医患关系中信任建构的社会工作介入研究
|
摘要
从最近几年的报纸、电视等大众媒体和网络的大量报道中,可以看到目前医疗环境中存在着一种普遍现象,即医院方与患者方之间存在着一种紧张冲突关系,如职业“医闹”,非医疗事故纠纷,病人或家属蓄意伤害、报复医生的恶性事件,“天使保镖”等激烈现象出现。这种现象的本质原因是医患之间信任关系的严重缺失。本文以社会学信任理论为基础,认为这种矛盾的实质是社会制度转型所带来的社会信任危机在医患双方人际关系中的反映和体现,基于沟通不畅问题而致。由于双方在权力与地位上的事实不平等、信息不对称造成相互间的信任缺失和沟通不畅,导致彼此达不成共识,出现利益上的纠纷和冲突。
文章首先是绪论部分,包括研究的背景和问题提出、对现有医患关系研究的文献进行回顾与综述,分别总结了国内外研究的成果及其可能的不足,另外是研究方法的阐明；其次对医患信任关系进行了全面的剖析,内容包括分析沟通与信任的关联机制、对武汉G医院医患关系及医患沟通现状的的调查研究与医患沟通的原因机理、功能和必要性阐述；再次从社会学信任理论视角、社会工作专业的应用性和沟通的实践性出发,说明医患信任关系能够被建构的可能性；然后研究社会工作介入策略与技术如何建构医患信任关系机制；最后运用访谈和满意度问卷对社会工作介入效果进行评估,然后是研究结论。
总之,医患沟通问题造成医患信任关系的缺失,这成为调查研究医院医患矛盾存在的真实原因。而社会工作专业为医患关系的信任缺失问题提供一个全新的分析视角和建构思路,提供了可能的解决策略和方法路径,最终能促进医患关系动态平衡、和谐良性发展。
With a lot of reports from newspapers, television and other mass media and the network in recent years, there is a widespread phenomenon in the current health care environment that there is a tense conflict between hospital side and patients, such as occupational medical trouble, intentional infliction of non-medical malpractice disputes, serious incidents of revenging doctor by patients or their families, intense phenomenon of Angels bodyguards.and so on. The nature of reason is the serious lack of trust relationships between doctors and patients. This article is based on the sociological trust theory that the essence of this contradiction is the social crisis of confidence with the social system restructuring reflected and embodied in the relationships of both doctors and patients. Mutual lack of trust and poor communication caused by the inequality of power and status and asymmetric information lead to lack of consensus with each other and the emergence of disputes and conflicts of interest.
Firstly, it is the introduction of the article, including the background and the study question, review and summary of the literature of the existing physician-patient relationship, summarizing the results and the possible lack of the research at home and abroad and other research methods stated. Secondly, it carries out a comprehensive analysis to the doctor-patient relationship of trust, including analysis of the correlation mechanism between communication and trust, the research of relationship and communication status in doctor-patient in Wuhan G Hospital and elaborating reason mechanism, function and necessity.Thirdly, from a sociological perspective of trust theory, the application of the social work profession and the practice of communication, it explains the possibility of the construction of trust in the doctor-patient relationship. And then, it studies how to construct the doctor-patient trust relationship mechanism by social work intervention strategies. Finally, to assess the effect of social work intervention with interviews and Satisfaction Questionnaire,then the conclusion.
In short, the lack of trust in doctor-patient relationship is caused by communication problems which becomes the real reason of doctors-patient contradiction.The social work aims to provide a new analytical perspective and constructivist thinking for the lack of trust relationship,provide a possible solution strategy and method path and ultimately promote the harmonious and healthy development of the physician-patient relationship.
文章首先是绪论部分,包括研究的背景和问题提出、对现有医患关系研究的文献进行回顾与综述,分别总结了国内外研究的成果及其可能的不足,另外是研究方法的阐明；其次对医患信任关系进行了全面的剖析,内容包括分析沟通与信任的关联机制、对武汉G医院医患关系及医患沟通现状的的调查研究与医患沟通的原因机理、功能和必要性阐述；再次从社会学信任理论视角、社会工作专业的应用性和沟通的实践性出发,说明医患信任关系能够被建构的可能性；然后研究社会工作介入策略与技术如何建构医患信任关系机制；最后运用访谈和满意度问卷对社会工作介入效果进行评估,然后是研究结论。
总之,医患沟通问题造成医患信任关系的缺失,这成为调查研究医院医患矛盾存在的真实原因。而社会工作专业为医患关系的信任缺失问题提供一个全新的分析视角和建构思路,提供了可能的解决策略和方法路径,最终能促进医患关系动态平衡、和谐良性发展。
With a lot of reports from newspapers, television and other mass media and the network in recent years, there is a widespread phenomenon in the current health care environment that there is a tense conflict between hospital side and patients, such as occupational medical trouble, intentional infliction of non-medical malpractice disputes, serious incidents of revenging doctor by patients or their families, intense phenomenon of Angels bodyguards.and so on. The nature of reason is the serious lack of trust relationships between doctors and patients. This article is based on the sociological trust theory that the essence of this contradiction is the social crisis of confidence with the social system restructuring reflected and embodied in the relationships of both doctors and patients. Mutual lack of trust and poor communication caused by the inequality of power and status and asymmetric information lead to lack of consensus with each other and the emergence of disputes and conflicts of interest.
Firstly, it is the introduction of the article, including the background and the study question, review and summary of the literature of the existing physician-patient relationship, summarizing the results and the possible lack of the research at home and abroad and other research methods stated. Secondly, it carries out a comprehensive analysis to the doctor-patient relationship of trust, including analysis of the correlation mechanism between communication and trust, the research of relationship and communication status in doctor-patient in Wuhan G Hospital and elaborating reason mechanism, function and necessity.Thirdly, from a sociological perspective of trust theory, the application of the social work profession and the practice of communication, it explains the possibility of the construction of trust in the doctor-patient relationship. And then, it studies how to construct the doctor-patient trust relationship mechanism by social work intervention strategies. Finally, to assess the effect of social work intervention with interviews and Satisfaction Questionnaire,then the conclusion.
In short, the lack of trust in doctor-patient relationship is caused by communication problems which becomes the real reason of doctors-patient contradiction.The social work aims to provide a new analytical perspective and constructivist thinking for the lack of trust relationship,provide a possible solution strategy and method path and ultimately promote the harmonious and healthy development of the physician-patient relationship.
引文
[1]央视国际.两会声音：医患关系怎样走向和谐?健康频道网,http://www.cctv.com/ health/.
[2]黄丽英.从医患关系的现状看医务社工在医患沟通中的作用[J].医学与社会,2004,17(1).
[3]倪辕.医患纠纷的现状分析及对策[J].健康管理,2010(9).
[4]宋晓亭.再论医患关系是民事法律关系中的合同关系[J].法律与医学杂志,2001(3).
[5]刘激扬,田勇泉.医患关系问题与诚信的缺失[J].求索,2007,6.
[6]王化悟.41例非医疗过失引起医疗纠纷的原因分析[J].中国卫生治疗管理,1999,6(2).
[7]曹文妹.医患关系物化的表现及法律控制[J].医学与哲学,1999,20(12).
[8]孔祥泉.市场经济条件下医患关系的发展趋势及对策[J].解放军医院管理杂志,2002,9(5).
[9]刘继同.构建和谐医患关系与医务社会工作的专业使命[J].中国医院管理,2006,26(3).
[10](美)威廉·科克汉姆.医学社会学[M].杨辉,译.北京：华夏出版社,2000.
[11]袁政文.“督导式医患关系”应该缓行[J].中国医学伦理学,1998,11(4).
[12]肖慧欣,朱红梅.福建省医患关系现状及协调模式探析[J].安徽卫生职业技术学院学报,2007,6(6).
[13]张颖,谢舟.诚信缺失：医患冲突的法律症结[J].现代医院管理,2008,6(3).
[14]熊雄.论医患信任何以不能[J].湖南环境生物职业技术学院学报,2008,14(4).
[15]王一帆,孟楠.国外医务社会工作者的发展、现状及启迪[J].卫生软科学,2010,24(6).
[16]卢鸿雁.日本医务社会工作的特征及其对我国的启示[J].医学与社会,2009,22(8).
[17]刘朝晖.目前医患关系现状及对策探讨[J].社会研究,2009.
[18]李正关,冷明祥.医患关系研究进展综述[J].中国医院管理,2009,29(3).
[19]杨阳.信任是医患关系的内在价值——中国与新西兰医患信任关系之比较研究[D].2007年硕士学位论文.
[20]李德玲,卢景国.从患者视角看预设性信任/不信任及其根源[J].中国医学伦理学,2011,24(4).
[21]王锦帆.关于我国医患沟通内涵与目的的思考[J].中国医院管理,2007,27(3).
[22]张竞超,李顺民.从信任角度及信息不对称角度分析医患关系[J].中国医药指南,2009,7(4).
[23]耿玉如.防止因医患沟通不当而引发医疗纠纷[J].中华医院管理杂志,2002,18(4).
[24]Maynarl DW, Heritage J. Conversation analysis, doctor-patient interaction and medical communication [J]. Med Educ,2005,39(4).
[25]佚名.日本处理医患关系三大经验[J/OL].http：//中国金药网.
[26]刘少杰.国外社会学理论[M].北京：高等教育出版社,2006：455-456.
[27]向江平,陈平.信任问题研究文献综述[J].广州大学学报,2003,2(5).
[28]Pellegrino ED. Trust and distrust in professional ethics [M]. Washington, DC: Georgetown University Press,1991:84.
[29]王占宇,刘俊,段丽娥.论医务社工在构筑和谐医患关系中的作用[J].医学与社会,2008,21(7).
[30]刘江平,范春梅,张铁山.加强医务社会工作,构建和谐医院[J].医院与社会,2008,12(9).
[31]肖慧欣,黄子杰,李跃平.浅论医务社工在医生社会支持系统中的角色[J].中国医学伦理学,2009,22(2).
[32]柴双,徐金凤.军队医院引入医务社会工作的思考[J].解放军医院管理杂志,2011,18(14).
[33]李平,郭永松,吴水珍等.医务社会工作的功能定位及其在医患冲突中的作用[J].卫生经济研究,2009(1).
[2]黄丽英.从医患关系的现状看医务社工在医患沟通中的作用[J].医学与社会,2004,17(1).
[3]倪辕.医患纠纷的现状分析及对策[J].健康管理,2010(9).
[4]宋晓亭.再论医患关系是民事法律关系中的合同关系[J].法律与医学杂志,2001(3).
[5]刘激扬,田勇泉.医患关系问题与诚信的缺失[J].求索,2007,6.
[6]王化悟.41例非医疗过失引起医疗纠纷的原因分析[J].中国卫生治疗管理,1999,6(2).
[7]曹文妹.医患关系物化的表现及法律控制[J].医学与哲学,1999,20(12).
[8]孔祥泉.市场经济条件下医患关系的发展趋势及对策[J].解放军医院管理杂志,2002,9(5).
[9]刘继同.构建和谐医患关系与医务社会工作的专业使命[J].中国医院管理,2006,26(3).
[10](美)威廉·科克汉姆.医学社会学[M].杨辉,译.北京：华夏出版社,2000.
[11]袁政文.“督导式医患关系”应该缓行[J].中国医学伦理学,1998,11(4).
[12]肖慧欣,朱红梅.福建省医患关系现状及协调模式探析[J].安徽卫生职业技术学院学报,2007,6(6).
[13]张颖,谢舟.诚信缺失：医患冲突的法律症结[J].现代医院管理,2008,6(3).
[14]熊雄.论医患信任何以不能[J].湖南环境生物职业技术学院学报,2008,14(4).
[15]王一帆,孟楠.国外医务社会工作者的发展、现状及启迪[J].卫生软科学,2010,24(6).
[16]卢鸿雁.日本医务社会工作的特征及其对我国的启示[J].医学与社会,2009,22(8).
[17]刘朝晖.目前医患关系现状及对策探讨[J].社会研究,2009.
[18]李正关,冷明祥.医患关系研究进展综述[J].中国医院管理,2009,29(3).
[19]杨阳.信任是医患关系的内在价值——中国与新西兰医患信任关系之比较研究[D].2007年硕士学位论文.
[20]李德玲,卢景国.从患者视角看预设性信任/不信任及其根源[J].中国医学伦理学,2011,24(4).
[21]王锦帆.关于我国医患沟通内涵与目的的思考[J].中国医院管理,2007,27(3).
[22]张竞超,李顺民.从信任角度及信息不对称角度分析医患关系[J].中国医药指南,2009,7(4).
[23]耿玉如.防止因医患沟通不当而引发医疗纠纷[J].中华医院管理杂志,2002,18(4).
[24]Maynarl DW, Heritage J. Conversation analysis, doctor-patient interaction and medical communication [J]. Med Educ,2005,39(4).
[25]佚名.日本处理医患关系三大经验[J/OL].http：//中国金药网.
[26]刘少杰.国外社会学理论[M].北京：高等教育出版社,2006：455-456.
[27]向江平,陈平.信任问题研究文献综述[J].广州大学学报,2003,2(5).
[28]Pellegrino ED. Trust and distrust in professional ethics [M]. Washington, DC: Georgetown University Press,1991:84.
[29]王占宇,刘俊,段丽娥.论医务社工在构筑和谐医患关系中的作用[J].医学与社会,2008,21(7).
[30]刘江平,范春梅,张铁山.加强医务社会工作,构建和谐医院[J].医院与社会,2008,12(9).
[31]肖慧欣,黄子杰,李跃平.浅论医务社工在医生社会支持系统中的角色[J].中国医学伦理学,2009,22(2).
[32]柴双,徐金凤.军队医院引入医务社会工作的思考[J].解放军医院管理杂志,2011,18(14).
[33]李平,郭永松,吴水珍等.医务社会工作的功能定位及其在医患冲突中的作用[J].卫生经济研究,2009(1).