作者 ｜
張菊惠(台灣大學公共衛生學院公共衛生研究所)、胡幼慧(陽明大學醫學院衛生福利研究所)、張玨(台灣大學公共衛生學院公共衛生研究所)
摘要 ｜
本研究探討非癌症診斷婦女面臨子宮切除手術決定時，醫師告知之內容，以及對醫師告知之反應。研究場域為某都會區之醫學中心。採用質性方法中的多元方法，交叉檢視婦女問卷訪談與知情人士訪談資料。研究重要發現如下:(1)醫師告知乃以醫師為中心的權威性告知，醫病溝通問的醫病地位不對等。(2)醫師對手術影響的告知偏頗，僅談手術好處與不手術的壞處。(3)醫師對切除子宮告知抱持「無用論」與「癌症預防之道」的態度，並以此說詞說服病人。(4)手術決策過程是由醫師隱藏性操弄資訊，進而操控手術的決定權。(5)病人對醫師告知是不理性的絕對順從。文中就幾個重要發現進行討論，並綜合研究結果與國際間醫病溝通或子宮切除的經驗，提出四點政策啟示，分別為制訂衛生監核政策、保障婦女權益的醫院管理、建立婦女健康網絡與醫學教育的改善。
關鍵字 ｜
子宮切除、醫師告知、多元方法、婦女健康
Title ｜
Physician's Inform on Hysterectomy
Author ｜
Chu-Hui Chang(Institute of Public Health, College of Public Health, National Taiwan University)、Yow-Hwey Hu (Institute of Health and Welfare Plolicy, College of Medicine, National Yang-Ming University)、Chueh Chang(Institute of Public Health, College of Public Health, National Taiwan University)
Abstract ｜
The purpose of this study was to explore the content of physician’s inform on hysterectomy when women with non-cancer diagnoses faced the surgical decision-making. The data was collected from a medical center located at an urban area. We used multimethod to triangulate two sources of data: women’s questionnaire guided interview and key informants interview. Major findings are as follow: (1) since the physician-patient encounter was doctor-centered, the physician had an asymmetrical power-advantage over the patient; (2) the information provided by the physician was biased, rather beneficial than risky; (3) the physician’s attitude toward hysterectomy was “uterus useless” and “preventing cancer”; (4) the physician manipulated the information while women making the surgical decision to control the power of decision making; (5) the patient adhered to the physician’s regiment irrationally. It is recommend that women’s informed right should be improved through policy reform, hospital management, building of women’s health network and the changes of Medical education.
Keywords ｜
hysterectomy, physician inform, multimethod, women's health