「逛醫師」的邏輯:求醫歷程的分析
The Logic of Care Seeking
作者:張苙雲(Ly-Yun Chang) | 首次發表於 2020-07-20 | 第 21 期 October 1998
DOI:https://dx.doi.org/10.6786/TJS.199810.0059
論文資訊 | Article information
摘要 Abstract
本篇論文以患有癌症、糖尿病、和肺部慢性阻塞等疾病的四十三位病人求醫歷程的資料,處理醫療使用文獻中的兩個疑點:複向能醫和就醫頻率的增加。求醫真是如「推理行動理論」所示,是信念和態度的體現?病人之所以“逛醫師”是否肇因於對醫師藥到病除的要求,是「一針見效」的易開罐心態作祟?是道德風險的反映?還是尋求解答和解決問題的過程?從四十三位病人求醫的起始動力、最初求醫點的選擇、和轉換求醫點的原因等議題的分析,可以很簡要地以「選擇性的注意與警覺」、「地緣和熟識」、和「釋惑的渴求」等三點為前述議題的主要發現。病人過去就醫經驗、對症狀性質的暸解、症狀部位嚴重陸的評估、家庭生活的時序,交相作用決定就醫的時機。就醫時機的選擇有相當“權變”的意味,除了問題的持續且惡化外,真正能發揮示警作用的,主要還是在明顯可見的症狀,反應出中國人直觀思維方式的影響。這個發現與「推理行動理論」的預測是有所出入的。其次,病人從初級基層醫療資源開始,經過一而再,再而三的嘗試、錯誤、和選擇,反映在轉折的求醫歷程的是企求問題之得以紓解,是我們稱之為釋惑的求醫邏輯。從這個小規模的樣本和深入觀察訪談的資料得知,醫者的作為關係到醫療資源的使用。從醫療供給面思考民眾的求醫行為,是值得開發的研究切入點。

關鍵字:求醫行為、推理行動理論、慢性疾病、質化研究、台灣社會
The purpose of this paper is to address two puzzles in the literature of health resource utilization. First, the use of multiple channels in medical care is incompatible with the theory of reasoned action (Fishbein and Ajzen 1975). According to the theory, care seeking should be a unique manifestation of fundamental medical belief and attitude specific to a social and cultural context. Second, medical utilization has been on steadily rising. One interpretation is the abuse of resources-the problem of moral hazard. In order to investigate the validity of the hypotheses of reasoned action and moral hazard, this paper analyzes the pathway to medical care for 43 patients who were diagnosed as suffering cancer, diabetes, or COPD. These 43 patients had visited one to seven clinics before reaching the three hospitals under study. Three major findings are obtained from event history data on care seeking: (1) patients selectively attend to physical symptoms according to the location, intensity and persistence of the suffering, and the absence/presence of bleeding: (2) patients typically start the search for an appropriate physician with nearby clinics and acquainted doctors: and (3) unsolved physical suffering is the main reason for patients to switch clinics/doctors. Care seeking should be understood in the framework of healer/patient interaction. The direction of future research and policy implication of the findings are discussed.

Keywords: help seeking behavior, reasoned action model, chronical illness, qualitative research and Taiwan society