某醫學中心子宮切除婦女自述醫病溝通之探討

Physician-Patient Communication Reported by Women of Hysterectomy

10.6288/CJPH1997-16-01-01

張珏(Chueh Chang)；張菊惠(Chu-Hui Chang)；胡幼慧(You-Hwey Hu)

子宮切除 ； 醫病溝通 ； 醫師告知 ； Hysterectomy ； Physician-patient communication ； Physician's Informed

中華公共衛生雜誌

16卷1期（1997 / 02 / 01）

1 - 12

繁體中文

本研究欲探討前往某醫學中心求診之非癌症診斷婦女在面臨子宮切除時，醫病溝通問醫師告知與婦女認知的情形。訪視72位術後3-9個月的婦女，結果發現三成的婦女對疾病診斷、手術範圍認知不正確。889%曾有醫師解釋病情，50.0%曾與醫師討論病情；72.2%曾有醫師說明手術範圍，68.9%曾與醫師討論手術範圍。32.6%的病人在術前並未被醫師告知會合併單或雙側卵巢切除，51.7%的人未被醫師告知子宮切除的範圍涵蓋子宮頸。750%的婦女被告知「過了生育年齡子宮就沒有用了，拿掉沒有關係」，444%被告知子宮切除後的好處，只有6.9%與13.5%的婦女被告知手術對身體與性生活可能會有影響，42%被告知可能會有合併症，其餘則是沒有說或說沒影響。結果得知，醫師告知偏向於手術的好處，而手術風險與可能影響較少提及，婦女對疾病與手術範圍認知不正確，反映出醫師告知的不清楚與不充份。根據本研究結果，建議改善醫學教育，建立婦女健康資源網絡，立法規範醫師告知的責任，敦促醫病溝通中醫師告知的落實。

Focusing on women of one medical center in Taiwan metropolitan area with non-cancer diagnoses who are faced with hysterectomy, this research investigates the physicians-patients communication about the extent of information provided by physicians, and women's knowledge of hysterectomy. The 72 subjects in this study were women who had a hysterectomy 3-9 months prior to interview. The results showed that 29.2% of the women were unclear of their own diagnosis, 27.8% were unclear of their operations. 72.2%-88.9% of the physicians had explained the operations and disease to their patients, and 50.0%-68.9% had discussed thedisease and operations. Among the 72 women interviewed, 61.1% had either a unilateral or bilateral oopho-rectomy, 32.6% were not advised by a physician to heave the oophorectomny. In the course of physician-patient communication, 75.0% of the women were told that the uterus is useless beyond childbearing age. 44.4% were told the benefits of hysterectomy. Only 6.9-13.5% were told the possible side effects of the surgery, and 4.2% were told the possible complications of the surgery: the rest of the subjects were not told of the possible negative outcomes. Therefore, physicians prefer to tell women the benefits of surgery rather than the risks, side effects and complications of surgery. The facts that women were unclear of their diagnosis and operations reflect the information of physicians supply were unclear and inadequate This research implies a need for improving the medical education as well as developing women's health network, legislating the physicians responsibility of informing patients to improve the physicians-patients communication.