The Influences of Physician’s Characteristic and Hospital’s Medical Dispute Supporting System on the Physician’s Willingness to Disclose and Apologize for Medical Errors

• Main Authors: Pei-Yu Liou, 劉佩瑜
• Other Authors: 戴志展
• Format: Others
• Language: zh-TW
• Published: 2009
• Online Access: http://ndltd.ncl.edu.tw/handle/26076394892186405353

碩士 === 中國醫藥大學 === 醫務管理學研究所碩士班 === 97 === Research Purpose: Nowadays, the physician-patient relationship has been changed. How to protect the rights of patient as well as that of physician turns to be a significant topic. Although “informed consent” has been devoted to implement in healthcare society, for those unpleasant adverse evens or medical errors happened from healthcare delivery, we are still lacking any clear consensus in facing that, in additional to establishing a patient safety reporting system in hospital for prevention. Some other countries have introduced a new policy for this issue – disclosure of medical error and found that disclosure of medical error has positive impact on physician-patient relationship and can decrease the medical lawsuit. However, the behavior of physician would be affected by both the internal and external environment, whether the policy is suitable or not in our country is still challengeable. The study aims to realize, in different dispute supporting system, physicians’ experience and willingness regarding disclosing medical error to their patients, and analyze the possible factors that may influence physician’s willingness to disclose. Research Method: The study population is the physicians in six hospitals, including 1 non-public medical center, 1 public medical center, 1 non-public regional hospital, 1 public regional hospital, 1 non-public local hospital and 1 public local hospital. Self-administered questionnaire will be delivered by probability proportionate to physician size of the individual hospital. Factors may influence their disclosure are evaluated by logistic regression analysis. Total 510 copies of the questionnaire were delivered to the subjects. 457 valid questionnaires were received (90% response rate). Research Results: Of the physicians, 87% had experienced medical error, 79% had disclosed error to patient, and 26% expressed that disclosure had have negative impact on physician-patient relationship. 89% express that they would disclose and apologize to patients about medical error what caused by themselves. Physicians who were an internist, spending longer time in caring hospitalized patient, spending shorter time in high-risk medical practice, ever disclosing, ever apologizing, and having no negative impact on physician-patient relationship after disclosure, were independently associated with higher willingness for disclosing and apologizing for medical errors. The willingness of physician’s disclosing medical errors was not different across hospitals. Overall, specialty, time in high-risk medical practice, apology experience, disclosure experience about the impact of disclosure on physician-patient relationship, are the important predictors of the willingness to disclose medical error and apologize to patient. Conclusion and Suggestion: Educating and training were suggested, by cultivating and training physician through medical ethics committee, improving the culture transformation by constituting a specialty committee, and building a medical environment that can discuss medical error freely, in order to enhance the positive willingness of physician toward disclosure medical error and apology, and aiming in a win-win healthcare environment.