The Plight and Educational Needs of Physicians in Taiwan regarding Medical Disputes

• Main Authors: Hsin-Hui Lin, 林欣慧
• Other Authors: 吳建昌
• Format: Others
• Language: zh-TW
• Published: 2017
• Online Access: http://ndltd.ncl.edu.tw/handle/zjqm8z

碩士 === 國立臺灣大學 === 醫學教育暨生醫倫理研究所 === 105 === 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.