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題名:醫療糾紛之社會控制:社會學的分析
作者:林東龍
作者(外文):Dong-long Lin
校院名稱:國立中山大學
系所名稱:中山學術研究所
指導教授:朱柔若
學位類別:博士
出版日期:2004
主題關鍵詞:紮根理論鉅觀--微觀整合社會控制第三方醫療糾紛Social ControlMacro-Micro IntegrationThird PartyMedical MalpracticeGrounded Theory
原始連結:連回原系統網址new window
相關次數:
  • 被引用次數被引用次數:期刊(3) 博士論文(1) 專書(0) 專書論文(0)
  • 排除自我引用排除自我引用:3
  • 共同引用共同引用:0
  • 點閱點閱:108
本研究主要針對目前台灣社會多樣化的醫療糾紛處理之道進行深入探究,以瞭解病患及其家屬處理醫療傷害的經驗、想法,以及影響糾紛決策過程和結果的相關因素。先前文獻對病患及其家屬選擇醫療糾紛處理方式之探究,絕大多數是從假定個人是出於貨幣理性的動機、或是受制於醫病不平權下的劣勢地位為前提,說明病患及其家屬採行某種處理糾紛機制之原因,侷限於靜態的原因變項的陳鋪。本論文則結合鉅觀與微觀取向的研究架構,利用紮根理論研究程序之特點—著重行動的動態歷程和背景脈絡分析,來理解鉅觀、微觀因素,以及行動決策三者之間的互動歷程。本研究以深度訪談法共收集31名受訪者之醫療糾紛處理經驗,包括病患及其家屬16名、第三方13名,以及2名當事醫師。其中16名病患及其家屬是來自14例醫療糾紛案件。
從病患及其家屬的訪談資料中發現,「要求認錯」是病患及其家屬處理醫療糾紛經驗的核心概念。當醫療疏失造成病患身體傷害程度屬輕傷害時,醫方較容易在糾紛初期主動表示認錯。若屬重傷害,由於病患及其家屬在醫療專業知識、社會經濟地位,以及組織動員能力等層面屬於相對弱勢,並無法要求醫方道歉和說明醫療傷害真相,至多只能獲得金錢補償。這些獲得金錢補償的案件主要有兩項關鍵因素,一是醫病之間具有交錯的人際網絡,使得第三方如地方人士或民意代表可以發揮協調能力;二是進入訴訟後,在檢察官或法官勸醫方與病患和解而獲得金錢補償,但非直接做出判決。雖然病患及其家屬對於醫方的回應不滿意,要求醫方認錯的行動仍會因病患及其家屬不願繼續承擔訴訟成本、地方人際壓力,以及其他家屬反對持續追究等原因而停止。另一方面,從第三方和當事醫師的訪談資料發現,公立醫院或醫院評鑑層級較低的醫院面對醫療糾紛案件時,較擔心病患及其家屬的非理性行為和民意代表的介入。即便醫療過程中沒有醫療疏失,也可能屈服於病患及其家屬要求。
This study explores resolution mechanisms for all types of medical malpractice cases with a special focus on the patients and their families’ subjective experiences in such disputes, as well as the relevant factors that influence the process of decision-making and the relevant results. The previous studies on patients’ actions to medical disputes in the literature assumed that patients and their families took certain actions due to monetary reasons or discriminated status under a restricted medical system. Most studies simply state the variables that led the patients and their families to certain resolution mechanism. Nevertheless, not many researchers have explored the micro experiences of meaning construction during the process to resolve malpractice cases. Neither did they study how the patients interpret the cultural and structural variables, which might result in different dispute resolution mechanism being used. Therefore, this study attempts to develop a tentative approach to integrate macro and micro analyses and take the advantage of the procedure of grounded theory to explore the dynamic process in the resolution of disputes over medical malpractice. In-depth interviews were applied in the study involving 16 patients and their family members, 13 third party groups and two physicians for a total of 31 people. Among the 16 patients and their family members, there were 14 cases of medical treatment dispute.
It was found that the core concept of “admitting a mistake was made” is the main goal of patients and their family members when dealing with the dispute. If the injury is not critical, normally the physician will admit his/her mistake in the beginning of the dispute. If the injury is critical, since the patients and their family members not having professional knowledge regarding medical injury and their social economical status as well as lower mobilization capabilities than physicians, they do not get an apology or the truth regarding the medical injury. They only receive compensation at most. There are two key causes of providing compensation: (a) crisscrossed interpersonal connection between patient, physician and the third party, such as a civil representative, who plays the role of coordinator; (b) after litigation, usually the court prosecutor or the judge will mediate between the patient and physician, so that compensation can be made. No direct judgment is made. Yet the patients and their family members are not satisfied because they do not receive a response from the involved physician regarding their request about “admitting mistake was made” which is terminated since their is no money for further litigation, pressure from the civil representative or other objections of the family members. Furthermore, the interview of the third party and the involved physician show that public hospitals are more afraid of irrational acts from patients and their family members or the intervention of the civil representative when dealing with medical disputes. Even if there is no medical negligence, they still submit to the requests of the patients and their family members.
參考文獻
中文部分
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三、其他
http://www.thrf.org.tw/index.html
http://www.consumers.org.tw/
http://tapwer.womenweb.org.tw/fem/topic/topic.htm
http://www.thrf.org.tw/index.html




英文部分
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