Medical hermeneutics: Where is the “text” we are interpreting?

The present paper is a commentary on an article by Drew Leder [1]. Leder identifies a series of texts in the clinical encounter, emphasizes the central role of interpretation in making sense of each of these texts, and articulates ordering principles to guide the interpretive work.The metaphor of clinical work as textual explication, however, creates the expectation that there is a text somewhere to be found. Such an expectation invites doctors and patients to search for the text and runs the risk of conceptualizing patients as more static than they are. If one is to use the textual metaphor, one must appreciate the radical extent to which the clinical encounter is a mutually produced and shifting entity. The qualities of mutuality and indeterminacy are not those one usually associates with texts. One might ultimately be better served by a different metaphor based more directly on uncertainty.     

Peer review: Selecting the best science

The major challenge facing today’s biomedical researchers is the increasing competition for available funds. The competitive review process, through which the National Institutes of Health (NIH) awards grants, is built upon review by a committee of expert scientists. The NIH is firmly committed to ensuring that its peer review system is fair and objective. Wendy Baldwin, Ph.D., is Deputy Director for Extramural Research, National Institutes of Health. This paper is based on a presentation at a workshop, “Advances in Peer Review Research”, American Association for the Advancement of Science Meeting, Baltimore, MD, February 9, 1996.     

Competing interests: The need to control conflict of interests in biomedical research

Individual and institutional conflict of interests in biomedical research have becomes matters of increasing concern in recent years. In the United States, the growth in relationships — sponsored research agreements, consultancies, memberships on boards, licensing agreements, and equity ownership — between for-profit corporations and research universities and their scientists has made the problem of conflicts, particularly financial conflicts, more acute. Conflicts can interfere with or compromise important principles and obligations of researchers and their institutions, e.g., adherence to accepted research norms, duty of care to patients, and open exchange of information. Disclosure is a key component of a successful conflict policy. Commitments which conflict with a faculty member's primary obligations to teaching, research, administrative responsibilities, or patient care also need attention. Institutional conflict of interests present different problems, some of which are discussed in an analysis of an actual problem posed by two proposed clinical trials. This paper is adapted from a lecture presented to a Symposium on Scientific Integrity, Warsaw, Poland, 23 November 1995. Daniel Steiner was Vice-President and General Counsel of Harvard University (1972–92) and in that capacity became familiar with conflict of interest issues. He is currently Counsel to the Boston law firm. Ropes and Gray, and is Adjunct Lecturer in Public Policy at the John F. Kennedy School of Government. Harvard University.     

麻醉科医患沟通现状及认知分析一一我国45家医院联合调查报告——

2017年8月1日~9月30日,在全国45家医院进行了电子问卷调查,旨在从医方角度调研麻醉科医患关系的现状。结果显示在导致医患沟通不畅的原因中除客观因素(病情复杂及疗效不确定)之外,麻醉科医务人员对患者防备心理过重位列首位(37.8%),其次为沟通时间不够(33.4%)、沟通意识缺乏(29.2%)以及沟通能力不足(28.3%),由此可见如今麻醉科医患沟通问题比较突出。建议麻醉科医生通过转变医疗观念,强化沟通意识;掌握语言工具,提高沟通技能;积极向患者科普麻醉学科的进展和局限等综合措施,逐渐改善麻醉科医患沟通现状。

     

德国医学院医学交流能力培养模式探究

德国政府和高校对医学生医学交流技能的培养非常重视,由德国联邦卫生部医学交流纵向示范课程项目开发的医学交流纵向示范课,为德国各大高校医学院医学交流课程的构建和实施提供上层指导。以德国几所知名高校医学院为例,分别对医学交流课程内容设置、教学方式、师资团队构建、课程测试和评估等方面进行阐述,剖析德国医学交流课程体系特点：基于临床案例的教学素材、主题模块的课程形式、丰富的教学方式、专业的教学团队等,德国医学交流课程标准一致,课程体系完善,为我国医学交流课程完善和改革提供参考。

     

叙事医学本土化的若干思考

叙事医学为人文社会学科介入医学范畴提供了建构性方案,使技术至上的医疗实践逐渐转向重视患者个体的生活价值、痛苦关怀的人文实践,对于医患主体间的鸿沟消弭、理解改善具有独到之处。然而,在中国式现代化的路径视角下,依然需要对西方语境中的叙事医学方法论进行审慎反思,尤其是要考虑国别体制下的文化差异与社会现实,避免造成简单化搬运与应用。在扎根中国本土情境的基础上,探索适应我国的医疗卫生实践、构建和谐医患环境的叙事医学模式。

     

患者的诊治期望值与医患矛盾的关系研究

从患者视角来探索医患矛盾发生的原因,寻找一种有效的医患沟通方法。研究认为医患矛盾的核心问题是患者对诊治期望值的不满意,通过构建以患者诊治期望值为主体的医患沟通方法,发现医生和患者之间对诊治期望值存在明显差异。医生通过对医患之间存在的差异性诊治期望值进行充分沟通,形成医患诊治期望值差异下的共识,建立互信合作的关系,最终实现医患互惠共赢。以患者诊治期望值为主体的医患沟通方法,为避免医患矛盾发生,促进和谐医患关系提供一种新的思路。

     

医患关系内涵及模式:基于社会交换理论的研究

梳理了国外医患关系的相关文献,基于社会交换理论视角探析医患关系的内涵,深入剖析了医疗质量和患者信任是构成医患关系的两个重要因子,并进一步构建了简约化的四类医患关系模式,即和谐医患关系模式、改善医患关系模式、不善医患关系模式和紧张医患关系模式。认为医患关系的建立是一个动态的过程,在诊疗过程中医患关系模式之间是可以相互转换的,患者信任是构建和谐医患关系的基础,为我国和谐医患关系的建立进行了理论上的探索。     

父母冲突频率与青少年生活满意度的关系：青少年行为反应的中介作用

父母冲突与青少年的身心健康息息相关。本研究以366名青少年为被试,采用问卷调查法研究父母冲突频率与青少年生活满意度间的关系,以及父母冲突时青少年行为反应在其中的中介作用。结果表明：（1）父母冲突频率显著负向预测青少年生活满意度;（2）青少年的介入行为与生活满意度呈显著正相关,回避行为则与生活满意度呈显著负相关;（3）在主张–回避的父母冲突场景中,青少年的回避行为在父母冲突频率与生活满意度间起到部分中介作用,中介效应占总效应的22.90%。     

Group problem-solving among teachers: A case study of how to improve a colleague’s teaching

A case study of six teachers cooperating to improve a teacher’s teaching showed the dynamics of the group problem-solving process. An analysis of their verbal interactions showed the importance of shared understanding to successful group problem solving. The cooperative group structure helped members resolve cognitive conflicts and build group understanding. During this process, the members’ past teaching experiences and knowledge contributed to their conceptualization of the teacher’s teaching problems and their proposed solutions to improve the teacher’s teaching. Tsz Cheung Lam graduated from the Department of Educational Psychology at the Chinese University of Hong Kong in 2004 and obtained his Master of Education degree. His research interests lie primarily on cooperative learning and problem solving. As a primary school teacher in practice, he is now studying part-time for another master degree in data science at the Department of Statistics of the Chinese University of Hong Kong.