某醫學中心醫療糾紛訴訟案件之發生原因及其相關因素

中文摘要研究目的夲研究之目的為探討某醫學中心醫療糾紛訴訟案件之發生原因及其相關性，並藉由探討個案醫院醫療糾紛處理流程之適當性後修正醫療糾紛處理流程。主要目的有四：一、描述某醫學中心醫療糾紛訴訟案件病人和醫師之個人特質。二、探討病人和醫師之個人特質及其他相關因素與訴訟案件之相關性。三、比較某醫學中心與全國醫療院所醫療糾紛之發生原因。四、分析影響某醫學中心醫療糾紛訴訟案結果之相關因素。研究方法夲研究之研究樣本來自於為南部某醫學中心，對象來自於此醫學中心於1991年至2006年所發生之醫療糾紛訴訟案件，共計41件。將資料收集後，依據本研究之研究目的、研究架構及研究假設，選用適當的統計方法進行分析，除了一般描述性統計分析及相關分析外並加入質性分析部份，其說明如下： 1描述性統計：夲研究之統計分析方法包括訴訟案件自1991年到2006年的發生件數與病人和醫療人員的描述性資料分析，如人數、百分比及平均值等。 2推論性資料分析：則包含病人和醫療人員的資料與訴訟結果做相關、勝算比及迴歸性分析等研究結果 1、個案醫院醫療糾紛訴訟案有持續上升之趨勢。 2、個案醫院醫療糾紛訴訟案的發生數量主要在內科系與外科系上，共佔 73.18％，以刑事訴訟案件佔多數，共佔75.61％。 3、個案醫院醫療糾紛訴訟案案家提告的原因以不滿醫療過程或結果最多，佔85.37％，其次為溝通不良，佔31.71％，服務態度不佳則佔7.32％。 4、個案醫院醫療糾紛訴訟發生原因以對醫療過程或結果不滿意（佔68.29 ％）、治療相關（佔17.07％）及態度問題（佔17.07％）為主。 3、已結案的訴訟案件31件，法院判決案家勝訴的僅一件佔2.44％。 4、醫療糾紛訴訟結果與病人出院結果、醫病雙方之溝通不良和醫療過失及未落實醫療糾紛處理模式有顯著相關。 5、本論文亦嘗試修正個案醫院醫療糾紛處理方式，將之分為預防階段及處理階段等二個流程結論與建議本研究結論： 1、本研究可以發現造成醫療糾紛最主要關鍵因素之一可能是醫師與病患之間的溝通不良。 2、結果可以進一步歸納出，醫療糾紛引起最主要可能的另一個因素為醫事人員與病患及其家屬對於整個醫療過程產生不同的認知，對於結果有所不滿意，以致於在期望上有所落差，因無法取得平衡點，就可能由抱怨演變成為醫療糾紛。 3、本研究亦發現對醫療訴訟案件產生的原因之ㄧ有可能是因為醫療人員未確實執行醫院所建構醫療糾紛相關作業規定的流程而導致失去處理的黃金時機。根據研究結果，本研究提出以下建議： 1、機構應對醫療糾紛案件的處理程序應多做宣導，且應重視醫療相關人員的在職教育或認證工作，減少因專業上不純熟或疏失造成之醫療糾紛機率。 2、醫師在醫病溝通上，應考量病人的理解能力，並儘量針對處置作詳細的說明，避免不必要的誤解。 3、醫事人員面對醫療爭議或糾紛，應基於醫院整體考量主動溝通化解，或配合承辦單位協調處理，不宜規避卸責，致使事態擴大，難以收拾。

關鍵字

醫病關係；醫療糾紛訴訟

並列摘要

The objective of this research is to explore the causes and the relevance of a medical center’s medical service litigation cases by exploring the case study, its implementations and proper procedures. The four objectives are: 1. To describe the patients and doctors’ personal characteristics in medical litigation cases at a particular medical center. 2. To explore the patients and doctors’ personal characteristics and other factors related to the litigation cases. 3. To compare the causes of the medical disputes at a particular medical center with other national medical facilities. 4. To analyze the results of medical litigation cases and the related factors at a particular medical center. Research Methods This research is derived from a medical center in southern Taiwan. A total number of 41 litigation cases were recorded between 1991 and 2006. The data is based on the research objectives, research framework and assumptions, selection of appropriate statistical methods for analysis, descriptive statistics analysis and correlation analysis, and qualitative analysis, as follows: 1. A descriptive statistics: this statistical analysis method includes the number of incidence from 1991 to 2006 and the information on descriptive analysis of the patient and medical staff, such as the number of people, percentage and the average value. 2 Inferential data analysis: this includes information related to the outcomes of the litigation cases, the degree of certainty and regression analysis between patient and medical staff. Research Results 1. The hospital medical litigation cases are on the upward trend. 2. The hospital medical litigation cases mainly occurred in the Internal Medicine and the Surgical departments. These departments accounted for 73.18% of all dispute cases of which 75.61% are major criminal cases. 3. Of all hospital file medical litigation cases, dissatisfying with the process of medical treatments or the clinical outcomes accounted for 85.37%, followed by 31.71% in poor communication and 7.32 % in poor attitude. 4. The cause of medical litigation for dissatisfaction with the process of medical treatments or the clinical outcomes accounted (68.29%), treatment-related (17.07%) attitude (17.07%). 3. There are 31 closed cases; there is only one case that was ruled in favor of the plaintiff, accounted for 2.44%. 4. There are significant correlations in the outcomes of the medical litigation cases, the outcomes of the discharged patients, poor doctor-patient communication, medical negligence and failed medical dispute implementation practices. 5. This thesis paper will also try to amend how the hospital medical litigation cases should be managed and can be divided into a two-stage process of conflict prevention and dispute resolution. Conclusions and recommendations: 1. This study discovered that a key factor in causing medical disputes is likely to be poor communication between doctors and patients. 2. Further, the misunderstanding between medical staff and patients, and their families may be the other cause for medical disputes during the whole treatment process. Unsatisfactory clinical outcomes due to the expectation gaps and the inability to make compromise generally lead to medical disputes. 3. The study also found that in many medical litigation cases, the opportunity to resolve the dispute was diminished due to medical staff’s failure to properly follow hospital dispute guidelines. The following recommendations were made based on the above findings: 1. The organization involved in medical litigation cases should promote more awareness campaigns; emphasize on-job training and certification program for medical staff to minimize unprofessional medical errors. 2. In cases involving doctor-patient communication, doctor should consider each patient’s ability to comprehend fully and then explain clearly and accurately to avoid any unnecessary misunderstanding. 3. The medical personnel facing disputes or conflicts should take an initiative to resolve them promptly and in the best of the hospital’s interest, alternatively, collaborating with a mediator to resolve the disputes. It is not advisable to circumvent the responsibilities as this may escalate the disputes hence complicating the situation.