以病案為基礎之全人照顧教學：病人安全、醫療倫理法律與實證醫學之運用

為改革醫學教育，強調全人照顧的重要性，醫策會積極辦理相關訓練，其內容包含「以病人為中心的醫療」、「實證醫學」、「醫學倫理與法律」、「醫療品質」等等，而各醫院亦陸續派員參與。但臨床上如何運用卻不是上課受訓後即可施行的。本文即希望借由一個全人照顧之示範教學，提供同儕間參考與探討。本案內容牽涉病人安全、醫療倫理與法律、及一般醫學訓練學員的實證醫學文獻查詢教育；參與之單位包含相關之醫療科別、護理部、藥劑部、研考品管組及法律顧問。總結本會議之互動與結論：我們看到醫病相關之法律問題是醫師們最常提問及感到興趣的，而全人照顧之根本～醫病溝通之技巧仍然有待加強，實證醫學之文獻評估及自評能力仍嫌不足，病患安全方面則有待院內擬訂一套處理病人不適當醫療要求的政策與程序。

關鍵字

全人照顧；臨床醫學教育；病人安全；醫學倫理與法律

並列摘要

To reform medical education and highlight the importance of holistic patient care, the Taiwan Joint Commission on Hospital Accreditation has actively held many training programs on various subjects such as patient-oriented medical care, evidence-based-medicine (EBM), medical ethics and the law, and medical quality improvement. In response, many hospital representatives have attended these activities. However, because it is quite difficult to apply these approaches to clinical settings immediately after these kinds of classes, we herein try to demonstrate a holistic patient care teaching round for peer reference and discussion. This case, which was designed for PGY1 training, involves many issues including patient safety, ethics and the law, and EBM. Furthermore, many hospital faculty members were included in the discussion arising from the case, ranging from physicians, nurses, pharmacists and lawyers to administrators. After this discussion, we came to a number of conclusions and these were as follows. Legal problems related to the patient-physician relationship were most frequently mentioned by and were of great interest to clinicians. Communication skills as a basis for providing holistic care still requires further augmentation in the future. Both the teachers' and students' capabilities in the area of critical appraisal and self-auditing in EBM are still insufficient. Finally, the hospitals need to establish a well formulated official process to deal with any patient's inappropriate medical requests.