医患双方对医患关系认知情况的调查分析

为了解医患双方对医患关系的认知情况,对江西吉安市五家医院的医生和住院患者采取整群随机抽样法进行随机问卷调查。发现医患双方对医患关系性质、发展趋势及医患冲突的主要诱因、责任主体、主要解决途径的认识状况均存在显著性差异。这种差异直接影响医患关系发展。如何解决医患双方认知的差异是重构和谐医患关系的根本措施。     

人权视野中的医患关系转归

试图从人权的视角来审视医患关系,展示尊重和保障人权在医患关系中的重要作用:尊重和保障人权,医患关系将变得更为人性化、理性化、规范化,医患关系将走向法制化和全球化.旨在规范医患行为,为形成良好的医患关系,缓和医患矛盾和解决医患纠纷提供对策.     

医生执业特点引发的心理变化对医患关系的影响

近年来医患关系紧张成了一个社会热点问题.医生在执业过程中,可能受到一些内在心理因素的影响.通过对医生的执业特点及其引发的心理变化进行分析,包括工作压力、职业倦怠、风险、收入、伦理、信心等,试图寻找引起医患关系紧张的医生内在思想问题.通过这些问题的解决以期达到改善医患关系,增进卫生事业发展的目的.     

老年下背痛诊断的思考

医患关系是医务人员与患者在医疗过程中产生的特定医治关系,是医疗中人际关系的核心。近年来,我国的医患矛盾有激化趋势。以心理动力学方法来描述普通医患关系中医、患双方的心理互动过程,并对维系正常医患关系所需的医、患双方的心理学特征作出设想。     

重视医患沟通产生的功效--从成功诊治一例寄生虫病妄想患者说起

良好医患沟通直接影响到医疗活动的正常进行,有效的医患沟通是构建和谐医患关系必要的途径和手段。而医患沟通技能和医患沟通方法是实现良好医患沟通的基础。本文从诊断、治疗一种罕见的精神性疾病---寄生虫病妄想个案过程中,具体应用医患沟通听、说基本活动的技能,融洽与患者交流,构建良好医患关系,成功治愈这一寄生虫病妄想患者。阐明临床医生不仅仅需要仁爱之心、专业的医学知识,还需重视医患沟通,掌握医患沟通技巧。     

医患关系面临的课题:利益的冲突

我国当前医患间存在利益冲突的现实,并呈现出种种特点。医患间相互戒备的加深和防御性医疗的出现,不利于融洽和互动医患关系的形成,医院在引入市场某些机制和扩展自身财力时,应尽力维护中低收入者的医疗保健权利,损害病人的利益,同时坚持医学伦理学的四项原则,建立相互间的诚信,充分运用社会调节和医疗诉讼的杠杆,实行医务公开,有望调节和平衡这种利益冲突,使医患双方的利益得到合理的归缩。     

和谐医患关系建构中患者的道德责任

患者具有正常的理性自觉能力决定了其应当承担相应的道德责任。导致患者在医患关系中失责的原因在于患者的病人角色意识强化了患者无责的心理,制度设计中价值标准失衡导致患者的愿望错位以及媒体“妖魔化”医院和医生的形象加剧了患者的对医疗机构的不信任情绪。患者在和谐医惠关系建构中应当承担的道德责任主要有：提高认知水平,尊重医学技术发展规律和医护人员的劳动,宽容对待具体情境中的问题。     

Physicians, Patients, and Medical Dialogue in the NYPD Blue Prostate Cancer Story

Extending literature on health information to entertainment television, we analyze the prostate cancer narrative presented in the police drama, NYPD Blue. We explain how the physician-patient interaction depicted on the show followed (and sometimes did not follow) the medical dialogue model. Findings reveal that the producers of this show advocate a more dialogic model of medical interaction. Portrayals of incompetent, ineffective physicians are contrasted with the superior, effective efforts of other physicians. The audience learns that a non-dialogic approach characterizes "bad doctors," while the dialogic method typifies "good doctors." Likewise, medical professionals can use such texts to enhance physician-patient interaction.     

Doctors and patients: Partners or adversaries?

The author suggests that an inadequate understanding of the ethical relationship between doctors and patients is at the core of many current health care issues. The doctor-patient relationship is discussed with an emphasis on the expectations of patients and physicians. Three sets of expectations or models of doctor-patient interaction are reviewed and a number of health care issues are explored in this frame-work. It is hypothesized that when doctors and patients have similar expectations they will be partners and that when they differ, they are more likely to be adversaries. Finally it is suggested that unless national health policy is designed to take into account the effect of legislation on physicians' and patients' expectations, dissatisfaction with health care will continue to increase.     

<Emphasis Type="Italic">Recta Ratio Agibilium</Emphasis> in a medical context: the role of virtue in the physician-patient relationship

Acting for the good of the patient is the most fundamental and universally acknowledged principle of medical ethics. However, given the complexity of modern medicine as well as the moral fragmentation of contemporary society, determining the good is far from simple. In his philosophy of medicine, Edmund Pellegrino develops a conception of the good that is derived from the internal morality of medicine via the physician-patient relationship. It is through this healing relationship that rights, duties, and privileges are defined for both physicians and patients. Moreover, this relationship determines the characteristics or virtues that are necessary to engage in the medical telos. This paper addresses the role of the moral virtues in clinical medicine and the physician-patient relationship. First, it provides a brief background of the Aristotelian foundations of virtue-ethics. Second, it delves into Pellegrino’s philosophy of medicine understood as a practice oriented towards a teleological goal. Third, it relates the telos of medicine to the notion of the medical community as a fundamentally moral community. Finally, it concludes with a section that creates a dialogue between virtue ethics and principlism.     

浅论医患关系中的权利冲突——以医师的诊疗权与患者的知情同意权为例

现实中医患关系呈现给人们的似乎是永远纠缠不清的利益,掩盖了医惠之间模糊的、缺失的权利。实质上引发医患矛盾的主要原因不是利益而是权利的冲突,从医师的诊疗权与患者的知情同意权的角度出发,分析了医患关系中权利冲突的成因及其表现,提出了相关解决的方法。     

关于构建和谐医患关系的思考

扼要介绍了医患关系令人担忧的现状及医患纠纷的总体特点,深入探讨了造成医患关系紧张的深层次原因,并据此从主观意识、医患的对立统一关系、医务工作者、患者、舆论和法律氛围等角度提出了构建和谐医患关系的意见和主张,并着重就如何深化改革、促进政府职能的转变与到位展开了阐述。     

论医院伦理委员会的建设

医院伦理委员会作为维护医患关系之间权益公平的中介力量,把医学技术与人文关怀结合起来,在医患之间构筑起一种新型的关系,让患者得到细致入微的人本关怀。目前,我国在依法推进、规范医学伦理审查方面仍是空白,所以应尽快对医院伦理委员会的工作性质及作用做出明确的规定,以保障医疗工作更加安全。     

Voluntary Control of Behavior and Responsibility

Malpractice insurance rates have created a crisis in American medicine. Rates are rising and reimbursements are not keeping pace. In response, physicians in the states hardest hit by this crisis are feeling compelled to take political action, and the current action of choice seems to be physician strikes. While the malpractice insurance crisis is acknowledged to be severe, does it justify the extreme action of a physician walkout? Should physicians engage in this type of collective action, and what are the costs to patients and the profession when such action is taken? I will offer three related arguments against physician strikes that constitute a prima facie prohibition against such action: first, strikes are intended to cause harm to patients; second, strikes are an affront to the physician-patient relationship; and, third, strikes risk decreasing the public's respect for the medical profession. As with any prima facie obligation, there are justifying conditions that may override the moral prohibition, but I will argue that the current malpractice crisis does not rise to the level of such a justifying condition. While the malpractice crisis demands and justifies a political response on the part of the nation's physicians, strikes and slow-downs are not an ethically justified means to the legitimate end of controlling insurance costs.     

Physicians and strikes: can a walkout over the malpractice crisis be ethically justified?

Malpractice insurance rates have created a crisis in American medicine. Rates are rising and reimbursements are not keeping pace. In response, physicians in the states hardest hit by this crisis are feeling compelled to take political action, and the current action of choice seems to be physician strikes. While the malpractice insurance crisis is acknowledged to be severe, does it justify the extreme action of a physician walkout? Should physicians engage in this type of collective action, and what are the costs to patients and the profession when such action is taken? I will offer three related arguments against physician strikes that constitute a prima facie prohibition against such action: first, strikes are intended to cause harm to patients; second, strikes are an affront to the physician-patient relationship; and, third, strikes risk decreasing the public's respect for the medical profession. As with any prima facie obligation, there are justifying conditions that may override the moral prohibition, but I will argue that the current malpractice crisis does not rise to the level of such a justifying condition. While the malpractice crisis demands and justifies a political response on the part of the nation's physicians, strikes and slow-downs are not an ethically justified means to the legitimate end of controlling insurance costs.     

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。     

Impact of health beliefs, quality of life, and the physician-patient relationship on the treatment intentions of inflammatory bowel disease patients.

The research tested a model of treatment decision making in chronic illness that includes health beliefs, quality of life, and relationship with the physician (shared or not). Inflammatory bowel disease patients (N = 218) reported on their physician-patient relationship, general and disease-specific quality of life, and intentions to take a drug, for which perceived benefits and costs were manipulated. For more symptomatic patients, both costs and benefits predicted intentions; however, for less symptomatic patients, costs played a more important role. Physician recommendation predicted intention primarily among those who shared a decision-making relationship with their physician. Overall, the model accounted for 57.8% of the variance in medication-taking intention. Findings suggest that an integrative consideration of relationship factors, health beliefs, and health status may help explain treatment intentions among the chronically ill.     

临床医疗中知情同意的实践与思考

尊重患者的知情同意权是患者和社会对医方所提出的要求,也是医方应尽的法律和伦理义务。医方应充分尊重患者的自主性,积极、有效地履行注意和告知义务,以切实保障患者知情同意权的实现。它不仅体现了医疗工作对人及其权利的尊重,也会对提高医疗质量、改善医患关系起到极其重要的作用。     

手术同意书的相关法律问题

医患双方都非常重视手术同意书,从法理角度分析,手术同意书是患者知情同意权利和医方告知义务的体现;符合民事法律要件的合法有效的手术同意书,证明了医患之间告知与知情同意权的实现.对手术同意书的法律性质及法律效力进行探究,有助于维护医患双方的合法权利.     

创伤外科医患冲突原因分析及换位思考的应用

医患关系是医疗人际关系中的关键。当今医患关系不和谐的现象时有发生,创伤外科领域尤甚,医患双方缺乏相互之间的沟通、交流与理解、信任是导致不和谐的主要因素,当今社会因素和媒体的影响也在一定程度上激化了医患之间的矛盾。如果在矛盾发生时,医患双方能够进行适时的角色互换,诸多医疗纠纷将迎刃而解,医患关系也将更加和谐。