医患交流中医生话语对病患注意力影响的实证研究
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摘要
过去几十年间,有关医患交流的话题受到了人们的极大关注,大量系统性的研究被用于这一课题,取得了丰硕的成果。回顾以前的研究成果,不难发现这方面的研究大多从单纯的社会学、语言学或者心理学的角度来进行。要想取得更具有广泛意义上的研究成果,建立更和谐的医患关系,有必要综合这些研究成果,采用跨学科的研究方法。在这样的背景下,本文采取现场观察的方式,通过对仪陇医院门诊部门的医患对话样本以及对针对这一话题所设计的问卷调查的分析,对医患对话中医生的话语是否对病患的注意力有所影响,如何影响以及其对病人问诊时回答方式的影响进行了探索性的研究。
结合心理学上“注意”研究方面的成果,本文主要探讨以下问题：(1)医生话语(本研究中指对话时间,医生所提出的问题以及医学术语的使用)是否会对病人问诊时的注意力有所影响?(2)医生话语对病人注意力的影响是如何进行的?(3)这种医生话语对病人注意力的影响如何进一步影响病人的回答方式?通过对现场录音所得到的医患对话的文本加以分析并对问卷调查的量化分析,本研究得到以下结论：
(1)医生话语的三个方面,即对话时长、医生所提问题以及医学术语都对病患注意力分配有影响；
(2)熟练的语言运用需要各种认知能力的相互配合才能实现,然而由于通常情况下医患对话时间相对较短,一些语言技能如对对话语言的注意,对语言环境中发生的一些变化的注意(语调的变换等)以及在对话过程中表达方式的抑制和选择等并不能顺利的进行；医生所提问题的不同类型会对病患注意力的程度有不同的影响,如一些医学问题会加剧病人的紧张感从而使病人的注意力主要集中在自身的身体状况方面而忽视医生的其他话语,相反一些会话问题和社会心理问题却能一定程度上使病人平静,因此病患能更好的将注意力集中在医生所提供的信息方面；医患对话中过多医学术语的应用会增加病患注意力的负担。
(3)医生话语的三个方面对病患注意力产生的影响反过来会影响病患的回答方式。在这个过程中,由于注意力资源的保持和转移使得病患的回答方式通常伴有短暂的停顿、问题的重复以及一些肢体语言的运用等。也正因为这些回答方式的适当转变才使得整个问诊对话才得以完整的进行。
全文共分五章：
第一章阐述了论文的研究背景、目的、重要性以及文章的结构。
第二章是对医患交流以及注意相关研究的批评性回顾。总结和概括了医患交流以及注意研究理论及实证方面研究的成果,提出了存在的问题。
第三章阐述了医患对话中医生话语的三个重要方面即对话时间,医生提出的问题以及医学术语的相关内容。
第四章阐述了研究问题,参与者,研究过程以及具体方法。对转录后的医患对话文本内容进行了定性分析并对问卷做了量化分析。
第六章总结了前面的内容,并明确提出医生话语对病患注意力影响的实际性意义。指出了本研究的局限性以及可能为以后研究所提供的参考价值。
Over the last few decades, considerable attention has been paid to the study of doctor-patient communication and extensive systematic empirical research has been conducted, which has brought forth fruitful results. However, after a review of the literature, it is found that most studies were carried out from the sociological, linguistic or psychological perspective respectively. To make research on doctor-patient communication more meaningful, it is necessary to use multi-disciplinarily and interdisciplinary research approach so as to provide more clues about how to establish a good doctor-patient relationship. The present study, therefore, adopts real-life observation to investigate the doctor-patient conversations in outpatient department of Yilong Hospital. Linguistic material is obtained through tape-recording on the spot. And before the research is done, questionnaires concerning the study issue have been handed out to selected participants to collect data.
The study, combining psychological studies on attention with linguistic studies on doctor-patient communication, addresses the following questions:(1) Does the discourse of doctor, namely, the length of conversation duration, questions in doctor-patient dialogue and the use of medical jargon have effects on patient's attention? (2) How does the discourse of doctor influence patient's allocating of attention? (3) How does such discourse affect patient's way of response?
After analysis of the data by using both quantitative and qualitative methods, the thesis reached the following findings:
(1) All of the three aspects of doctor's discourse have effects on patient's allocating of attention resources.
(2) Skilled language use, requires the coordination of a number of cognitive abilities, while some language skills such as attending to a conversation, attending to changes in a linguistic environment (i.e., change in tone of voice; introduction of unexpected ideas), as well as inhibiting and selecting particular expressions cannot proceed smoothly as a result of the general short conversation duration. Different kinds of questions asked by doctor have different effects on the degree of patient's concentration of attention:some medical questions intensify the degree of patient's nervousness, which cause patient's attention to be mainly focused on his/her physical states; while conversational questions and psychosocial questions can calm down patient, thus he/she can better focus on the conversational information provided by doctor. And too many medical terminologies used by doctor increase attention load to patient.
(3) Patient's way of responses may change due to the impact of doctor's discourse on patient's attention. In this process, the sustaining of attention on one object and shifting of attention from one object to another object make patient's response way often accompanied with "temporary stop", "repeat of questions" or even "body gestures". In this way, the whole medical conversation goes further.
This dissertation consists of five chapters. The first chapter introduces the background to the study, purpose and significance of the study as well as organization of this thesis. Chapter Two critically reviews the development of the research on doctor-patient communication comprehensively and research on attention related. Chapter Three elaborates three important aspects of doctor's discourse in doctor-patient communication:namely, conversation duration, questions in doctor-patient dialogue and medical jargon. Chapter Four presents the research issue, participants, research procedure and methods, and analyses the results. Chapter Five makes a conclusion about the impact that doctor's discourse may have on patient as well as the influence it has on patient's way of response; then limitations and research implications of the study are presented and at last, it recommends further areas for future study.
结合心理学上“注意”研究方面的成果,本文主要探讨以下问题：(1)医生话语(本研究中指对话时间,医生所提出的问题以及医学术语的使用)是否会对病人问诊时的注意力有所影响?(2)医生话语对病人注意力的影响是如何进行的?(3)这种医生话语对病人注意力的影响如何进一步影响病人的回答方式?通过对现场录音所得到的医患对话的文本加以分析并对问卷调查的量化分析,本研究得到以下结论：
(1)医生话语的三个方面,即对话时长、医生所提问题以及医学术语都对病患注意力分配有影响；
(2)熟练的语言运用需要各种认知能力的相互配合才能实现,然而由于通常情况下医患对话时间相对较短,一些语言技能如对对话语言的注意,对语言环境中发生的一些变化的注意(语调的变换等)以及在对话过程中表达方式的抑制和选择等并不能顺利的进行；医生所提问题的不同类型会对病患注意力的程度有不同的影响,如一些医学问题会加剧病人的紧张感从而使病人的注意力主要集中在自身的身体状况方面而忽视医生的其他话语,相反一些会话问题和社会心理问题却能一定程度上使病人平静,因此病患能更好的将注意力集中在医生所提供的信息方面；医患对话中过多医学术语的应用会增加病患注意力的负担。
(3)医生话语的三个方面对病患注意力产生的影响反过来会影响病患的回答方式。在这个过程中,由于注意力资源的保持和转移使得病患的回答方式通常伴有短暂的停顿、问题的重复以及一些肢体语言的运用等。也正因为这些回答方式的适当转变才使得整个问诊对话才得以完整的进行。
全文共分五章：
第一章阐述了论文的研究背景、目的、重要性以及文章的结构。
第二章是对医患交流以及注意相关研究的批评性回顾。总结和概括了医患交流以及注意研究理论及实证方面研究的成果,提出了存在的问题。
第三章阐述了医患对话中医生话语的三个重要方面即对话时间,医生提出的问题以及医学术语的相关内容。
第四章阐述了研究问题,参与者,研究过程以及具体方法。对转录后的医患对话文本内容进行了定性分析并对问卷做了量化分析。
第六章总结了前面的内容,并明确提出医生话语对病患注意力影响的实际性意义。指出了本研究的局限性以及可能为以后研究所提供的参考价值。
Over the last few decades, considerable attention has been paid to the study of doctor-patient communication and extensive systematic empirical research has been conducted, which has brought forth fruitful results. However, after a review of the literature, it is found that most studies were carried out from the sociological, linguistic or psychological perspective respectively. To make research on doctor-patient communication more meaningful, it is necessary to use multi-disciplinarily and interdisciplinary research approach so as to provide more clues about how to establish a good doctor-patient relationship. The present study, therefore, adopts real-life observation to investigate the doctor-patient conversations in outpatient department of Yilong Hospital. Linguistic material is obtained through tape-recording on the spot. And before the research is done, questionnaires concerning the study issue have been handed out to selected participants to collect data.
The study, combining psychological studies on attention with linguistic studies on doctor-patient communication, addresses the following questions:(1) Does the discourse of doctor, namely, the length of conversation duration, questions in doctor-patient dialogue and the use of medical jargon have effects on patient's attention? (2) How does the discourse of doctor influence patient's allocating of attention? (3) How does such discourse affect patient's way of response?
After analysis of the data by using both quantitative and qualitative methods, the thesis reached the following findings:
(1) All of the three aspects of doctor's discourse have effects on patient's allocating of attention resources.
(2) Skilled language use, requires the coordination of a number of cognitive abilities, while some language skills such as attending to a conversation, attending to changes in a linguistic environment (i.e., change in tone of voice; introduction of unexpected ideas), as well as inhibiting and selecting particular expressions cannot proceed smoothly as a result of the general short conversation duration. Different kinds of questions asked by doctor have different effects on the degree of patient's concentration of attention:some medical questions intensify the degree of patient's nervousness, which cause patient's attention to be mainly focused on his/her physical states; while conversational questions and psychosocial questions can calm down patient, thus he/she can better focus on the conversational information provided by doctor. And too many medical terminologies used by doctor increase attention load to patient.
(3) Patient's way of responses may change due to the impact of doctor's discourse on patient's attention. In this process, the sustaining of attention on one object and shifting of attention from one object to another object make patient's response way often accompanied with "temporary stop", "repeat of questions" or even "body gestures". In this way, the whole medical conversation goes further.
This dissertation consists of five chapters. The first chapter introduces the background to the study, purpose and significance of the study as well as organization of this thesis. Chapter Two critically reviews the development of the research on doctor-patient communication comprehensively and research on attention related. Chapter Three elaborates three important aspects of doctor's discourse in doctor-patient communication:namely, conversation duration, questions in doctor-patient dialogue and medical jargon. Chapter Four presents the research issue, participants, research procedure and methods, and analyses the results. Chapter Five makes a conclusion about the impact that doctor's discourse may have on patient as well as the influence it has on patient's way of response; then limitations and research implications of the study are presented and at last, it recommends further areas for future study.
引文
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