可能的關係，供醫界與醫療管理決策者參考，本研究檢索2006年7月前國內外內容涉及病人、家屬或民眾對醫療錯誤主動揭露之看法或反應之中、英文實證研究文獻，計找出以假設性狀況進行之調查或質性研究14篇，醫療訴訟或糾紛案件分析7篇，及以介入性案例報告2篇，納入回顧。研究發現，病人及大眾普遍期望一旦有醫療錯誤發生，醫師能在最短時間內主動揭露並提供詳盡訊息；以各種假設性狀況進行調查，在大多數情況下，有主動揭露時病人想要訴諸法律的比率顯著較未主動揭露者低，而錯誤的嚴重度、類型以及其他相關處置亦會影響病人的反應。訴訟案件分析發現最常見的訴求是希望類似事件不要再發生以及想獲得更多訊息釐清真相。美國Lexington榮民醫學中心與密西根大學醫療體系的經驗則顯示在推動主動揭露政策後醫療訴訟支出大幅降低。因此，主動揭露不僅是醫師倫理義務的一環，並可能有助於降低訴訟成本。建議國內應加速展開相關研究，並在醫院導入主動揭露系統過程進行更嚴謹的評估，建立適用於我國之模式。

關鍵字

主動揭露 ； 醫療錯誤 ； 病人安全

並列摘要

Disclosure is an important issue in handling medical errors. It is proclaimed as ethical obligation of physicians in many developed countries and is included in the accreditation standards by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) in the U.S. Experts in Taiwan noticed this issue in recent years, but tremendous doubt of its necessity and effect still exists in medical society. Understanding the views of patients and the public regarding physician disclosure of medical errors and clarifying their potential impact on malpractice liability and the patient-physician relationship will provide needed information to assist with decision making in medical society and healthcare management. Data was gathered by comprehensively searching for empirical studies involving the views or response of patients, families, or the public towards disclosure of medical errors published in the English or Chinese language before 2006 July. We found and reviewed 14 surveys or qualitative studies using hypothetical scenarios, 7 studies which analyzed the causes of lawsuits or complaints, and 2 interventional case reports. It was found that patients and the public universally wanted the physicians to tell them the truth of everything as soon as possible once a medical error occurred. Under most hypothetical scenarios, patients had significantly lower intention to take legal action if the error was disclosed versus nondisclosure of the error. The severity and type of errors as well as other aspects of management after the events also affected patient response. Analysis of lawsuits and claims found that the most common reasons for action were to prevent similar events in the future or to get more information and explanation about the truth. Experiences from Lexington Veterans Affairs Medical Center and the University of Michigan Health System in the U.S. showed that implementing hospital-wide disclosure policy led to a significant reduction in their liability costs. We concluded that disclosing medical errors is not only an ethical obligation but also a way to reduce liability costs. To develop an appropriate model in Taiwan, we suggest that Taiwan should launch more investigations in this field and perform conscientious evaluations while introducing the disclosure system into hospitals.

並列關鍵字

disclosure ； medical errors ； patient safety

參考文獻

American Medical Association, Council on Ethical and Judicial Affairs(1997).Code of Medical Ethics: Current Opinions with Annotations.Chicago, Ill:American Medical Association.

Open disclosure standard: a national standard for open communication in public and private hospitals, following an adverse event in health care

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