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題名:西醫醫療體系醫病互動的影響因素探討
作者:林萬壹
作者(外文):Wan-Yi Lin
校院名稱:國立中正大學
系所名稱:社會福利學系暨研究所
指導教授:陳孝平
學位類別:博士
出版日期:2011
主題關鍵詞:防衛性醫療醫療糾紛健保制度醫病互動關係模型內容分析法Defensive practice of medicineMedical disputesHealth insurance systemPhysician-patient interaction modelsContent analysis
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本研究希望瞭解在西方醫療體系主導下的國內醫療市場中,影響醫病雙方互動關係的潛在因素。研究者分別從民眾的求醫期待、健保制度、醫病糾紛等不同面向,交叉探討臨床醫師與一般民眾的看法。研究第一階段採量化方式以主流醫療體系的醫師作為研究母群體,以機率隨樣本大小成比例抽樣(PPS)及系統隨機抽樣方式選出研究對象,繼以郵寄方式寄出問卷,回收所得資料經SPSS軟體彙整分析出結果後,再經第二階段的質性訪談做進一步的驗證與擴充。後續質性研究的受訪對象來源,於醫師部份是以立意取樣、滾雪球以及自願參與方式獲得,民眾部份則是以立意取樣、滾雪球與醫師轉介方式取得,訪談結果以內容分析方式,運用Nvivo7軟體對資料內容作編碼整理。
第一階段量化研究顯示,98.8%受訪醫師的親友或99.2%受訪醫師的患者都有詴過中醫治療,而有86.3%受訪醫師的親友或93%受訪醫師的患者都曾詴過民俗療法。然而受訪醫師中真正能完全接受其親友或患者接受中醫治療的不到6%,能完全接受親友或患者接受民俗醫療的比例也僅佔2.1%。第二階段質性研究指出其間的落差在於,醫師是以體諒的心情以及擔心發生醫療糾紛的壓力下來看待民眾的複向求醫行為。本研究結果指出影響醫療糾紛的五大因素,依序為醫療費用、醫師態度、醫療疏失、新聞媒體以及醫病溝通等。
最後,研究者列出醫師與民眾在互動過程中的六大交集與歧異觀點,並提出本土性的醫病互動關係模型,即父權關係模式、協商關係模式以及商業關係模式等三大分類以及其下的六個次級分類。本模型同時解決了文獻上對於醫師誘發需求與患者誘發需求兩者不容易區分的困徬,並具有普遍性的臨床實際應用優點。
This study investigated potential factors that had impact on the physician-patient interactions in Taiwan’s medical environment dominated by western-medicine system. The researcher explored several aspects including patients’ expectations in seeking medical treatment, insurance systems, medical disputes, and also cross reference between the viewpoints of clinical physicians and the general public. The study utilized a mix of methods. Firstly, quantitative approach was applied on the targeted physicians in the mainstream medical system. Sampling techniques included probability proportionate to size (PPS) and systematic random sampling for the purpose of identifying potential research subjects. Questionnaires were mailed, and participants’ responses were analyzed using SPSS in order to identify trends and factors for the follow-up qualitative research. Sampling techniques involved in the qualitative study included purposive sampling, snowballing, and voluntary sampling for obtaining study participants from both pools of physicians and patients. Interviews were conducted, and content analysis was performed with Nvivo7 for coding and analysis.
The result of quantitative research indicated that 98.8% of the physicians’ families and friends or 99.2% of the physicians’ patients had experienced estern medical treatment, and 86.3% of the physicians’ families and friends or 93% of the physicians’ patients had tried alternative therapy. However, only less than 6% of the physicians indicated acceptance of their families and friends toward eastern medical treatment, and only 2.1% indicated acceptance of their patients toward alternative therapy. The result of qualitative study revealed that a physician’s compassion toward patients and worries about medical disputes could impact a physician’s view on the multiple medical seeking. This study identified five critical factors including medical expense, physician’s attitude, medical negligence, news media, and communication between physicians and patients, which could impact the probability of medical disputes.
Finally, six similarities and differences in viewpoints that characterized physician- patient interactions were also identified, and the researcher recommended a localized physician-patient interaction approach that combined paternalistic relationship model, consultative relationship model, and commercial relationship model. This approach may contribute to current literature by clarifying the confusion between the physician-induced demands and the patient-induced demands, and will be of benefit to clinical practice as well.
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