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研究生:陳冠妤
研究生(外文):Kuan-Yu Chen
論文名稱:以橫斷式方法研究醫師職業倦怠經驗、盛行率及其相關因子
論文名稱(外文):The Burnout Experience, Prevalence and Risk factors among Physicians-A Cross-Sectional Study
指導教授:邱文達邱文達引用關係
指導教授(外文):Wen-Ta Chiu
口試委員:楊哲銘劉士豪黃勝堅洪國盛
口試日期:2014-01-10
學位類別:博士
校院名稱:臺北醫學大學
系所名稱:公共衛生學系暨研究所
學門:醫藥衛生學門
學類:公共衛生學類
論文種類:學術論文
論文出版年:2014
畢業學年度:102
語文別:中文
論文頁數:87
中文關鍵詞:職業倦怠;醫療錯誤;醫療糾紛;高風險科別
外文關鍵詞:BurnoutMedical MalpracticeHigh-Risk SpecialtyMedical Error
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近幾年國內外的醫療糾紛率皆有明顯增加的趨勢,以台灣的醫療糾紛法院判決觀之,2008 年的判決案件約為2004 年的4 倍。隨著醫病關係的改變,越來越多醫師不願選擇高訴訟風險的科別執業。在1999 年美國Kohn L.等人的研究中發現每年約有100,000 病人死於醫療錯誤或是可預防的醫療不良事件中。在AMA 2007 年至2008 年的研究中發現,高於42% 的美國醫師曾經因醫療糾紛被訴1。該研究亦發現,外科系較非外科系有較高的醫療糾紛發生率。醫療糾紛的發生率高低會受醫師執業科別、病人病情嚴重程度、醫師過於倦怠所造成的疏失或錯誤因素所影響。
根據2011 年全國醫師公會全國聯合會統計資料顯示,目前台灣約40,183位醫師2(各科別醫師人數詳參表1),而總人口數約共23,261,747 人(2012年6月統計) 3,平均每位醫師服務的人數約為579人,由此平均數目可見台灣醫師有極大的工作忙碌壓力,當醫師面臨工作壓力與高訴訟風險的雙重壓力下,台灣年輕的實習醫師或是醫學生們有較高的傾向選擇工作較輕鬆的科別或是醫療糾紛發生率較低的科別執業。醫療行為有其急迫性、必要性及嚴謹性,且醫護人員工作量極大,很容易造成過度的工作壓力,進而產生職業倦怠。美國醫學會期刊(JAMA)曾發表,在高密度值班後(80hr/week),醫師行為表現約等同於血液中0.05%的酒精濃度4。本研究係採用橫斷式研究法及問卷調查法以結構性問卷針對不同類別與科別的執業醫師為調查對象,在研究期間內收集台灣醫師職業倦怠相關資料。本研究擬達成之研究目標如下:調查醫師職業倦怠情形、計算職業倦怠盛行率、高訴訟風險科別醫師職業倦怠分析、影響職業倦怠相關因子。目前全國博碩士論文網資料庫中有關於職業倦怠相關的博碩論文研究,主要集中於教育人員、軍警人員或服務業人員之相關研究。目前醫師職業倦怠的議題尚未有研究進行大規模調查。隨著醫療糾紛案件及醫師過勞案件的日益增加,該研究有其必要性,希冀藉由該研究結果可以提供更多的資料給未來相關研究領域做參考。
Medical malpractice rates at home and abroad have obviously been increasing
in recent years. Medical malpractice cases in 2008 were approximately four times
than those in 2004. As doctor-patient relationship gets worse, more and more doctors
would not like to choose high-risk specialties for practice. According to the study of
Kohn L.,et al in 1999, about 100,000 patients died from medical errors or preventable
medical adverse events each year.Key factors affecting medical malpractice
incidence rate include physician specialty, patient severity of illness, and physician
burnout causing medical negligence/errors.
According to statistics made by Taiwan Medical Association in 2011, there
were 40,183 physicians in Taiwan. The population of Taiwan was 23,261,747 based
on the official statistics of June 2012. It means one physician per 579 people on
average, which indicates heavy work load of physicians in Taiwan. In considering
work pressure and high litigation risk, more and more medical students are inclined
to choose low-risk specialties. Medical treatment has the characteristics of urgency,
necessity and high-precision, which is much likely to cause excessive pressure on
and even burnout in physicians. The Journal of the American Medical Association
(JAMA) has shown that after highly intensive work (80hr/week), the physicians
would act like those who have a blood alcohol concentration of 0.05%.This research will use a cross-sectional study and questionnaire survey,
carrying out a structured questionnaire survey for various physicians to collect the
data of the physician burnout and medical malpractice experience during the research
period. The study sets a cross-sectional study to estimate the prevalence of physician
burnout, analysis the descriptive characteristic of participants, burnout types, burnout
analysis of medical malpractice specialty at high risk, and the factors associated with
burnout.The existing burnout researches in Taiwan are mainly concerned about
education, police, and service industries. There is a lack of research on physician
burnout. In view of the increasing cases of medical malpractice and karoshi, this
research is essential. The results of this research can be provided not only for policy
makers to effectively handle the problem of physician burnout and medical
malpractice but also for scholars to do further studies in the field of burnout.
中英文摘要 ................................................................ iv
第一節 中文摘要 ............................................................. iv
第二節 Abstract ............................................................ vi
第一章 緒論 ................................................................ 1
第一節 研究背景 .............................................................. 1
第二節 文獻探討 .............................................................. 5
第二節 研究目的 ............................................................. 10
第三節 研究對象 ............................................................. 11
第四節 研究範圍與限制 ....................................................... 11
第二章 研究方法與材料 ..................................................... 12
第一節 研究流程 ............................................................. 12
第二節 研究方法 ............................................................. 14
第三節 研究工具與材料 ....................................................... 15
第三節 研究變項之操作型定義 ................................................. 17
第四節 資料分析方法 ......................................................... 19
第三章 結果 ............................................................... 20
第一節 受訪者基本資料描述性統計分析 ........................................ 20
第二節 情緒耗竭相關因子分析 ................................................ 27
第三節 去人格化相關因子分析 ................................................ 33
第四節 低個人成就感相關因子分析 ............................................ 38
第五節 醫師職業倦怠之盛行率估算 ............................................ 43
第四章 討論及建議 ......................................................... 50
參考文獻 .................................................................. 66
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