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台灣醫謢人員工時未受保障。圖為護理人員舉牌向衛生署抗議。資料照片
醫療行為要醫病，更要醫心，唯有視病猶親，才能讓病家與民眾感動。大多數醫療工作人員願意付出的時間與精力不是加班費可彌補的，病人與家屬的信任與尊重才是醫護人員最在乎的成就感與精神支柱。
醫療工時太長太累？說穿了，就是病人太多！《勞基法》下，護理人員爭取的加班費就必須當做醫院經營的必要成本。然而，只在有限的健保大餅下做拉鋸戰是沒有辦法真正解決醫療品質問題。衛福部長官也都很清楚許多內外婦兒科住院醫師查完房，下班回家都是晚上八、九點，一個月在醫院值班睡覺半個月。他們真的活的很累！為什麼不將醫師工時保障也納入於《勞基法》？住院醫師真的很笨嗎？為什麼還沒團結起來抗爭？只因為身為醫師對病人責任感的醫德理念還烙印在他們腦海，還願意努力追求病人的最大利益的自律行規！
台灣健保醫療制度最大優點是看病方便，民眾也不可能感受到台灣醫療勞工的廉價。健保給付的概念是每個醫療行為都有金錢代價，健保大餅是固定的，當全國所有醫師的醫療行為做得越多，點值就會越低，要增加收入就必須安排更多病人回來看門診與做檢查。醫師工作量增加，卻要求很好的品質，根本就是緣木求魚。當民眾少因生病去醫院，醫師也減少開立不必要的檢查與用藥時，在健保大餅不變下，點值就變高，收入可能更高。
回歸醫病共扛責任
全國醫護人員看不見美好的將來，健保署與醫界也都已經很努力提出許多追求醫療品質改善方案來控制醫療浪費。筆者認為想要根本改善醫療品質與保護醫護人員與民眾權益，執政者與立委應該要擺脫選舉壓力，一定要釜底抽薪，務實面對人性不願吃虧的弱點。除了急診、重大疾病與罕見疾病等病患外，一般民眾就醫一定要有真正部分負擔，藥費也是如此。當要民眾自付費用時，醫師就得好好解釋病情，省視自己的診斷與治療方向，善盡病情告知義務，必然會減少醫療糾紛。用最簡單的策略將醫療責任回歸到醫師與民眾來共同承擔，減少不必要的醫療行為，才有可能徹底改善醫師與護理人力不足的困境，真正抑制未來健保保費再度增加！
真正好的醫療是以真性情、同理心與精湛醫術來贏得民眾的信任，醫療品質要好，絕對不是喊喊就會好，也不是幾個法條就能解決整體環境的問題。大家應該要有共識，營造好的醫療環境，讓盡本分的醫護人員能無後顧之憂，增添醫護新血的信心，讓在世界上名列前茅的台灣健保醫療品質繼續維持下去。
成大醫學院外科教授、衛福部臺南醫院院長
焦點評論：醫療工時降不下來嗎（李伯璋）
版主: 版主021
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auricle
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- 來自: 黑心島國
Re: 焦點評論：醫療工時降不下來嗎（李伯璋）
欺侮醫護人員是當今顯學 , 會改才有鬼 !
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李誠民
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- 註冊時間: 週三 6月 23, 2010 10:18 am
Re: 焦點評論：醫療工時降不下來嗎（李伯璋）
"衛福部長官也都很清楚許多內外婦兒科住院醫師查完房，下班回家都是晚上八、九點，一個月在醫院值班睡覺半個月。他們真的活的很累！為什麼不將醫師工時保障也納入於《勞基法》？".....???.residency 是Trainee可能嗎?!
The battle for NHS 111: who should run it now?
BMJ 2014; 348 doi: http://dx.doi.org/10.1136/bmj.f7659 (Published 2 January 2014)
Cite this as: BMJ 2014;348:f7659
NHS medical director proposes two tier emergency service
BMJ 2013; 347 doi: http://dx.doi.org/10.1136/bmj.f6828 (Published 13 November 2013)
Cite this as: BMJ 2013;347:f6828
• July 2010—Coalition聯合, 聯盟 government’s white paper Equity and Excellence: Liberating the NHS (BMJ 2010;341:c3796, doi:10.1136/bmj.c3796) outlines plan to develop “a coherent 24/7 urgent care service in every area of England”
• October 2011—Prime Minister David Cameron and the health secretary, Andrew Lansley, announce that each area of England will have an NHS “111” service, a new number to call for all non-emergency NHS care and advice, by April 2013 (http://bit.ly/1esJO4h)
• February 2012—BMA and ambulance services call on government to delay rollout of 111, to allow adequate time to evaluate pilots and carry out local procurements for the service (BMJ 2012;344:e1204, doi:10.1136/bmj.e1204). Laurence Buckman, chairman of BMA’s General Practitioners Committee, said, “GPs are happy to work with NHS 111 to iron out any problems, but they need time in order to do that”
• March 2013—BMA renews call for national launch of 111 to be delayed until system is “fully safe for the public,” amid growing reports of chaos ahead of planned rollout (BMJ 2013;346:f2077, doi:10.1136/bmj.f2077)
• April 2013—Ministers press ahead with national rollout of 111. On launch, service is beset by problems, including staff shortages, treatment delays, and ambulances being summoned unnecessarily (BMJ 2013;346:f2394, doi:10.1136/bmj.f2394)
• July 2013—MPs conclude that 111 has failed to relieve pressure on hospital emergency departments in England since introduction and needs to be remodelled to give greater priority to early clinical assessment (BMJ 2013;347:f4717, doi:10.1136/bmj.f4717). Stephen Dorrell, chairman of health select committee, said, “It is vital to ensure that the needs of patients who don’t need to be at A&E are properly met elsewhere so that those who do need to be there receive prompt and high quality care”
• July 2013—NHS Direct withdraws from all its contracts to run NHS 111 services in England, claiming that the contracts were not financially sustainable (BMJ 2013;347:f4837, doi:10.1136/bmj.f4837)
• November 2013—NHS England’s review of urgent and emergency care, led by medical director Bruce Keogh, proposes enhancing 111 so patients can talk directly to a doctor, nurse, or health professional or book an appointment with their GP if needed (BMJ 2013;347:f6828, doi:10.1136/bmj.f6828)
Roll-out of 111 telephone hotline causes hospitals severe problems
BMJ 2013; 346 doi: http://dx.doi.org/10.1136/bmj.f2394 (Published 15 April 2013)
Cite this as: BMJ 2013;346:f2394
..........
..........
沒錢什麼都是假的?!
The battle for NHS 111: who should run it now?
BMJ 2014; 348 doi: http://dx.doi.org/10.1136/bmj.f7659 (Published 2 January 2014)
Cite this as: BMJ 2014;348:f7659
NHS medical director proposes two tier emergency service
BMJ 2013; 347 doi: http://dx.doi.org/10.1136/bmj.f6828 (Published 13 November 2013)
Cite this as: BMJ 2013;347:f6828
• July 2010—Coalition聯合, 聯盟 government’s white paper Equity and Excellence: Liberating the NHS (BMJ 2010;341:c3796, doi:10.1136/bmj.c3796) outlines plan to develop “a coherent 24/7 urgent care service in every area of England”
• October 2011—Prime Minister David Cameron and the health secretary, Andrew Lansley, announce that each area of England will have an NHS “111” service, a new number to call for all non-emergency NHS care and advice, by April 2013 (http://bit.ly/1esJO4h)
• February 2012—BMA and ambulance services call on government to delay rollout of 111, to allow adequate time to evaluate pilots and carry out local procurements for the service (BMJ 2012;344:e1204, doi:10.1136/bmj.e1204). Laurence Buckman, chairman of BMA’s General Practitioners Committee, said, “GPs are happy to work with NHS 111 to iron out any problems, but they need time in order to do that”
• March 2013—BMA renews call for national launch of 111 to be delayed until system is “fully safe for the public,” amid growing reports of chaos ahead of planned rollout (BMJ 2013;346:f2077, doi:10.1136/bmj.f2077)
• April 2013—Ministers press ahead with national rollout of 111. On launch, service is beset by problems, including staff shortages, treatment delays, and ambulances being summoned unnecessarily (BMJ 2013;346:f2394, doi:10.1136/bmj.f2394)
• July 2013—MPs conclude that 111 has failed to relieve pressure on hospital emergency departments in England since introduction and needs to be remodelled to give greater priority to early clinical assessment (BMJ 2013;347:f4717, doi:10.1136/bmj.f4717). Stephen Dorrell, chairman of health select committee, said, “It is vital to ensure that the needs of patients who don’t need to be at A&E are properly met elsewhere so that those who do need to be there receive prompt and high quality care”
• July 2013—NHS Direct withdraws from all its contracts to run NHS 111 services in England, claiming that the contracts were not financially sustainable (BMJ 2013;347:f4837, doi:10.1136/bmj.f4837)
• November 2013—NHS England’s review of urgent and emergency care, led by medical director Bruce Keogh, proposes enhancing 111 so patients can talk directly to a doctor, nurse, or health professional or book an appointment with their GP if needed (BMJ 2013;347:f6828, doi:10.1136/bmj.f6828)
Roll-out of 111 telephone hotline causes hospitals severe problems
BMJ 2013; 346 doi: http://dx.doi.org/10.1136/bmj.f2394 (Published 15 April 2013)
Cite this as: BMJ 2013;346:f2394
..........
..........
沒錢什麼都是假的?!