门诊医患互动话语主题结构与差异分析
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摘要
通过对门诊医患互动自然观察获得数据资料,借助国外广泛应用的互动过程分析系统对医患互动中各类语言行为进行量化,分析并总结医患话语主题结构和差异。研究发现,门诊医患互动话语主题以生物医学为主,医生忽视患者的情感和信息需求,且互动中存在医患信息不对称、地位不对等现象。因此,建议医生加强对患者社会心理因素的关注,增加对患者的信息给予、人文关怀、鼓励和支持,逐渐将医患互动转变为以患者为中心,适应现代医学模式的要求。
This article collected data through observation of doctor-patient interaction in outpatient clinics, and used Roter Interaction Analysis System(RIAS), which has achieved widely application abroad, to quantify doctor and patient verbal behaviors. Then it analyzed and summarized the thematic structure and difference of discourse in doctor-patient interaction. It found that the main topic of doctor-patient interaction was biology-related, and doctors neglected emotional needs and information from patients. Besides, there were still asymmetry in information and unequal status between doctors and patients. Therefore, it was suggested that doctors should attach more importance to psychosocial factors of patients, give them more information, emotional care, encouragement and support, gradually turn doctor-patient interaction into patient-centered care so as to meet the requirements of modern medical model.
This article collected data through observation of doctor-patient interaction in outpatient clinics, and used Roter Interaction Analysis System(RIAS), which has achieved widely application abroad, to quantify doctor and patient verbal behaviors. Then it analyzed and summarized the thematic structure and difference of discourse in doctor-patient interaction. It found that the main topic of doctor-patient interaction was biology-related, and doctors neglected emotional needs and information from patients. Besides, there were still asymmetry in information and unequal status between doctors and patients. Therefore, it was suggested that doctors should attach more importance to psychosocial factors of patients, give them more information, emotional care, encouragement and support, gradually turn doctor-patient interaction into patient-centered care so as to meet the requirements of modern medical model.
引文
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[12] NEAL R D,ALI N,ATKIN K,et al.Communication between South Asian patients and GPs:Comparative study using the Roter Interactional Analysis System[J].Brit J Gen Pract,2006,56(532):869-875.
[13] LEONE D,BORGHI L,NEGRO D,et al.Doctor-couple communication during assisted reproductive technology visits[J].Hum Reprod,2018,33(5):877-886.
[14] 丰哲,黄有荣,邹环球,等.从医学模式的转变看中西医结合[J].中国卫生产业,2018,15(6):189-190.
[15] 李钟仁,杜勤,王敬茹,等.基于患者视角的多学科协作诊疗模式现状和对策研究[J].中国医院,2016,20(8):34-35.
[2] NAKAYAMA C,KIMATA S,OSHIMA T,et al.Analysis of pharmacist-patient communication using the Roter Method of Interaction Process Analysis System[J].Res Social Adm Pharm,2016,12(2):319-326.
[3] BEACH M C,ROTER D L,SAHA S,et al.Impact of a brief patient and provider intervention to improve the quality of communication about medication adherence among HIV patients[J].Patient Educ Couns,2015,98(9):1078-1083.
[4] 冀新艳.从会话分析的角度研究医患交际中的问与答[D].太原:山西财经大学,2015.
[5] 王茜,严永祥,刘炜.基于100例医患会话的社会学分析[J].医学与哲学:人文社会医学版,2010,31(7):29-31.
[6] 陈海庆,郭霄楠.医患语篇的会话模式分析[J].实用心脑肺血管病杂志,2011,19(1):115-118.
[7] 武宜金,李林子.医患会话打断现象研究[J].医学与哲学:人文社会医学版,2011,32(2):37-38.
[8] 朱丽萍.医患会话中的打断分析及对医患沟通的启示[J].中国医学伦理学,2014,27(1):31-34.
[9] 丁辉.汉语内科门诊医患对话中的修正研究[D].长春:东北师范大学,2008.
[10] BEACH M C,SAHA S,KORTHUIS P T,et al.Differences in Patient-Provider Communication for Hispanic Compared to Non-Hispanic White Patients in HIV Care[J].J Gen Intern Med,2010,25(7):682-687.
[11] WEINER S J,SCHWARTZ A,CYRUS K,et al.Unannounced Standardized Patient Assessment of the Roter Interaction Analysis System:The Challenge of Measuring Patient-Centered Communication[J].J Gen Intern Med,2012,28(2):254-260.
[12] NEAL R D,ALI N,ATKIN K,et al.Communication between South Asian patients and GPs:Comparative study using the Roter Interactional Analysis System[J].Brit J Gen Pract,2006,56(532):869-875.
[13] LEONE D,BORGHI L,NEGRO D,et al.Doctor-couple communication during assisted reproductive technology visits[J].Hum Reprod,2018,33(5):877-886.
[14] 丰哲,黄有荣,邹环球,等.从医学模式的转变看中西医结合[J].中国卫生产业,2018,15(6):189-190.
[15] 李钟仁,杜勤,王敬茹,等.基于患者视角的多学科协作诊疗模式现状和对策研究[J].中国医院,2016,20(8):34-35.