憂鬱症病友求醫經驗分析

The Analysis toward the Experiences of Medical-Care Seeking of Depression Paients

張嘉玲(Chia-Ling Chang)

指導教授 ： 張珏

國立臺灣大學/公共衛生學院/衛生政策與管理研究所/碩士(2004年)

https://doi.org/10.6342/NTU.2004.10373

摘要

摘要
聯合國世界衛生組織（WHO）將憂鬱症與愛滋病、癌症並列為二十一世紀最應受到重視的三大疾病後，多受重視，然而現今鼓勵憂鬱症就醫的風氣之下，究竟能提供如何的醫療品質？在短短數分鐘的時間，病友除了拿到一定份量的藥物之外，更遑論所謂的心理治療，在這樣的就醫模式裡，憂鬱症病友在精神科門診的求醫經驗為何？是否具有成效？值得我們重視與探討。

因此，本研究的目的希冀瞭解以下的問題：

1.瞭解憂鬱症病友在確立診斷前與一般醫師（非精神科醫師）的接觸經驗與看法。

2.探討憂鬱症病友精神科門診就醫經驗。

3.憂鬱症病友與精神醫療工作人員、志工互動的經驗及對其形象有何看法。

4.憂鬱症病友所期待的醫療或保健系統。

5.病友期待政府能有哪些相關的作為。

本研究採質性研究，並以「病友訪問病友」的方式，針對南部某醫學中心已確診為憂鬱症的病友進行深度訪談，資料收集自民國91年5月至91年10月止，共訪談13位病友。依據研究目的擬定訪談大綱，針對欲瞭解的研究範疇進行訪談，並將所得訪談內容依共同特性之主題組合加以整理，形成概念的主題及次主題呈現之。本研究之研究範疇分為五部分，分別為確立診斷前與一般醫師（非精神科醫師）的接觸經驗與看法、精神科門診就醫經驗、與精神醫療工作人員、志工互動的經驗及對其形象有何看法、所期待的醫療或保健系統及希望政府能為病友做什麼。結果內容簡述如下：

1.確立診斷前與一般醫師（非精神科醫師）的接觸經驗與看法：冤枉路－科別間的doctor-shopping、不斷尋求答案的過程、以器官為導向的專科門診，進入精神科前的掙扎。

2.精神科門診就醫經驗：藥物為主的治療、衛教資訊的不足、同科內的doctor-
shopping、「醫療的聲音」與 「生活世界的聲音」的衝突。

3.與精神醫療工作人員、志工互動的經驗及對其形象有何看法：
（1） 與精神醫療工作人員互動的經驗及對其形象有何看法：應具備專業的訓練與特質、同理心的展現、互動時間不足。
（2） 與志工（病友）團體的互動經驗：互動時間彈性、具有同理心、分享過來人的經驗、給予情緒支持、主動出擊，關心病友、成立（志工）互助團體的必要性。

4.所期待的醫療或保健系統：全民健保吸收醫療費用、心理治療普及化、建立
追蹤機制、相關福利措施規劃。

5.希望政府能為病友做什麼：成立社區心理衛生中心、協助就業輔導、加強精神
疾病之宣導、大眾媒體之再教育。

結果發現，病友們往往歷經一段時間的尋醫歷程及掙扎後，才踏入精神科的領域，可視為「不斷尋求答案的過程」。進入精神科之後，以藥物治療為主的模式中，病友們歷經了未知的藥物及副作用，且在資訊不透明、不對等的情況下，病友多對自身的病情診斷不清楚，多數病友仍在精神科中同樣進行「尋找醫師」的過程，而尋找醫師的資訊來源，多來自病友間的經驗交流。

針對以上的結果，研究者提出幾項建議：醫療衛生體系制度的改善、重視治療藥物對精障病友們的影響、治療應符合患者的最佳健康需要、醫療使用者的充權以及鼓勵國內自助團體成立，並轉型為精神健康倡導團體。

關鍵字：憂鬱症、精神科門診、求醫經驗

關鍵字

求醫經驗 ； 精神科門診 ； 憂鬱症

並列摘要

Abstract

The World Health Organization (WHO) considers that depression, AIDS, and cancer are three diseases should be taken seriously in the twenty-one century. However, what is the medical quality to be provided today when depression patients are encouraged to take medical treatment? In a few minutes, patients just get some drugs and lack psychotherapy. In this mode of taking medical treatment, what are the patients’ experiences of taking medical treatment in the psychiatric ambulatory department? Is it effective? It is important for us to consider and survey.

Therefore, the purposes of this study are to understand the following questions:

1. To understand the contact experiences and viewpoints of depression patients with doctors (not psychiatric doctor) before diagnosis being confirmed.

2. To survey the experiences of depression patients while taking medical treatment in the psychiatric ambulatory department.

3. To know the depression patients’ perspectives and experiences of interacting with psychiatric medical workers and volunteers.

4. The expecting medical and health system of depression patients.

5. The patients’ expectation corresponding to the actions of the government.

This study uses qualitative research and deeply interviews the patients who are confirmed to be depression patients. The data including interviews of thirteen patients are collected from May to October in 2002. There are five categories of this research: the contact experiences and viewpoints of depression patients with doctors (not psychiatric doctor) before diagnosis being confirmed, the experiences of depression patients while taking medical treatment in the psychiatric ambulatory department, the depression patients’ perspectives and experiences of interacting with psychiatric medical workers and volunteers, the expecting medical and health system of depression patients, and the patients’ expectation corresponding to the actions of government. The results are summarized as followings:

1. The contact experiences and viewpoints of depression patients with doctors (not psychiatric doctor) before diagnosis being confirmed: undeserved road---doctor shopping between different departments, the process of continuously seeking answers, organ direction, and struggle for entering the depression department.

2. The experience of depression patients while taking medical treatment in psychiatric ambulatory department: drugs being the major treatment, inadequate health education information, doctor-shopping in the same department, and the conflict between voice of the medical treatment and voice of the life world.

3. The depression patients’ perspectives and experiences of interacting with psychiatric medical workers and volunteers:
(1) psychiatric medical workers: must possess professional training and characteristics, and insufficient interaction time.
(2) volunteers: elastic interaction time, share experiences, emotional support, and caring for patients.

4. The expecting medical and health system of depression patients: national health insurance paying the medical fee and popularizing the psychiatric treatment.

5. The patients’ expectation corresponding to the actions of government: guidance to find a job and improving disease announcements.

The results discover patients always experienced a long time struggle before they entered the field of the depression department. After entering the depression department, patients experienced unknown drugs and side effects. In the information opaque and unequal situation, patients mostly did not know the condition of themselves. Mostly patients are still in the process of seeking doctors and the information of seeking doctors is from the exchanging experiences between patients.

According to the above results, the author advocates several suggestions: improving the medical and health system, respecting the drug influence on the depression patients, therapy conforming to the best health needs of patients, empowering the medical users, and encouraging self-help groups to be established and changed to mental health advocate groups.

Keyword: depression, psychiatric ambulatory department, experience of medical care seeking

並列關鍵字

depression ； the expriences of medical care seeking ； psychiatric ambulatory department

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