醫療法律糾紛之解決途徑研析 - 以大腸直腸肛門科為核心

醫療糾紛，是醫者最沉痛的試煉。時代變遷，病患權利意識逐漸抬頭，醫療環境已發生前所未有的改變。本論文以一位大腸直腸肛門科醫師，剖析親身經歷血淚交織的醫療糾紛個案，統整出相關法律議題，從涉及實務操作面向之醫療行為同意書的簽署、診斷書之開立、醫療鑑定之運作；制度層面的醫療事故預防與補償機制、非訟調處等，做深度探討。本文貴於真實，旨在提出解決方案。本研究結論：醫療糾紛的解決對策，須從醫糾的根源，醫療不良事件發生的預防，以免責為基礎、完善的病人安全制度做起；而和諧的醫病關係與良好的溝通技巧、善盡說明義務及鼓勵尋求第二意見、跨領域團隊合作照護及醫病共享決策，來防止爭議的產生；一旦從爭議轉變成糾紛，專業的醫療事故關懷處理團隊、善用有調解前「初步鑑定」程序的醫療糾紛非訴訟調處機制、社會救助及社會保險制度的適時介入、醫療專業責任保險與互助會適度移轉風險、為傷害止血；而法律制度面，秉持「醫療事故即時關懷」、「醫療爭議調解先行」、「預防除錯提升品質」三大原則的「醫療事故預防及爭議處理法」；以界定明確的醫療事故項目制定「大腸鏡醫療事故救濟條例」；醫院為醫師投保醫師業務責任保險，及醫事人員強制責任保險，應立法予以保障。由於醫療糾紛的特殊性，法庭不是醫病雙方最好的對話空間，進入訴訟程序，只是掉入另一個泥沼，對彼此都是傷害的延伸。讓醫師在醫院努力對抗疾病，不用浪費時間到法庭來打訴訟；讓病人在醫院接受最完整的治療，而不是奔波在法院重提舊傷口，才是最好的結果。

關鍵字

醫療糾紛；醫療事故；大腸直腸肛門科

並列摘要

Medical malpractices are the bitterest ordeals for doctors. As times change, the awareness of patients’ rights had gradually risen, and the medical environment has undergone unprecedented changes. In this paper, the author analyzed cases of medical disputes that he himself has experienced as a colorectoanal surgeon, and integrated,relevant legal issues from the signing of medical consent, issuing the certificate of diagnosis and the operations of medical assessment, to the prevention and compensation mechanism of medical malpractices at the institutional level as well as non-litigation mediation for an in-depth discussion. The article is valued for its authenticity and genuineness and aims to propose viable solutions. The conclusion of this study is that the solutions to medical disputes should start with the prevention of the cause of medical malpractice claim, and the improvement of patient safety system based on exemption. Harmonious doctor-patient relationship, good communication skills, elaboration of obligations, encouragement to seek a second opinion, cross-disciplinary teamwork, health care as well as shared decision making can all help to prevent disputes from arising. Once a controversy turns into disputes, the professional medical malpractice care team should be established, and it should make good use of non-litigation mediation mechanism with pre-mediation “preliminary appraisal” procedure. There should be also the timely and proper intervention of social assistance and social insurance system. Medical professional liability insurance and mutual assistance should also intervene appropriately to stop the situation from further deteriorating. In terms of the legal system, the “medical malpractice prevention and dispute resolution act” with the three principles of “immediate care for medical malpractice”, “preliminary mediation of medical dispute” and “prevention and removal of errors for quality improvement” should be adhered. To define clearly the medical malpractice items, the “regulations on the relief of colonoscopy medical malpractice” should be established. It should be guaranteed by legislation that hospitals should take out an insurance policy for medical professional liability insurance and compulsory liability insurance for medical personnel. For the particularity of medical malpractices, courts are not the best place for dialogue between doctors and patients. Entering the litigation process is just falling into another quagmire, and is simply an extension of the harm to each other. It is best to let doctors fight diseases in the hospital instead of wasting time in court. Allowing the patient to receive the most complete treatment in the hospital without rushing to the court to reopen the wounds is the best outcome.