患者对过度医疗的认知与行为调查分析

过度医疗越来越引起学界重视和讨论。基于患者角度,采用问卷调查的方式,定量描述卫生服务需求方对过度医疗的认知与行为选择,探索性地分析过度医疗影响因素。发现患者健康知识掌握不足,对过度医疗存在认知误区,医患沟通、信息不对称影响患者过度医疗认知,并且最终导致其过度医疗行为选择,医疗保险支付制度可能也是影响因素之一。提示要遏制过度医疗的发生,应提高患者健康素养,树立正确的就医观;并改善医患沟通,加强信息交流。     

中国社会医疗保险财务收支中的障碍与突破

财务收支是社会医疗保险制度运行的物质基础.近年来,财务收支失衡问题已经开始显现于我国社会医疗保险的部分统筹地区.其原因主要有责任主体、人口结构、财务机制、医疗递送等因素.为此,应该在走向全民医疗保险制度、加强医患双方的道德风险规避、扩展个人医疗账户的使用范围、适时建立退休人员的缴费制度等方面进行改革与发展.     

构建妇科门诊和谐医患关系的伦理学思考

本文从医院管理因素、医务人员因素和患方因素三个方面对妇科门诊医患关系的影响因素进行伦理学分析,提出加强医院管理;医务人员转变服务理念,改善服务态度;加强业务学习,提高医疗水平和加强宣传,改善医务人员社会形象是改善医患关系,提高患者满意率,增强医疗竞争优势的关键。     

中国社会医疗保险财务收支中的障碍与突破

财务收支是社会医疗保险制度运行的物质基础。近年来,财务收支失衡问题已经开始显现于我国社会医疗保险的部分统筹地区。其原因主要有责任主体、人口结构、财务机制、医疗递送等因素。为此,应该在走向全民医疗保险制度、加强医患双方的道德风险规避、扩展个人医疗账户的使用范围、适时建立退休人员的缴费制度等方面进行改革与发展。     

患者信任、参与行为对医患信任度影响研究

医患关系已不仅是医生和患者间的关系,还包括医疗机构、医疗服务等,直接影响诊疗活动效果。探讨患者信任、医患参与行为,分析影响医患信任度的主要原因,找出改善医患关系的建议,以此构建和谐的医患关系。采用问卷调查法对患者信任、医患参与行为等进行调查。个体差异对患者信任、参与行为具有影响,同时患者信任、医患参与行为等各因素对医患信任度也会产生一定作用。多种因素组合影响医患信任度,建议推进分级诊疗;提升诊疗技术服务价值;加强医患沟通,提高双方在诊疗中的参与行为;健全卫生医疗法律法规,规范媒体报道及舆论导向。     

矛盾论视角下医患关系紧张的成因及对策探析

近年来医患关系紧张已成为社会关注的热点问题,采用矛盾论的观点,深入分析导致医患关系紧张的四大矛盾:医生高技术的职业属性与其获得的薪酬收入之间的矛盾,医疗服务提供方与需求方的信息不对等,患者有限的支付能力与高昂的医疗费用的矛盾,医疗行业的高风险性与医疗风险分担机制缺失之间的矛盾。建议构建合理的医生薪酬体系,引入医疗保险谈判机制,提升民众的医疗服务购买力,设置医疗责任强制保险,提升整体医疗技术水平,从而化解医患矛盾,缓解医患关系。     

中国与新西兰医患信任的内在影响因素

医患信任通常与医疗服务的可及性和连续性,以及医方的资质能力和对职业精神的坚守密切相关.通过对医疗机构资金来源与医生的激励机制、医疗服务的可持续性与医患关系的密切程度、医疗信息公开化和行业监管等因素的分析,揭示导致中国与新西兰的不同医患信任状况内在因素,进而为改善我国现有医患信任危机提供思路与途径.     

循证医学在构建和谐医患关系中的应用

医患关系是一种特殊的人际关系.采用循证医学的原理和方法,规范医疗服务行为,缓解医患矛盾,构建和谐的医患关系,已越来越成为人们的共识.试图从循证医学的角度探索改善医患关系的途径,通过对循证医学理论的应用来缓解医患冲突,改善医患关系.     

我国社会医疗保险基金风险管理问题

通过对中国加入WTO进入后过渡期社会医疗保险基金管理现状、存在的问题进行分析,根据社会医疗保险基金的运作流程及对应主体可能对保险基金安全造成的影响,从基金保值增值、道德风险控制、宏观管理等角度提出了加强社会医疗保险基金安全的政策建议.     

医疗保险谈判关系承诺影响因素的实证研究

医改"十二五"规划方案明确指出将建立医疗保险谈判机制作为健全全民医保体系的重要任务之一加以推进。而医疗保险供需双方谈判关系的建立会受到诸多因素的影响。文章借鉴关系承诺理论来研究医疗服务提供方如何在医保谈判中获取医疗保险方的关系承诺,通过分析双方在关系承诺中的影响因素构建了一个以"前置影响因素—医疗保险方关系承诺—医疗保险方合作意愿"为思路的模型。以此为基础设定相关假设,并通过搜集样本地区医疗保险谈判影响因素的问卷调查数据对该模型及理论假设进行实证分析。最后在实证研究结果的基础上为医疗服务提供方获取医疗保险方的关系承诺以及进一步推动我国医疗保险谈判机制建设提出相应的政策建议。     

Together – apart: in touch in a time of separation

This paper explores the experience of working as a Jungian analyst through the various phases of the global COVID-19 pandemic, examining the importance of the physical containing space alongside the analyst’s internal mind and how technology can both help and hinder understanding. A number of clinical vignettes illustrate the challenge of communicating over a distance, paying particular attention to the way countertransference phenomena can become re-attuned. Reference is made to mythology and symbols of hope, and consideration given to the meaning and purpose of the pandemic.     

Language,politics and dreams: the challenges of building resilience in refugees

This paper describes a case study of a 60-year-old Peruvian refugee in some detail, focusing on the importance of building emotional resilience in a patient in Spanish in order to create a space for learning the English language – the patient did not speak English after 20 years of living in Britain. The work was carried out with an interpreter and some of the literature on working with interpreters is referred to. The paper also briefly outlines the refugee journey in broad terms, which is a journey from the culturally known to the culturally unknown. The question of how well the literature on resilience, which sits firmly within a Western developmental perspective, can be applied to refugees, most of whom come from group and family-based cultures dominated by ideas of honour and shame, is discussed. The paper also touches on the importance of the receiving country enabling or not, as the case may be, a transitional space for refugees who have lost their home and are seeking to find a safe haven in a strange culture.     

The Possibility of Meaning in Human Evolution

Science undermines the certitude of non-naturalistic answers to the question of whether human life has meaning. I explore whether evolution can provide a naturalistic basis for existential meaning. Using the work of philosopher Daniel Dennett and scientist Ursula Goodenough, I argue that evolution is the locus of the possibility of meaning because it has produced intentionality, the matrix of consciousness. I conclude that the question of the meaning of human life is an existentialist one: existential meaning is a product of the individual and collective tasks human beings undertake.     

When is it time to stop? When good enough becomes bad enough

This article draws on Winnicott’s concept of the good enough mother to discuss how to know whether a therapeutic situation is good enough to continue or bad enough to end. This dilemma is explored in terms of clinical syndromes, such as anorexia and pathological gambling, but focuses mainly on analyst-initiated endings, which are termed the ‘Casablanca dilemma’, based on an amplification of the ending of the film Casablanca. The author goes on to discuss such one-sided endings, drawing on interviews with 40 analysts and therapists about their clinical experience. A typology of bad enough endings is presented. The psychological differences between a good enough analysis as opposed to a bad enough one are explored through the ideas of Winnicott and Neumann.     

The transcendent function in Spitteler’s Prometheus and Epimetheus

In August 2020, John Beebe and Steve Myers met via Zoom to discuss their differing interpretations of psychological typology and the different sources within Jung’s writings that influenced their books: Integrity in Depth: Energies and Patterns in Psychological Type (Beebe), and Myers-Briggs Typology vs Jungian Individuation (Myers). The discussion centred on Spitteler’s epic poem Prometheus und Epimetheus, which forms the basis of chapter V of Psychological Types. This is both the largest chapter and one of two chapters that Jung highlighted in the Argentine foreword as containing the essence of the book. Jung’s book is primarily about the transformation of personality rather than the categorization of people. Although it contains a critical psychology that deconstructs the nature of consciousness, that is only one half of the book and a stepping-stone to the other half, which is the reconciliation of opposites with particular emphasis on the relation of consciousness and the unconscious. Jung assumed that readers were already familiar with Prometheus und Epimetheus, an understanding of which sheds light on the nature of the transformation that Jung described – the development of a new attitude towards attitude itself.     

Kann Es Ein Argument Für Den Skeptizismus Geben? Das Epistemische Problem Der Irrtumsmöglichkeit

Summary  Is there any argument for scepticism? The epistemic problem of the possibility of error. Arguments for scepticism rest on the assumption that knowledge claims are fallible. For this reason the concept of knowledge appears to be questionable. Since it is necessary to distinguish doubts from possible doubts, the arguments for scepticism appear to be unconvincing. If we take it into account that we know something that is immune to doubt, we should draw the conclusion that, contrary to scepticism, knowledge claims have to be compatible with being fallible. Thus any knowledge claim is capable of being doubted.     

Chapter 6: Biblical Foundations for a Practical Theology of Aging

SUMMARY

This article reviews Biblical sources pertaining to the elderly, particularly the frail elderly. Founded on these sources, implications for elderly with Alzheimer's Disease and other forms of dementia are addressed through a personal perspective informed by writings of Christian mystics.     

Mythological Underpinnings of Feminine Development

In the manner of Oedipus Rex, the myth of Myrrha—a story about a daughter's initiation of sex with her father—promises to divulge insights about feminine development. Given parallels between these two myths, the author asks why Jung identified Electra rather than Myrrha as the feminine counterpart to Oedipus, and revisits Freud's and Jung's differing interpretations of the incest theme in personality development. To break open the metaphor of Myrrha's incest, the author analyzes a similar account of incest in the Old Testament story of Lot and his wife and finds that they share a theme of female bitterness related to wounding of the mother and its arresting effect on the daughter's maturation. The article then considers the Demeter-Persephone myth, a tale not of incest but rape in Persephone's initiation into womanhood. In contrast to Myrrha, Persephone's development unfolds with strong maternal support tempered by the opposing claims on her by the masculine. The article draws these stories together to illuminate the archetypal forces that drive feminine development as well as the human affairs that resist and complicate them. The article concludes with a case study of a client whose developmental “stuckness” follows the contours of the Myrrha myth.     

Contribution de la neuropsychologie développementale à l'étude des sujets à haut potentiel : une revue de questions

Developmental neuropsychology studies cognitive development in relation with brain maturation and cerebral plasticity. Some authors have reported physiological correlates of intellectual precocity with the purpose of demonstrating neural basis of intelligence. A part of the literature also reports various cognitive profile and specific talents in information processing in the clinical population of gifted children. Thus, the study of exceptional performances may contribute to our knowledge of functional brain organization taking into consideration individual differences.