临床医师对医学人文认知的社会学分析——大连医科大学、哈尔滨医科大学、南京医科大学、河北医科大学、重庆医科大学联合调查之二

调查了1 836名在职医师对医学人文的认知情况,以从业时间、学历、职称和科室为分析变量,从对医学人文理念核心思想的认知、对当前临床实践人文水平的认知、对医学人文理念在医疗实践中体现方式的认知、对临床实践人文水平不高(或不理想)原因的认知、对临床诊疗技术应用与服务中的医学人文实践的认知、对医院管理中的医学人文实践的认知、对医学生的医学人文教学存在问题的认知等方面,对不同从业时间、不同学历、不同职称和不同科室医师的医学人文认知情况进行社会学分析.     

临床医师医学人文认知情况的问卷分析——大连医科大学、哈尔滨医科大学、南京医科大学、河北医科大学、重庆医科大学联合调查之一

调查5个城市24所附属或教学医院的1 836名在职医师对医学人文的认知情况,结果表明,从总体来看,医学人文的问题已经开始引起医师们的重视,医师对医学人文的诸多问题有相当清楚的认识,医生们认为医学人文的核心思想是关爱、敬畏、呵护生命;实现医疗人性化的目标,更为重要的是临床诊疗实践中的人性化;在医院管理中落实医疗人性化,最主要的是优化行政管理,为医师们减轻压力;医学人文教育存在的最主要问题是医学人文教育与临床实践脱节;等等.     

重视医疗缺陷研究全面提高服务质量

随着医疗卫生事业体制改革的不断深入,全面提高服务质量成为医疗市场竞争的一种手段.结合工作实际,分析引发医疗纠纷的各种原因和因素,提出重视每一例投诉,发现问题及时解决的几点措施.通过重视医疗缺陷研究,对症下药,持续改进,逐渐达到全方位的"零缺陷"服务.     

过度医疗、适度医疗与诊疗最优化

过度医疗与过度服务有所不同.适度医疗应当是为患有某种疾病的病人提供有效、安全、便捷、耗费少的医疗服务.最优化的医疗是一种包括以优质的医疗服务实现了最佳疗效、最安全、痛苦最少、最便捷和费用低的医疗.一般地说,最优化的医疗首先应当是适度的医疗.最优化的医疗比适度医疗有更高的要求.不宜用优质医疗取代适度医疗,也不宜将适度医疗改称为最优化医疗.我们可以将适度医疗作为保健服务的基本要求,而将最优化医疗作为努力目标,一种理想化的目标.在满足人民的基本医疗、实行基本医疗保险过程中,我们更应当提倡适度医疗.     

Medical science, culture, and truth

There is a fairly closed circle between culture, language, meaning, and truth such that the world of a given culture is a world understood in terms of the meanings produced in that culture. Medicine is, in fact, a subculture of a powerful type and has its own language and understanding of the range of illnesses that affect human beings. So how does medicine get at the truth of people and their ills in such a way as to escape its own limited constructions? There is a way out of the closed circle implicit in the idea of a praxis and the engagement with reality that is central to it and the further possibility introduced by Jacques Lacan that signification is never comprehensive in relation to the subject's encounter with the real. I will explore both of these so as to develop a conception of truth that is apt for the knowledge that arises in the clinic.     

Medical disorder,harm, and damage

Theoretical Medicine and Bioethics - Jerome Wakefield’s harmful dysfunction analysis (HDA) of medical disorder is an influential hybrid of naturalist and normative theories. In order to...     

Medical Paradigm: Construction,Deconstruction, Reconstruction

Theoretical Medicine and Bioethics -     

医疗风险、责任与对策

医疗风险是医疗实践中客观存在的一种具有不确定性、损害性事件,对患者、医院和医学的发展有着不利的影响。医疗风险的存在有着复杂的原因,因此,对医疗风险管理与防范也应该采取包括提高医疗技术水平、加强风险教育、实行医疗责任保险等多种手段。     

正确认识医疗诉讼的举证责任倒置、规范医务人员的医疗行为

针对就如何正确理解医疗诉讼举证责任倒置的规定,举证责任倒置给我国医疗卫生界带来挑战,以及如何适应举证责任倒置规定等问题进行了论述,提出了提高医务人员法律素质,依法行医,防范医疗纠纷的办法。     

Governmentality, Critical Scholarship, and the Medical Humanities

Foucault's work has had a profound impact on the medical humanities over the last decade or so. However, most work to date has focused on Foucault's earlier writings rather than his later contributions on the self and governmentality. This article assesses the significance of the concept of governmentality for critical scholarship in the medical humanities, particularly in creating ethical awareness in the field of health care. It examines the context for Foucault's later work, and contributions arising from scholarship building on this work. The governmentality literature, it is argued, raises novel questions about the ways we have come to think about health care in late modern societies. However, there are some limitations with this body of work which have not been fully acknowledged by scholars. The article discusses some of these limitations and offers some suggestions for a fruitful way forward.     

外科患者安全、医疗缺陷和并发症

在医疗工作中,由于客观存在的各种医疗缺陷、过失,甚至错误,会引起各种并发症,影响着患者安全。在以往常注意到了医疗工作中所发生的各种并发症的结果,但是没有或较少重视发生这些并发症的过程,以及在此过程存在的缺陷。在外科领域中,应注意可能发生外科并发症的环节和过程,尽量避免医疗缺陷,同时还要注意开展新技术,减少因技术能力不足带来的伤害;减少侵害性医疗干预。     

Medical malpractice, mistake prevention, and compensation.

Clinicians' fear of malpractice litigation is the most significant obstacle to the open reporting of medical mistakes. Without open reporting of medical mistakes, however, root cause analysis of mistakes cannot be done, thus undermining efforts to implement safeguards to minimize the occurrence of future mistakes. Efforts to prevent medical mistakes, therefore, must first directly address clinicians' fear of malpractice litigation. In this paper, we explore the relationship between the current malpractice system and clinicians' fear of litigation. Ultimately, we argue that both the prevention of medical mistakes and the goals of malpractice litigation itself will be better served if substantial malpractice reform is undertaken.     

外科患者安全、医疗缺陷和并发症

在医疗工作中,由于客观存在的各种医疗缺陷、过失,甚至错误,会引起各种并发症,影响着患者安全.在以往常注意到了医疗工作中所发生的各种并发症的结果,但是没有或较少重视发生这些并发症的过程,以及在此过程存在的缺陷.在外科领域中,应注意可能发生外科并发症的环节和过程,尽量避免医疗缺陷,同时还要注意开展新技术,减少因技术能力不足带来的伤害;减少侵害性医疗干预.     

倡导医学整合加强疾病防控

医学的专科发展给医学带来了飞速的发展,但随着社会的进步,这种医学已难以适应社会的需要,其弊端逐渐显露出来.由此,对于医学整合的呼声越来越高.临床科室的整合是医学整合的重要组成部分,医疗中心的建立对于方便患者、减轻患者的经济负担、为患者提供最优化的诊疗服务等均起到极大的作用,其优势已逐渐显现.     

The Hippocratic Oath,Medical Power,and Physician Virtue

Philosophia - In this paper, I supplement T. A. Cavanaugh’s arguments against physician-assisted suicide in his book, Hippocrates’ Oath and Asclepius’ Snake, by focusing more...     

Medical problems,maladaptive behaviors,and the developmentally disabled

Research has shown that aberrant behaviors of people with developmental disabilities have multiple determinants; of these, medical problems and their potential relations to aberrant behaviors, have been, for the most part, not studied. This retrospective study examined the relations of 26 acute medical treatements to the aberrant behaviors of 10 elderly people with developmental disabilities. Results showed that 73.1% of the aberrant behaviors decreased in frequency after medical treatments. The study suggests the importance of acute medical problems and treatments as possible factors in the occurrence of aberrant behaviors in this population.