美国判例法上医师注意义务的扩展

法律的一般原则是医师仅就自己的过失行为对自己的患者承担责任,但是,从近年来美国判例法的发展看,如果医师在诊治患者时可以合理预见第三人将会遭受患者损害,医师的注意义务可扩展到与其不存在直接的医患关系但存在特殊关系的非患者.     

医师裁量权与患者决定权的冲突与协调

医师裁量权与患者决定权处理不当易导致医患纠纷.从医师裁量权与患者决定权的含义入手,分析了医师裁量权与患者自主决定权的冲突原因及表现.从法律制度构建、多元化纠纷解决机制的建立、医师职业伦理的养成和医疗技术的提高等方面,提出了协调医师裁量权与患者自主权冲突,构建和谐医患关系的对策建议.     

社会阶层分化视角下医患信息行为对医患关系的影响

目前社会阶层分化进程中的医患关系比较紧张,医患信息行为起了很大作用.由于历史原因多数医师未能认识到医患信息行为对医患沟通及医患关系的影响.患者作为医疗信息掌握的弱势群体,其对从医师处获得信息的依赖将长期存在,医师与患者信息行为必然相互影响.针对信息行为建立相应的培训及评价机制是十分必要的.     

患者同意权与生命健康权冲突的法律研究

肖志军"拒签"事件所酿成的悲剧引起了人们对患者同意权、生命健康权与医师强制治疗权的广泛关注.首先揭示临床医疗中存在的患者同意权与生命健康权冲突的种种现象,然后分析了患者同意权与生命健康权冲突的理论争议,最后就如何在法律上解决患者同意权与生命健康权冲突问题提出自己的建议.     

论医师说明义务的法律性质

厘清医师说明义务的内涵、性质能够使患者和医师明晰自己的权利和义务,有利于保护患者知情同意权.对于医师说明义务的法律性质,有主张医师的说明系患者有效同意之逻辑前提的“承诺无效说”;也有“医疗合同上的附随义务”的观点;还有认为其应是一项法定的注意义务.在对这些观点进行评析后提出此义务应是一项法定的合同义务.     

医师职业精神现状与挑战——基于新疆某医院的调查

随着医患关系日趋紧张,传统的医师职业精神建设迎来了新的挑战。以新疆某医院医师作为调查对象,对医师队伍职业道德行为及职业精神知晓率进行调查。结果显示,该院大部分医师能够一视同仁地对待不同身份的患者;当个人私事与处理患者二者发生冲突时,部分医师对发扬无私奉献精神持保留态度;此外,医师以病情轻重收治患者现象在该院比较普遍。在此背景下,医师职业精神培养途径亟待重建,一方面是尽量减轻医务人员的职业压力,降低职业倦怠和职业精神退化;另一方面是探索新形势下医师职业精神建设道路。     

患者同意权与生命健康权冲突的法律研究

肖志军“拒签”事件所酿成的悲剧引起了人们对患者同意权、生命健康权与医师强制治疗权的广泛关注。首先揭示临床医疗中存在的患者同意权与生命健康权冲突的种种现象，然后分析了患者同意权与生命健康权冲突的理论争议，最后就如何在法律上解决患者同意权与生命健康权冲突问题提出自己的建议。     

知情同意与心理抚慰

近年来 ,随着社会的发展、法律的不断健全及社会舆论强有力的影响 ,患者的知情同情权已成为构建现代医患关系的基础。患者不仅对自己所患疾病的病因病机、诊断方法、治疗原则以及可能的预后等都有知情的权利 ,而且对医师在治疗上的决定可行使同意或否决的权利。在手术治疗过程中 ,因手术医生忽视或不尊重患者及家属的知情同意权 ,更有甚者 ,医生将其个人意念强加给患者 ,由此引发的医疗纠纷屡见不鲜。因此 ,手术治疗过程中坚持知情同意及心理抚慰具有极其重要的临床意义。1　麻醉医师应在手术前对患者进行心理抚慰由于患者年龄、性别、职业…     

消化内镜医师培训的现状及计算机模拟训练系统的应用

传统的以患者为基础的消化内镜医师培养模式已不能适应消化内镜的快速发展和病患对内镜操作技术的高要求,通过多媒体和虚拟现实技术建立的计算机辅助的内镜模拟训练系统相对于传统的消化内镜医师培训方式是一个巨大进步,它能帮助初学者较快掌握消化内镜诊疗操作的基本技能,使各级消化内镜培训中心的规范化教学成为可能.但是,模拟内镜训练必须结合实际病例的操作才能巩固从模拟内镜得到的内镜操作技能.本文总结了目前消化内镜医师培训的现状,重点对消化内镜模拟训练系统在内镜医师培训中的作用和存在的问题进行探讨,并提出了自己的观点.     

临床医师医学人文认知缺失与教育重构

临床医师在实践中医学人文理念存在以下一些问题:医学人文理念的认知存在偏差、医学人文教育与临床实践脱节、患者对临床医师人文素质的认同度较低等问题。反映出临床医师医学人文素质薄弱和缺失,如缺乏医者仁心的人文理念、哲学辨证思维、综合医学人文素养、心理沟通艺术、法律意识。因此,必须创新性重构临床医师医学人文教育模式,完善临床医学人文执业技能培训,实行医学人文教育全程化培训,完善医学人文教育的考核评价体系,提高临床医师为患者提供人性化医疗服务的水平。     

德与法有机结合--论和谐医患关系之建设

建设和谐的医患关系有赖于道德与法律的有机结合.既要发挥道德在法治建设中的作用,又要发挥法律在道德建设中的作用.在和谐的医患关系的建设中,道德与法律相互作用,但道德是统帅.     

The Balint group experience for medical students: a pilot project

Loss of empathy has been reported in medical students as they move through the clinical phases of their training. Several researchers have attempted to address this issue by exploring ways of heightening students’ awareness of the emotional, non-biomedical aspects of illness and the dynamics of the doctor–patient relationship, using a variety of reflective group discussion methods. This pilot project employed the specific group method developed by Michael Balint for general practitioners working in London after the Second World War. The pilot was based on one group of six third-year graduate students, meeting weekly over six weeks. Evaluation includes pre- and post-questionnaires, a 1000-word essay and leaders’ observations. The results suggest that the traditional Balint method needs to be modified for students at a point in their training where they have not yet been exposed to patients for long enough to develop meaningful patient relationships. Nevertheless, there was some evidence of a heightened awareness of the dynamics of doctor–patient relationships and the importance of psychological/emotional factors (including their own prejudices) when interacting with a patient. Balint-style groups could be an effective way of encouraging medical students to reflect on the importance of emotions in the doctor–patient relationship.     

Medicine as a trade

The doctor-patient relationship is usually seen and accepted as a giving-taking association, in which the doctor is a giver and the patient is a taker. The paper challenges such a one-way relationship, and stresses the patient as a giver and the doctor as a receiver. The patient is described as a source for the emotional development of the doctor, and as a source of knowledge. He is also a source for what could be called ‘life experience’. By serving as a source for these three elements, the patient is also seen as a source for reward. There is a danger of under-utilisation of this reward by the doctor, when (1) he is engaged only in giving, (2) he wilfully obstructs the channel of information, and (3) he feels ‘saturation’ called by the doctor ‘experience’. This under-utilisation will ultimately lead to ‘medical parasitism’. This parasitism is seldom recognised by the patient, because the arrest of development of a doctor is usually hardly noticed, and this will lead to neglect of the patient, so that the ‘trade’ between doctor and patient becomes unfair, as the long-term investment which the patient has placed in the doctor, does not pay off any longer.     

从李丽云事件看生命健康权、患者自主权和医生干涉权

当患方行使自主权所做的决定危及自身生命健康权时,能否赋予医生干涉权以实现生命高于一切的理念？阐明了生命健康权、患者自主权和医生干涉权的关系．并从我国实际出发,论述不能通过赋予医生干涉权来避免类似李丽云悲剧的发生,建议立法完善对民事行为能力的规定,建立司法机关或其他第三方机构提前快速审查机制来解决自主权与生命权的冲突。     

肢体自然重建理念——一种人文关怀治疗

著名的医学家、哲学家Hippocrates在公元前4世纪就指出：医生的责任仅在于促进疾病的自然康复过程,而非阻拦这个过程.患者得以治愈的根据是患者自身存在的康复能力;医生首先必须清楚：自己所治疗的对象是人,是有生命的、有思想的、活在社会上的人,而不是被修理的物件.医生能够做到的只是为患者创造或提供一定的有利于康复的条件.20世纪50年代,前苏联骨科专家Ilizarov发现了张力-应力法则,并因此创造出的牵拉再生、自然重建技术,正是很好地诠释了Hippocrates的思想.     

The representation of social relations by monkeys

Monkeys recognize the social relations that exist among others in their group. They know who associates with whom, for example, and other animals' relative dominance ranks. In addition, monkeys appear to compare types of social relations and make same/different judgments about them. In captivity, longtailed macaques (Macaca fascicularis) trained to recognize the relation between one adult female and her offspring can identify the same relation among other mother-offspring pairs, and distinguish this relation from bonds between individuals who are related in a different way. In the wild, if a vervet monkey (Cercopithecus aethiops) has seen a fight between a member of its own family and a member of Family X, this increases the likelihood that it will act aggressively toward another member of Family X. Vervets act as if they recognize some similarity between their own close associates and the close associates of others. To make such comparisons the monkeys must have some way of representing the properties of social relationships. We discuss the adaptive value of such representations, the information they contain, their structure, and their limitations.     

The drama of the gifted child and the psycho-analyst's narcissistic disturbance.

In order to develop a true self, the child needs, in the first weeks and months of his life, his mother's appropriate emotional response, mirroring and respect. These narcissistic aspects have to be distinguished from the drive wishes. Only the mother's appropriate responses make it possible for the child to experience his feelings as belonging to his own self. If the child does not get the right narcissistic response, he will continue to search for narcissistic supplies for the rest of his life. The most suitable objects for this will be his own children initially, who are completely at his disposal. Specially gifted children who are sensitive, alert and have many 'antennae', will quickly learn to adapt to the narcissistic needs of their parents. Their behaviour will then give the mother all the mirroring, consideration and admiration which she had missed as a child herself. The result will be that, in spite of excellent performance, the child's own true self cannot develop. All this leads to narcissistic vulnerability and to new attempts in the adult to find at last an available 'mother' in his own child, partner, or, if he has become a psycho-analyst, in his patient. In the transference this type of analysand first experiences narcissistic rage before deep mourning is possible. This process of mourning enables him finally to accept his own deprivation as a child, to give up the unconscious idealizations and with them the hope of finding such a 'mother'. This leads regularly to the liberation of the life forces and allows creativity to develop. Only after this has been achieved is the analysis of drive conflicts possible and becomes emotionally effective.     

论医生的双重角色及其激励相容

在医患关系中,医生充当着双重角色,不仅作为患者的代理人或顾问为患者利益着想,同时也作为医疗服务的提供者为自己的利益着想。在这种双重角色下极易发生供者诱导需求,并进而导致过度医疗与医疗费用的上升。因此,有必要在支付机制、成本费用约束和外在监督等方面实现对医生的激励相容,以规范医疗行为,切实降低医疗费用。     

医患关系中医务人员的伦理学思考

医患关系是一种特殊的人际关系,医务人员应从伦理学角度深入思考医患关系。了解熟悉并懂得患者,运用医患沟通技巧缩短医患间的心理距离。加强自身修养,提高思想道德水平和专业技能。充分发挥健康宣传教育在促进和谐医患关系中的作用。让我们共同努力构建和谐医患关系