医疗剧:健康文化传播的主阵地

医疗剧作为一种大众传播媒介,是医学与社会沟通的桥梁,使患者、社会能够更加立体地了解医学、医院和医生,应承担起健康文化传播的社会责任。通过分析中美医疗剧在编剧、制作、传播中的差异,提出国产医疗剧应取长补短,借鉴美国医疗剧的发展经验,本着尊重科学、敬畏生命、尊重事实、崇尚人文的原则,追求医学专业特质的严肃性,呈现医学技术的有限性,正视医疗差错的不可避免性,体现医学专业精神的内涵,制播根植于中国文化背景、具有本土特点的精品医疗剧,发挥健康文化传播主阵地的引领作用。     

也谈医学专业精神

专业精神有着其固定的内涵和社会经济文化基础.在构建医学专业精神的基本框架已经坍塌的社会背景下,即使在西方,医学专业精神存在的价值也受到了极大的挑战.照搬西方的经典医学专业精神或是生搬硬套中国的传统医学都不利于中国现代医疗体制的发展及和谐医患关系的构建.     

也谈医学专业精神

专业精神有着其固定的内涵和社会经济文化基础。在构建医学专业精神的基本框架已经坍塌的社会背景下,即使在西方,医学专业精神存在的价值也受到了极大的挑战。照搬西方的经典医学专业精神或是生搬硬套中国的传统医学都不利于中国现代医疗体制的发展及和谐医患关系的构建。     

再论医学专业精神的价值

医学专业精神是学界十年前就提出的概念,并引起学者对该问题的关注与讨论。但是,随着医疗卫生事业的发展,医学专业精神的价值呈现日渐式微,主要表现为医患之间的不信任引发的关系紧张。究其原因,医学价值反思仅囿于较低层面的职业性价值,以致专业精神彰显的人本价值被技术至上的功利主义思想所遮蔽。基于此,比照专业精神与职业精神之间的区别就成了言说医学专业精神的逻辑起点,理清专业精神对职业的价值塑造以及其对人的德性完善,才能窥探专业精神彰显更高层面的价值,并对医疗实践中的现实问题进行回应。     

医学的商业化与医学专业精神的危机

传统上能够定义为专业的职业承认该专业人员与其服务对象的关系具有利他性质,并且期望专业人员以有利于服务对象的方式行动。专业涉及到社会契约。而专业之所以要强调其从业者要承担社会责任,是因为在行业领域中,专业拥有排他性的垄断特权以及由此获得的社会尊重与信任。医学专业是这样一种能自我调控的职业,它要求通过系统的、有既定目标或学院式的训练,使执业者拥有专业知识技能,从而提供规范的、有伦理准则约束的服务。医学专业精神要求患者利益至上。过度商业化的医学导致医学究竟是商业还是专业的界限越来越模糊。坚持医学的专业精神需要重新确定医疗服务的目标和方向。     

医学专业卫生法学教育的“异化”现象探析

近年来,由于医疗诉讼的增多,使得"法学"在临床实践中成为一门颇受业内关注的"显学",甚至一些医学院校开设了本科专业。但是,如果对医学专业的卫生法学教育脱离了"人文"精神与价值,就无法实现改善医患关系之初衷,甚至可能出现"异化"现象,近年一些见死不救的典型医疗纠纷案例可见一斑。举例阐述针对医学专业学生的卫生法学教学中,如何通过"以问题和案例为导向的教学方法"让学生透过法律条文,把握社会发展趋势,巩固医师职业精神,形成法律思维模式。     

医学专业精神的初步研究

由于历史和社会文化的差异,中西方对医学专业精神有着不同的理解。在中西不同语境下,分析了“Profession”和“Professionalism”这两个核心概念的涵义,并从中西对比的视角,对中西方医学专业精神所面临的几个共同问题进行了初步研究,包括医学专业核心道德价值观念、利益冲突、行业自治等。在此基础之上,还对我国医学专业精神的发展提出建议。     

市场经济条件下人生价值取向对医学专业精神的影响

市场经济条件下人生价值取向对医学专业精神有很大影响,表现为价值取向与医学专业精神的变化相伴行.在市场经济条件下价值取向以个体自我本位价值凸显,使医学专业精神中涉及的整体本位价值主体地位难以确立,物质利益与医学专业精神的核心思想发生冲突的方式影响医学专业精神,提出医学专业精神的贯彻执行还是一个漫长的探索过程.     

医学专业精神教育的生命叙事维度

生命叙事不仅要求从"人"的角度倾听患者的"故事",而且要从人的完整性方面对患者进行综合的理解。医学专业精神内涵中彰显的叙事特征反映出医患互动中双方主体共存性。叙事把"患者"引入医学专业精神教育的场域,不仅在实践层面强化了医者的专业责任,而且体现了职业到专业跨越式的自我改造。所以,生命叙事一方面使医患关系中"人"的主体价值重新显现,另一方面又消解医疗实践中的异化现象。异化现象作为医学专业精神构建中的绊脚石,人的主体性价值回归是战胜它最核心的利器之一。     

医疗安全之“墨菲定律”和“海恩法则”

医疗安全既是医学专业问题,也是人文社会问题.保证医疗安全,避免医疗意外、差错、事故的发生,是医务工作者的主要职责和面临的重大课题.“墨菲定律”和“海恩法则”是安全产生领域的重要安全法则,它揭示了事故发生的偶然性与必然性.本文结合“墨菲定律”和“海恩法则”探讨医疗安全问题,认为医疗安全问题是无法避免的,但又是可以预防的,这一看似矛盾的命题,给我们深深的思索和无穷的启迪.     

Reflective Writing about Near-Peer Blogs: A Novel Method for Introducing the Medical Humanities in Premedical Education

Narrative analysis, creative writing, and interactive reflective writing have been identified as valuable for professional identity formation and resilience among medical and premedical students alike. This study proposes that medical student blogs are novel pedagogical tools for fostering peer-to-peer learning in academic medicine and are currently underutilized as a near-peer resource for premedical students to learn about the medical profession. To evaluate the pedagogical utility of medical student blogs for introducing core themes in the medical humanities, the authors conducted qualitative analysis of one hundred seventy-six reflective essays by baccalaureate premedical students written in response to medical student-authored narrative blog posts. Using an iterative thematic approach, the authors identified common patterns in the reflective essays, distilled major themes, coded the essays, and conducted narrative analysis through close reading. Qualitative analysis identified three core themes (empathic conflict, bias in healthcare, and the humanity of medicine) and one overarching theme (near-peer affinities). The premedical students’ essays demonstrated significant self-reflection in response to near-peer works, discussed their perceptions of medical professionalism, and expressed concerns about their future progress through the medical education system. The essays consistently attributed the impact of the medical student narratives to the authors’ status as near-peers. The authors conclude that reading and engaging in reflective writing about near-peer blog posts encourages premedical students to develop an understanding of core concepts in the medical humanities and promotes their reflection on the profession of medicine. Thus, incorporating online blogs written by medical trainees as narrative works in medical humanities classrooms is a novel pedagogical method for fostering peer-to-peer learning in academic medicine.

     

医患关系的本质:医生的专业视角及其伦理意蕴

力图从为西方医学领域已完善发展及广为接受的专业(Professional)视角对医患关系(Patient-professional Relationship,以下及正文中皆简称为PPR)的伦理意蕴做探讨.简要追溯了现代医护专业精神的起源,说明了道德责任之所以是专业这一概念的重要组成部分的原因,并且指出为病人最大利益着想是医护专业最根本的道德规范与责任,亦是医患关系不可缺少的伦理基石.     

The professionalism movement: can we pause?

The topic of developing professionalism dominated the content of many academic medicine publications and conference agendas during the past decade. Calls to address the development of professionalism among medical students and residents have come from professional societies, accrediting agencies, and a host of educators in the biomedical sciences. The language of the professionalism movement is now a given among those in academic medicine. We raise serious concerns about the professionalism discourse and how the specialized language of academic medicine disciplines has defined, organized, contained, and made seemingly immutable a group of attitudes, values, and behaviors subsumed under the label of "professionalism." In particular, we argue that the professionalism discourse needs to pay more attention to the academic environment in which students are educated, that it should articulate specific positive behaviors, that the theory of professionalism must be constructed from a dialogue with those we are educating, and that this theoretical and practical discourse must aim at a deeper understanding of social justice and the role of medicine within a just society.     

Towards a Confucian Virtue Bioethics: Reframing Chinese Medical Ethics in a Market Economy

This essay addresses a moral and cultural challenge facing health care in the People’s Republic of China: the need to create an understanding of medical professionalism that recognizes the new economic realities of China and that can maintain the integrity of the medical profession. It examines the rich Confucian resources for bioethics and health care policy by focusing on the Confucian tradition’s account of how virtue and human flourishing are compatible with the pursuit of profit. It offers the Confucian account of the division of labor and the financial inequalities this produces with special attention to China’s socialist project of creating the profession of barefoot doctors as egalitarian peasant physicians and why this project failed. It then further develops the Confucian acknowledgement of the unequal value of different services and products and how this conflicts with the current system of payment to physicians which has led to the corruption of medical professionalism through illegal supplementary payments. It further gives an account the oblique intentionality of Confucian moral psychology that shows how virtuous persons can pursue benevolent actions while both foreseeing profit and avoiding defining their character by greed. This account of Confucian virtue offers the basis for a medical professionalism that can function morally within a robustly profit-oriented market economy. The paper concludes with a summary of the characteristics of Confucian medical professionalism and of how it places the profit motive within its account of virtue ethics.     

外科医生面临的困惑和思考

外科医生面临越来越大的压力和严峻的挑战,由于外科技术的局限性和人体差异的复杂性以及社会诉求价值过高等因素决定了外科是一门高风险的职业。如何规避职业风险?我们可以从加强责任心、严格执行医疗常规、提高医疗技术入手;但这还不够,一个外科医生智慧与技能的发掘以及处理问题的能力与技巧,还需要良好的职业素养、崇高的职业精神、科学的思维方法、和睦的医患关系。     

Cost containment as professional challenge

Cost containment by means of prospective payment and other mechanisms is widely seen as a challenge to modern medicine; but the challenge is seldom articulated clearly in terms of core professional values and the moral content of a claim to professionalism. Medical ethics, as it has evolved as a field of study in the past twenty years, has contributed little to the concept of professionalism in medicine. For an investigation of professionalism in the face of cost containment to evolve fruitfully, several things must occur. The true nature of today's challenge to medicine must be appreciated. The balance between tradition and response to social change in defining a professional value system must be appreciated. Physician income must be explicitly addressed as a moral issue. And practical strategies for investigating and affirming core professional values must be developed for health delivery systems and medical education settings.     

Online professionalism: social media, social contracts, trust, and medicine

The AMA Council on Ethical and Judicial Affairs (CEJA) has initiated an important discussion on medical professionalism and the use of social media by issuing thoughtful and practical guidance for physicians and medical students. The implications of online activities for trust in the profession, as well as for trust between patient and doctor, however, will need further exploration as digital life expands and evolves.     

Understanding the Trusted Doctor and Constructing a Theory of Bioethics

This paper offers a constructivist account of bioethics as an alternative to previous discussions that explained the ethics of medicine by an extrapolation of principles or virtues from ordinary morality. Taking medicine as a higher and special calling, I argue that the practice of medicine would be impossible without the trust of patients. Because trust is a necessary condition for medical practice, the ethics of the profession must provide the principles for guiding physician behavior and the profession toward promoting trust and being trustworthy. In a phrase, that principle is “seek trust and deserve it.” I sketch out how the concept of trust provides a different justification for common sense principles of bioethics and explain how the concept of trust provides reasonable guidance for resolving moral conflicts within medicine. The trust-seeking approach provides a new and unexpected ordering of some traditional medical values, it reveals the weightiness of previously undervalued bioethical precepts, and illuminates the centrality of some largely ignored obligations of medicine. It also has the power to guide clinical practice and to inform the profession about standards for medical institutions. This revised version was published online in August 2006 with corrections to the Cover Date.     

医学生对医师责任和伦理修养若干问题的认知

为了探索以患者为中心的医学生医师职业精神教育,本研究调查了四川大学医学生对医师职业精神中的“伦理修养”（“保密与尊重”和“知情同意”）和“医师责任”两方面的认知,并将其与患者认知进行比较。笔者分析了医学生和患者认知差异,并对医学生医师职业精神的影响因素进行探讨。结果显示,医学生对医师职业精神的认识停留在比较肤浅的层面,未能发自内心地把患者的利益放在首位,最重视的仍然是临床技能的提高。研究提示医学生医师职业精神教育需要增强感染力和实践性。