| 摘要: | 本論文採質性研究，針對十八位青年中醫師做半結構式深入訪談，旨在探討中醫師專業素養的形塑過程，以及中醫師在診所執業時的人際互動與生存策略。本研究結論如下：（1）中醫作為一門專業，但不具備充分的專業自主與支配權，以及民眾認可；（2）與西醫相比，中醫的醫療管轄權處於弱勢地位；（3）中醫的醫學教育不足；（4）中醫欠缺壟斷與排外。中醫診所與民俗調理的異業結盟，是中醫診所在國家整體醫療環境下所發展出的生存策略，然而卻傷害到中醫的專業形象；（5）在異業結盟環境執業的中醫師面臨醫師、民俗調理人員、以及病人之間的三角關係，影響到醫療專業素養與醫病關係；（6）「中醫傷科輔助醫療人員」並非改善中醫環境的首要解決之道，而是提升中醫師本身的專業素養；（7）未來中醫可能走向專業分工，但不盡然適用現代醫學的分工方式。此研究結果的後續建議是：第一，爭取國家對中、西醫同等的重視。第二，全民健康保險制度重新調整，給予中醫合理的給付。第三，考慮在學校教育中納入師徒制。第四，加強畢業後醫學訓練，完善「負責醫師訓練計畫」的內容與方式。第五，強化實證研究，鼓勵學術分享。第六，中醫師公會加強發揮自治能力、化解世代衝突。第七，唯有中醫整體價值提升，才有進一步討論專業分工的可能性。第八，中醫的專業分工方式還需要更多研究與討論，若未來真的成立「中醫傷科輔助醫療人員」，其給付應比照物理治療辦理。
This qualitative research analyzed the shaping process of professionalism and the interpersonal interactions and the practice of Chinese medicine practitioners (CMPs) in the clinics. The researcher interviewed eighteen young CMPs with a semi-structured in-depth interview method. The results of this study were as follows: (1) Traditional Chinese Medicine (TCM) is a profession, but it had no sufficient professional autonomy, dominance, or the public recognition. (2) Compared with Western medicine, TCM had a weaker medical jurisdiction. (3) The medical education in TCM was inadequate. (4) TCM lacked monopoly and exclusion. Cross-sector alliance with folk conditioning was a survival strategy developed by TCM clinics in the medical environment in Taiwan, but it hurt the professional image of TCM. (5) CMPs faced a triangular relationship between themselves, folk conditioning practitioners, and patients. This situation affected medical professionalism of CMPs and the relationship between CMPs and patients. (6) The primary solution to improve the professionalization of TCM was not the new establishment of “traumatic auxiliary medical staff for TCM” but the enhancement of the professionalism of CMPs. (7) TCM might develop towards a professional division of labor, but it might not apply to the same way as Western medicine. The suggestions of this study are as follows. First, we should strive for the equal status of TCM and Western medicine. Second, the National Health Insurance in Taiwan should be re-adjusted and give TCM a more reasonable payment. Third, we should consider incorporating the mentoring program in our education system. Fourth, we should elevate the quality of the post graduate medical education, and improve the content and the implementation measures of “the supervising physicians training program of traditional Chinese medical care institutions”. Fifth, we should strengthen the empirical research of TCM and encourage the CMPs to share research results. Sixth, The CMP’s Association should show its autonomous ability and resolve conflicts across generations. Seventh, only when the overall value of TCM is promoted can we further discuss the professional division of labor. Last, it requires more research and discussion to establish the way of the professional division of labor of TCM. If the “traumatic auxiliary medical staff for TCM” is really established in the future, the National Health Insurance should pay them equally as the physical therapists.
本論文採質性研究，針對十八位青年中醫師做半結構式深入訪談，旨在探討中醫師專業素養的形塑過程，以及中醫師在診所執業時的人際互動與生存策略。本研究結論如下：（1）中醫作為一門專業，但不具備充分的專業自主與支配權，以及民眾認可；（2）與西醫相比，中醫的醫療管轄權處於弱勢地位；（3）中醫的醫學教育不足；（4）中醫欠缺壟斷與排外。中醫診所與民俗調理的異業結盟，是中醫診所在國家整體醫療環境下所發展出的生存策略，然而卻傷害到中醫的專業形象；（5）在異業結盟環境執業的中醫師面臨醫師、民俗調理人員、以及病人之間的三角關係，影響到醫療專業素養與醫病關係；（6）「中醫傷科輔助醫療人員」並非改善中醫環境的首要解決之道，而是提升中醫師本身的專業素養；（7）未來中醫可能走向專業分工，但不盡然適用現代醫學的分工方式。此研究結果的後續建議是：第一，爭取國家對中、西醫同等的重視。第二，全民健康保險制度重新調整，給予中醫合理的給付。第三，考慮在學校教育中納入師徒制。第四，加強畢業後醫學訓練，完善「負責醫師訓練計畫」的內容與方式。第五，強化實證研究，鼓勵學術分享。第六，中醫師公會加強發揮自治能力、化解世代衝突。第七，唯有中醫整體價值提升，才有進一步討論專業分工的可能性。第八，中醫的專業分工方式還需要更多研究與討論，若未來真的成立「中醫傷科輔助醫療人員」，其給付應比照物理治療辦理。
This qualitative research analyzed the shaping process of professionalism and the interpersonal interactions and the practice of Chinese medicine practitioners (CMPs) in the clinics. The researcher interviewed eighteen young CMPs with a semi-structured in-depth interview method. The results of this study were as follows: (1) Traditional Chinese Medicine (TCM) is a profession, but it had no sufficient professional autonomy, dominance, or the public recognition. (2) Compared with Western medicine, TCM had a weaker medical jurisdiction. (3) The medical education in TCM was inadequate. (4) TCM lacked monopoly and exclusion. Cross-sector alliance with folk conditioning was a survival strategy developed by TCM clinics in the medical environment in Taiwan, but it hurt the professional image of TCM. (5) CMPs faced a triangular relationship between themselves, folk conditioning practitioners, and patients. This situation affected medical professionalism of CMPs and the relationship between CMPs and patients. (6) The primary solution to improve the professionalization of TCM was not the new establishment of “traumatic auxiliary medical staff for TCM” but the enhancement of the professionalism of CMPs. (7) TCM might develop towards a professional division of labor, but it might not apply to the same way as Western medicine. The suggestions of this study are as follows. First, we should strive for the equal status of TCM and Western medicine. Second, the National Health Insurance in Taiwan should be re-adjusted and give TCM a more reasonable payment. Third, we should consider incorporating the mentoring program in our education system. Fourth, we should elevate the quality of the post graduate medical education, and improve the content and the implementation measures of “the supervising physicians training program of traditional Chinese medical care institutions”. Fifth, we should strengthen the empirical research of TCM and encourage the CMPs to share research results. Sixth, The CMP’s Association should show its autonomous ability and resolve conflicts across generations. Seventh, only when the overall value of TCM is promoted can we further discuss the professional division of labor. Last, it requires more research and discussion to establish the way of the professional division of labor of TCM. If the “traumatic auxiliary medical staff for TCM” is really established in the future, the National Health Insurance should pay them equally as the physical therapists. |
