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完整後設資料紀錄
DC 欄位 | 值 | 語言 |
---|---|---|
dc.contributor.advisor | 吳建昌 | |
dc.contributor.author | Hsin-Hui Lin | en |
dc.contributor.author | 林欣慧 | zh_TW |
dc.date.accessioned | 2021-05-13T06:48:59Z | - |
dc.date.available | 2020-09-12 | |
dc.date.available | 2021-05-13T06:48:59Z | - |
dc.date.copyright | 2017-09-12 | |
dc.date.issued | 2017 | |
dc.date.submitted | 2017-08-19 | |
dc.identifier.citation | 參考文獻
英文部分 Aoki, N., Uda, K., Ohta, S., Kiuchi, T., & Fukui, T. (2008). Impact of miscommunication in medical dispute cases in Japan. International Journal for Quality in Health Care, 20(5), 358-362. Bell, S. K., Moorman, D. W., & Delbanco, T. (2010). Improving the patient, family, and clinician experience after harmful events: the “when things go wrong” curriculum. Academic Medicine, 85(6), 1010-1017. Brennan, T. A., Leape, L. L., Laird, N. M., Hebert, L., Localio, A. R., Lawthers, A. G., . . . Hiatt, H. H. (1991). Incidence of Adverse Events and Negligence in Hospitalized Patients. New England Journal of Medicine, 324(6), 370-376. doi:10.1056/nejm199102073240604 Brewster, L. P., Risucci, D. A., Joehl, R. J., Littooy, F. N., Temeck, B. K., Blair, P. G., & Sachdeva, A. K. (2005). Management of adverse surgical events: a structured education module for residents. Am J Surg, 190(5), 687-690. doi:10.1016/j.amjsurg.2005.07.003 Brown, S. D., Callahan, M. J., Browning, D. M., Lebowitz, R. L., Bell, S. K., Jang, J., & Meyer, E. C. (2014). Radiology trainees' comfort with difficult conversations and attitudes about error disclosure: effect of a communication skills workshop. J Am Coll Radiol, 11(8), 781-787. doi:10.1016/j.jacr.2014.01.018 Cambridge University Press, (2017). dispute. Retrieved from http://dictionary.cambridge.org/zht/%E8%A9%9E%E5%85%B8/%E8%8B%B1%E8%AA%9E-%E6%BC%A2%E8%AA%9E-%E7%B9%81%E9%AB%94/dispute Chiu, Y. C. (2010). What drives patients to sue doctors? The role of cultural factors in the pursuit of malpractice claims in Taiwan. Social Science & Medicine, 71(4), 702-707. doi:http://dx.doi.org/10.1016/j.socscimed.2010.04.040 Cho, H. S., Lee, S. H., Shon, M. S., Yang, S. H., & Lee, H. R. (1998). Reasons why patients and families choose medical dispute. Journal of the Korean Academy of Family Medicine, 19(3), 274-291. Christensen, J. F., Levinson, W., & Dunn, P. M. (1992). The heart of darkness: the impact of perceived mistakes on physicians. J Gen Intern Med, 7(4), 424-431. Corbin, J., & Strauss, A. (1990). Grounded theory research: Procedures, canons and evaluative criteria. Zeitschrift für Soziologie, 19(6), 418-427. Coughlan, B., Powell, D., & Higgins, M. F. (2017). The Second Victim: a Review. Eur J Obstet Gynecol Reprod Biol, 213, 11-16. doi:10.1016/j.ejogrb.2017.04.002 Creswell, J. W., & Clark, V. L. P. (2007). Designing and conducting mixed methods research. Danzon, P. M. (1985). Medical malpractice : theory, evidence, and public policy. Cambridge, Mass.: Harvard University Press. Donaldson, M. S., Corrigan, J. M., & Kohn, L. T. (Eds.). (2000). To err is human: building a safer health system (Vol. 6). National Academies Press. Drukteinis, D. A., O'Keefe, K., Sanson, T., & Orban, D. (2014). Preparing emergency physicians for malpractice litigation: a joint emergency medicine residency-law school mock trial competition. J Emerg Med, 46(1), 95-103. Epner, D. E., & Baile, W. F. (2014). Difficult conversations: teaching medical oncology trainees communication skills one hour at a time. Acad Med, 89(4), 578-584. Etikan, I., Musa, S. A., & Alkassim, R. S. (2016). Comparison of convenience sampling and purposive sampling. American Journal of Theoretical and Applied Statistics, 5(1), 1-4. Fish, R., & Ehrhardt, M. (1992). Review of medical negligence cases: an essential part of residency programs. J Emerg Med, 10(4), 501-504. Frisch, P. R., Charles, S. C., Gibbons, R. D., & Hedeker, D. (1995). Role of previous claims and specialty on the effectiveness of risk-management education for office-based physicians. Western Journal of Medicine, 163(4), 346-350. Glaser, B. G. (1978). Theoretical sensitivity: Advances in the methodology of grounded theory: Sociology Pr. Gunderson, A. J., Smith, K. M., Mayer, D. B., McDonald, T., & Centomani, N. (2009). Teaching medical students the art of medical error full disclosure: evaluation of a new curriculum. Teach Learn Med, 21(3), 229-232. doi:10.1080/10401330903018526 Hochberg, M. S., Seib, C. D., Berman, R. S., Kalet, A. L., Zabar, S. R., & Pachter, H. L. (2011). Perspective: Malpractice in an Academic Medical Center: A Frequently Overlooked Aspect of Professionalism Education. Academic Medicine, 86(3), 365-368. doi:10.1097/ACM.0b013e3182086d72 Houry, D., & Shockley, L. W. (2001). Evaluation of a Residency Program's Experience with a One‐week Emergency Medicine Resident Rotation at a Medical Liability Insurance Company. Academic Emergency Medicine, 8(7), 765-767. James, S. S. (1994). Risk management in pediatric emergency medicine: a curriculum for fellowship training. Pediatr Emerg Care, 10(3), 168-171. Jena, A. B., Seabury, S., Lakdawalla, D., & Chandra, A. (2011). Malpractice risk according to physician specialty. N Engl J Med, 365(7), 629-636. doi:10.1056/NEJMsa1012370 Keller, D. R., Bell, C. L., & Dottl, S. K. (2009). An effective curriculum for teaching third-year medical students about medical errors and disclosure. Wmj, 108(1), 27-29. Kim, Y. D., & Moon, H. S. (2015). Review of medical dispute cases in the pain management in Korea: a medical malpractice liability insurance database study. The Korean journal of pain, 28(4), 254-264. Leape, L. L. (1997). A systems analysis approach to medical error. Journal of evaluation in clinical practice, 3(3), 213-222. Lefevre, F. V., Waters, T. M., & Budetti, P. P. (2000). A Survey of Physician Training Programs in Risk Management and Communication Skills for Malpractice Prevention. The Journal of Law, Medicine & Ethics, 28(3), 258-266. doi:doi:10.1111/j.1748-720X.2000.tb00669.x Lester, G. W., & Smith, S. G. (1993). Listening and talking to patients. A remedy for malpractice suits? West J Med, 158(3), 268-272. Levinson, W., Roter, D. L., Mullooly, J. P., Dull, V. T., & Frankel, R. M. (1997). Physician-patient communication. The relationship with malpractice claims among primary care physicians and surgeons. JAMA, 277(7), 553-559. Liebman, B. L. (2013). Malpractice mobs: medical dispute resolution in China. Columbia Law Review, 181-264. Localio, A. R., Lawthers, A. G., Brennan, et. al (1991). RELATION BETWEEN MALPRACTICE CLAIMS AND ADVERSE EVENTS DUE TO NEGLIGENCE - RESULTS OF THE HARVARD MEDICAL-PRACTICE STUDY-III. New England Journal of Medicine, 325(4), 245-251. doi:10.1056/nejm199107253250405 McNutt, R., Abrams, R., Hasler, S., Rosen, R., Brill, J., Dimou, C., . . . Levin, S. (2002). Determining medical error. Three case reports. Eff Clin Pract, 5(1), 23-28. Mira, J. J., Carrillo, I., Guilabert, M., Lorenzo, S., Perez-Perez, P., Silvestre, C., & Ferrus, L. (2017). The Second Victim Phenomenon After a Clinical Error: The Design and Evaluation of a Website to Reduce Caregivers' Emotional Responses After a Clinical Error. J Med Internet Res, 19(6), e203. doi:10.2196/jmir.7840 Otte, K. K., Zehe, S. C., Wood, A. J., Hernandez, J. S., & Karon, B. S. (2010). Legal aspects of laboratory medicine and pathology for residents and fellows: a curriculum for pathology training programs. Arch Pathol Lab Med, 134(7), 1029-1032. doi:10.1043/2009-0251-oa.1 Patton, M. Q. (1990). Qualitative evaluation and research methods: SAGE Publications, inc. Reading, E. G. (1986). The malpractice stress syndrome. N J Med, 83(5), 289-290. Rooney, J. J., & Heuvel, L. N. V. (2004). Root cause analysis for beginners. Quality progress, 37(7), 45-56. Sanbar, S. S., & Firestone, M. H. (2007). Medical malpractice stress syndrome. American College of Legal Medicine, editor. The medical malpractice survival handbook. 1st ed. Philadelphia: Mosby Elsevier, 9-15. Schlicher, N. R., & Ten Eyck, R. P. (2008). Medical malpractice: utilization of layered simulation for resident education. Acad Emerg Med, 15(11), 1175-1180. doi:10.1111/j.1553-2712.2008.00165.x Scott, S. D., Hirschinger, L. E., Cox, K. R., McCoig, M., Brandt, J., & Hall, L. W. (2009). The natural history of recovery for the healthcare provider “second victim” after adverse patient events. Quality and Safety in Health Care, 18(5), 325-330. Seys, D., Wu, A. W., Gerven, E. V., Vleugels, A., Euwema, M., Panella, M., . . . Vanhaecht, K. (2013). Health care professionals as second victims after adverse events: a systematic review. Evaluation & the health professions, 36(2), 135-162. Shuanliang, F., Jie, F., Ping, Z., Rongjun, Y., & Zhenyuan, W. (2004). Medical Dispute & Ethics of Autopsy [J]. Chinese Medical Ethics, 6, 009. Sloan, F. A., & Chepke, L. M. (2008). Medical malpractice. Cambridge, Mass.: MIT Press. Stroud, L., Wong, B. M., Hollenberg, E., & Levinson, W. (2013). Teaching medical error disclosure to physicians-in-training: a scoping review. Acad Med, 88(6), 884-892. doi:10.1097/ACM.0b013e31828f898f Studdert, D. M. L. L. B. S. M. P. H., Mello, M. M. J. D. P., & Brennan, T. A. M. D. J. D. M. P. H. (2004). Medical Malpractice. N Engl J Med, 350(3), 283-292. Tsao, C. I. P., & Layde, J. (2009). Three-session psychiatric malpractice curriculum for senior psychiatry residents. Academic Psychiatry, 33(2), 160. Vincent, C., Phillips, A., & Young, M. (1994). Why do people sue doctors? A study of patients and relatives taking legal action. The Lancet, 343(8913), 1609-1613. doi:http://dx.doi.org/10.1016/S0140-6736(94)93062-7 Walston-Dunham, B. (2006). Medical malpractice : law and litigation. Clifton Park, N.Y.: Thomson/Delmar Learning. Watling, C. J., & Brown, J. B. (2007). Education Research: Communication skills for neurology residents Structured teaching and reflective practice. Neurology, 69(22), E20-E26. Wong, B. M., Etchells, E. E., Kuper, A., Levinson, W., & Shojania, K. G. (2010). Teaching quality improvement and patient safety to trainees: a systematic review. Acad Med, 85(9), 1425-1439. doi:10.1097/ACM.0b013e3181e2d0c6 Wu, A. W. (2000). Medical error: the second victim: the doctor who makes the mistake needs help too. BMJ: British Medical Journal, 320(7237), 726. Wu, A. W., Folkman, S., McPhee, S. J., & Lo, B. (2003). Do house officers learn from their mistakes? Quality and Safety in Health Care, 12(3), 221-226. Wu, A. W., Lipshutz, A. K., & Pronovost, P. J. (2008). Effectiveness and efficiency of root cause analysis in medicine. JAMA, 299(6), 685-687. Zenlea, I. S., Scheff, E., Szeidler, B., Tess, A., Santangelo, J., Sato, L., . . . Focht, G. (2015). Enhancing Patient Safety in Pediatric Primary Care: Implementing a Patient Safety Curriculum. Clin Pediatr (Phila), 54(11), 1094-1101. doi:10.1177/0009922815584929 中文部分 方莉莉(2009)。我國醫療糾紛民事判決關鍵因素實證分析--以台北、士林、板橋地方法院為例。政治大學碩士學位論文,未出版。民106年6月17日,取自Airiti AiritiLibrary database。 朱俊嘉(2013)。醫療從業人員在醫療爭議調處暨訴訟階段需求探究。高雄醫學大學碩士學位論文,未出版。民106年6月17日,取自Airiti AiritiLibrary database。 吳心楷、辛靜婷(2011)。數位學習研究中質性資料的管理與分析: 以 NVivo 軟體的使用為例。載於宋曜廷(主編),數位學習研究方法。台北市:高等教育出版社。 吳俊穎, 賴惠蓁, 陳榮基(2009)。醫療糾紛與醫師特性分析。台灣醫學, 13(2), 115-121. doi:10.6320/fjm.2009.13(2).01 宋曜廷、潘佩妤(2010)。混合研究在教育研究的應用。教育科學研究期刊, 55(4), 97-130. 李佳穎(2013)。醫師經歷醫療糾紛後之身心與社會調適過程。國立臺灣大學碩士學位論文,未出版。 沈冠伶、莊錦秀(2012)。民事醫療訴訟之證明法則與實務運作。政大法學評論(127), 167-266. 林山田、林勳發(1988)。台北市立醫院醫療糾紛及其法律問題之研究。台北市政府研考會委託研究計劃,國立政治大學法律研究所。取自http://rdnet.taipei.gov.tw/xDCM/TPE_user/search_result_detail_research.jsp?dtdid=0000000014&DBType=1&xml_status=&concount=1&condition0=77.12&contype0=22_PDT&linktype0=1&searchtype=0&pagecount=10&xml_id=0000007097 林東龍(2004)。醫療糾紛之社會控制:社會學的分析。國立中山大學博士學位論文,未出版。民106年6月17日,取自Airiti AiritiLibrary database。 林東龍, 彭武德, 陳武宗(2009)。[告] 與 [不告] 之間-台灣醫療糾紛病患及其家屬之行動分析。長庚人文社會學報, 2(1), 165-199。 林達(2017)。2017年3月6日。林達觀點:慘遭濫訴的560位司機血淚能否換來一個司法改革。取自http://www.storm.mg/article/230212 邱懷萱(2001)。從醫療糾紛談台灣病患權益。國立陽明大學碩士學位論文,未出版。 許慎(約為121)。說文解字。民106年3月2日,取自http://www.zdic.net/z/swjz/ 張必正(2003)。醫師對於病人安全相關議題的認知, 看法與因應行為之硏究: 以北部醫院醫師為例。國立台灣大學碩士學位論文,未出版。 張芬芬(2010)。質性資料分析的五步驟: 在抽象階梯上爬升。初等教育學刊(35), 87-120. 張耘慈(2010)。台灣地方法院民事醫療糾紛判決之實證研究。國立陽明大學碩士學位論文,未出版。民106年6月17日,取自Airiti AiritiLibrary database。 郭書琴(2014)。進入法庭的金錢門檻──訴訟救助、當事人權益保障、與濫訴之防止。台灣法學雜誌, (241), 43-56. 陳榮基(1993)。台灣醫療糾紛的現況與處理。台北市: 健康世界雜誌社。 陳聰富(2014)。醫療責任的形成與展開。臺北市: 臺灣大學出版中心。 陳忠五(2004)。醫療糾紛的現象與問題。台灣本土法學雜誌, 55:, 1-4. 游宗憲(2008)。醫療糾紛病人自力救濟之個案分析。臺灣醫學, 12(3), 292-298. 黃鈺媖(2015)。病人為何要告醫師?訴訟外醫療糾紛解決機制之實証與比較法研究。國立陽明大學博士學位論文,未出版。 黃鈺媖、楊秀儀(2015)。病人為何要告醫生?以糾紛發動者為中心之法實證研究。台大法學論叢, 44(4), 1845-1885. doi:10.6199/ntulj.2015.44.04.04 楊秀儀(2002)。論醫療糾紛之定義、成因及歸責原則。台灣法學雜誌(39), 121-131. 楊秀儀(2015)。醫療糾紛之公共衛生思維。載於王榮德(主編),公共衛生學上冊第十四章。台北市:國立臺灣大學出版中心。 劉邦揚(2009)。我國地方法院刑事醫療糾紛判決之實證研究。國立陽明大學碩士學位論文,未出版。民106年6月17日,取自Airiti AiritiLibrary database。 劉斐文、邱清華、楊銘欽(1997)。消費者基金會醫療爭議案件之分析研究。中華公共衛生雜誌, 16(1), 77-85. doi:10.6288/cjph1997-16-01-07 盧昭文(1999)。醫師遭遇醫療糾紛之經驗與其認知、態度對醫師行為影響之研究--以大台北地區為例。國立台灣大學碩士學位論文,未出版。民106年6月17日,取自Airiti AiritiLibrary database。 Corbin, J. M., Strauss, A. L (2015)。质性研究的基础 : 形成扎根理论的程序与方法(朱光明譯)。重慶市: 重慶大學出版社。 Donaldson et al(2010)。人會出錯—建立一套更安全的健康照護系統(鄭紹宇等編譯)。臺北市 : 臺灣醫療品質協會出版 : 合記發行。 Rothman, E. L.(2004)。白袍 : 一位哈佛醫學生的歷練(朱珊慧譯)。台北市: 天下遠見。 Gawande, A (2003)。一位外科醫師的修煉(廖月娟譯)。台北市: 天下遠見。 Gibbs, G. R (2010)。質性資料的分析(廖佳綺譯)。臺北縣永和市: 韋伯文化國際。 Kvale, S(2010)。訪談研究法(陳育含譯)。臺北縣永和市: 韋伯文化國際。 中華民國司法院(2017)。105年司法統計年報。民106年7月17日,取自http://www.judicial.gov.tw/juds/ 中華民國醫師公會全國聯合會(2016)。2015年度台灣地區執業醫師、醫療機構統計資料。民106年7月17日,取自http://www.tma.tw/tma_stats_2015/2015_stats.pdf 中華民國教育部國語推行委員會(2015)。重編國語辭典修訂本,臺灣學術網路第五版試用版。民106年3月2日,取自http://dict.revised.moe.edu.tw/cbdic/ 中華民國衛生福利部醫事司(2017)。受理委託醫事鑑定案件數統計表1050623。民106年6月2日,取自http://dep.mohw.gov.tw/DOMA/cp-2712-7681-106.html 中華民國衛生福利部(2017)。醫院評鑑及教學醫院評鑑作業程序。民106年6月2日,取自http://mohwlaw.mohw.gov.tw/FLAW/FLAWDAT01.aspx?lsid=FL048300 財團法人醫院評鑑暨醫療品質策進會(2016)。醫院評鑑基準及評量項目。民106年6月2日,取自http://www.tjcha.org.tw/FrontStage/page.aspx?ID=FE5F1FDE-2839-4702-BA2A-A9DE1D3672FB&PID=637D42A4-9D35-407A-B01E-2EB3CAE2F0D7 | |
dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/2734 | - |
dc.description.abstract | 本研究目的有二:一、探索國內醫師在面對醫療糾紛時所遭遇的困境;二、對醫療糾紛相關教育的需求。
本研究在困境的探討方面,採用質性研究、半結構式面對面訪談方法進行。在民國106年3月至6月間,透過立意取樣(purposive sampling)之方式,訪談來自不同地區、科系、年齡層、性別,共16位曾有醫療糾紛經驗之醫師,以紮根理論((grounded theory)之方式,對訪談所得之文本作開放式編碼與軸心編碼分析;在國內醫師對醫療糾紛相關教育需求之部分,採用混和研究(mixed-methods research)之方式。除以前述困境探討之研究方法,收集與分析同一群受訪者對醫療糾紛相關教育需求之看法,同時間以立意取樣之方式,針對全國醫師,進行半結構式問卷調查,收集國內不同地區、層級、年齡層、科系之醫師對醫療糾紛相關教育的需求之量性資料,以敘述性統計及推論性統計之方法分析,最後將質性與量性資料整合討論,達到多重檢核(triangulation)與資料互補之目的。 研究結果顯示,台灣醫師面對醫療糾紛,有24項核心困境,包括訴訟程序與法律邏輯相關6項:1. 還原當時事發經過 2. 釐清責任歸屬 3.不懂法律邏輯或訴訟程序 4. 需配合法院隨傳隨到 5. 冗長之審判期 6. 刑事濫訴現象;自我認同危機相關2項:1. 第一次面臨刑法審判與究責之心理衝擊 2.行醫信念受到挑戰;人際網絡與社會互動相關15項: 1. 人身安全威脅2. 被原本關係良好的病家指責拿其當實驗品 3. 病家可能有人格特質疾患,不知如何與其溝通互動 4. 走入訴訟後被建議不再接觸病家,因此無法了解對方想法 5. 無法幫助病家6. 同儕在病家面前指責 7. 同事間推諉責任 8. 提供第二意見之醫師不同意原醫師看法 9. 主治醫師責任制10. 法官或檢察官之庭上斥責 11. 法律專業人士難了解醫療專業內容12. 疑似有鼓勵病人提告之掮客或律師 13. 醫院無協助人員與組織 14. 醫院協助人員負荷過重或專業不足 15. 病家透過媒體發言,造成對醫師名譽與醫病關係之損害;金錢賠償造成之壓力1項。國內醫師對醫療糾紛相關教育有其需求,超過九成填答者同意將相關課程納入醫師養成教育中。受國內醫師重視的授課主題為「醫療傷害訴訟」相關法規認識(56.7%)、「醫療糾紛」發生案例與處理經驗分享(73.7%)、「醫病溝通」:支持病人與家屬之相關溝通技巧,如傾聽、表達同理心、給予病人或家屬情緒支持、告知壞消息、了解病人或家屬之期望等(58.9%)、「醫療傷害」發生時,應如何告知病人及其家屬、如何告知同儕、遺憾或道歉之表示(59.3%)等,其中又以「醫療糾紛」發生案例與處理經驗分享最為重要。有約七成的醫師有上過醫療糾紛相關課程,最常上到的主題為「醫病溝通」、「醫學倫理」、「醫療品質」;在問卷所列的課程中,最少被上到又令醫師最有興趣的課程主題是「模擬法庭」、「醫療傷害訴訟裁判文」、「醫療糾紛」發生案例與處理經驗分享。八成以上醫師認為在醫學系畢業前即應開始接觸醫療糾紛相關課程,占必修課程裡3學分以下即可。授課單位部分,醫學中心之醫師偏好在自己醫院上課;基層院所執業之醫師偏好醫師公會所舉辦的課程,約有三成醫師最有意願參與各專科醫學會所辦之課程;影響醫師是否參與課程的考量包括方便性、以及是否有依專科特性的授課內容或醫療糾紛案例分享。未能修習課程的原因最多為「訓練或繼續教育過程沒有舉辦這類課程」,其次為「沒有時間去上課」、「上課地點太遠」。 本研究提供國內醫師在面對醫療糾紛時,所遭遇的困境,及對醫療糾紛相關教育的需求之探索性結果。醫師在處理醫療糾紛時所面對的困境非常多元化,除個人內在身心思索,亦牽涉到司法、人際、醫療糾紛處理制度、媒體等法學、政策學、醫院管理學或社會學議題,每一困境項目都值得未來研究深入探究。在醫療糾紛教育方面,國內醫師需求甚高,然而何種教育訓練方式與內容能有效幫助到醫師,值得更多實證研究探究。 | zh_TW |
dc.description.abstract | This research was aimed to explore (1) the plight of physicians in Taiwan regarding medical disputes (2) the educational needs of physicians in Taiwan regarding medical disputes.
To probe the plight of physicians in Taiwan regarding medical disputes, we performed qualitative, semi-structural face-to-face interview to collect our subjects’ opinion. The time of subjects’ recruitment and interview was between March, 2017 and June, 2017. Via purposive sampling, 16 physicians that had been involved in a medical dispute were enrolled in the study. The subjects were from various areas and medical specialties Taiwan. We analyzed and coded the subjects’ opinions openly and axially by grounded theory. To understand the educational needs of physicians in Taiwan regarding medical disputes, we collected opinions from the above-mentioned 16 subjects in the “plight” part of the study. Meanwhile, via purposive sampling, semi-structural questionnaires were collected from 273 physicians across the island. Descriptive and inferential statistics were both used to analyze the questionnaire data. A discussion was made to incorporate results from qualitative data and quantitative data. We identified 24 core plights in facing medical disputes by physicians in Taiwan. In the category “difficulty in litigation”, there were 6 plights: (1) difficulty in clarifying the incident (2) difficulty in deciding who to be responsible (3) unfamiliarity about the litigation process and rationale (4) need to cooperate with the court time (5) the lengthy trial period (6) vexatious litigation (especially the criminal procedures). In the category “self-identity crisis”, there were 2 plights: (1) psychological shock during criminal procedures (2) beliefs in medical practice being challenged. In the category “Interpersonal relationship and communications”, there were 15 plights: (1) threatening of personal safety (2) being accused of “doing experiments” on the patients (3) certain personality disorder of the patient-family hindering communication with the physician (4) being advised not to contact with the patient-family after the dispute has occurred (5) could not help the patient anymore (6) being blamed by staffs (7) shirking of responsibility by staffs (8) a second doctor not agreeing the viewpoint of the first doctor (9) the system of “attending physician responsible for all” (10) blame from the judge or the prosecutor (11) difficulty for the judge or the prosecutor to understand medical conditions (12) in some cases, the patient-family were pushed to litigation due to potential benefit of the adviser (13) lack of support from the hospital (14) amateur or overloaded support personals (15) pressure from the media. Another category was the compensation itself too high for the physician to afford. Need for education about medical dispute was obvious. Over 90% of subjects agreed the incorporation of this education into the training program. Of the 11 listed topics of this field, the most favored topics were: (1) knowing about the regulations (56.7%) (2) medical dispute case sharing (73.7%) (3) communication with the patient-family (58.9%) (4) how to respond to a medical dispute: focus on telling the patient-family, the staff and apologize (59.3%). Seventy percent of the subjects reported having attended any class about medical dispute. The most frequent attended classes were: “communication”, “medical ethics” and “healthcare quality”. The least attended and the most wanted classes were “simulation of the court”, “verdict of medical dispute” and “case sharing”. Over 80% of the subjects voted that the medical dispute classes should be delivered to the undergraduates, and that the credits should be below 3. As for the location of education, physicians in medical centers preferred taking a class in his or her own hospital; physicians in local clinics preferred the class at medical associations. Current hindrance to the classes were “class not available”, “time not available” and “too distant the location of the class”. In summary, the current study provided information about plights when physicians facing medical disputes, and physicians’ need for related education. The plights were found to be very heterogeneous, due to complex interactions between medical practices, regulations, personal beliefs, and various other personal and social factors. The interactions could be a further direction of research. Physicians’ interests were high in medical dispute education. The effectiveness and efficacy of specific content or method of education regarding medical disputes warrant further research. | en |
dc.description.provenance | Made available in DSpace on 2021-05-13T06:48:59Z (GMT). No. of bitstreams: 1 ntu-106-R04457004-1.pdf: 1867529 bytes, checksum: d17107484b0aa82193e0af70bafbeaeb (MD5) Previous issue date: 2017 | en |
dc.description.tableofcontents | 目 錄
口試委員會審定書 i 誌謝 vi 中文摘要 viii 英文摘要 x 第一章 緒論 1 第一節 研究動機 1 第二節 研究背景 2 第三節 研究目的 5 第二章 文獻回顧 6 第一節 醫療糾紛之定義 6 第二節 台灣醫師與醫療糾紛現況 8 第三節 醫療糾紛對醫師的影響 12 第四節 醫療糾紛相關教育課程 14 第三章 研究方法 18 第一節 研究設計 18 第二節 研究對象 20 第三節 研究工具 22 第四節 研究步驟與流程 24 第五節 資料處理與分析 25 第四章 國內醫師面對醫療糾紛的困境:研究結果 28 第一節 研究樣本特性 28 第二節 訪談研究編碼總論 33 第三節 軸心編碼(一):訴訟程序與法律邏輯相關 35 第四節 軸心編碼(二):自我認同危機相關 41 第五節 軸心編碼(三):人際網絡與社會互動相關 44 第六節 軸心編碼(四):金錢賠償造成之壓力 54 第五章 國內醫師面對醫療糾紛的困境:討論 56 第一節 醫療糾紛之真相調查與歸責 56 第二節 醫師與加害人 58 第三節 一般人也可能會遇到的司法困境 60 第四節 病家、同行、媒體、醫院與醫師 61 第五節 教育是否能改善困境 63 第六節 研究限制 64 第六章 國內醫師對醫療糾紛相關教育的需求:結果與討論 65 第一節 研究樣本特性 65 第二節 研究結果與討論:質、量資料多重檢核 69 第三節 研究結果與討論:質性資料補充 87 第四節 研究限制 90 第七章 結論與建議 91 第一節 國內醫師面對醫療糾紛的困境 91 第二節 國內醫師對醫療糾紛相關教育的需求 92 參考文獻 95 附錄一 問卷全文 ......101 附錄二 訪談研究邀請函 …..107 附錄三 訪談大綱 …..108 表 目 錄 表一:國內醫療糾紛發生率研究比較 4 表二:地方法院刑事判決案件數(與占整體百分比),以地理分布 11 表三:被告所屬之醫療院所層級分布 11 表四:地方法院刑事判決罪名類別、件數(與占整體百分比) 12 表五:台灣大學醫學院105學年度,網頁公告醫療糾紛相關教育課程 16 表六:受訪者基本資料表 28 表七:困境訪談研究結果編碼表 34 表八:問卷填答者之基本資料 66 表九:醫師養成教育加入醫療糾紛相關課程之需求統計 70 表十:醫療糾紛授課主題偏好統計 73 表十一:過去醫療糾紛相關課程上課經驗統計 76 表十二:醫療糾紛課程授課時間點與時數敘述性統計 80 表十三:醫療糾紛課程授課時間點與時數推論性統計 81 表十四:醫療糾紛課程授課地點敘述性統計 83 表十五:醫療糾紛課程授課地點推論性統計 83 表十六:影響醫療糾紛課程參與原因敘述性統計 84 表十七:影響醫療糾紛課程參與原因推論性統計 85 表十八:醫療糾紛課程選修或必修之偏好敘述性統計 86 表十九:醫療糾紛課程選修或必修之偏好推論性統計 86 圖 目 錄 圖一:衛福部醫事司醫審會受理委託醫事鑑定案件數歷年統計長條圖 3 圖二:Nvivo 11.0 軟體介面示意圖 26 | |
dc.language.iso | zh-TW | |
dc.title | 台灣醫師面對醫療糾紛的困境與教育需求 | zh_TW |
dc.title | The Plight and Educational Needs of Physicians in Taiwan regarding Medical Disputes | en |
dc.type | Thesis | |
dc.date.schoolyear | 105-2 | |
dc.description.degree | 碩士 | |
dc.contributor.oralexamcommittee | 陳聰富,陳彥元 | |
dc.subject.keyword | 醫療糾紛,醫師,困境,教育需求,紮根理論,台灣, | zh_TW |
dc.subject.keyword | medical dispute,medical malpractice,physician,plight,education,grounded theory,Taiwan, | en |
dc.relation.page | 108 | |
dc.identifier.doi | 10.6342/NTU201703304 | |
dc.rights.note | 同意授權(全球公開) | |
dc.date.accepted | 2017-08-19 | |
dc.contributor.author-college | 醫學院 | zh_TW |
dc.contributor.author-dept | 醫學教育暨生醫倫理研究所 | zh_TW |
顯示於系所單位: | 醫學教育暨生醫倫理學科所 |
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