医患关系不和谐的原因

由于政府监管部门的缺位与越位导致医疗市场混乱,医疗资源配置不合理与效率低下,医院为了自身利益而鼓励医务人员多收费,医务人员成了给钱治病的经济人,再加上舆论的推波助澜,社会保障体系不健全,以及医疗需求的刚性,医患间的信息不对称,患者对医疗预期值超越了当今的科技水平,导致医患矛盾越演越烈。     

防范医疗纠纷的载体建设——天津市人民医院投诉中心的绩效浅析

利用现代医学伦理的人本理念,将投诉中心作为防范医疗纠纷的载体,有效地解决就医者的投诉接待和处理,无疑是一种全新的理念和尝试。通过对投诉制度建设、投诉处理标准化流程、有效投诉信息的利用等方面的经验性论述,阐明了投诉中心的载体建设,为减少医疗纠纷、加强伦理道德建设、构建和谐的医患关系产生了积极的作用。     

A National Survey of Genetic Counselors’ Personal Values

Personal values are motivational sources for an individual’s actions [Hitlin and Piliavin (Annual Review of Sociology 30:359–393, 2004)]. Genetic counselors’ values may influence their behaviors in clinical practice, but a profile of their personal values has not been identified empirically. In this study, 292 genetic counselors completed the Schwartz Universal Values Questionnaire (SUVQ; Schwartz, S. H. (1992). Universals in the content and structure of values: Theoretical advances and empirical tests in 20 countries. In M. Zanna (Ed.), Advances in experimental social psychology (pp. 1–65). Boston, MA: Academic.), a widely used measure of value types, and provided information about their demographic characteristics. Results indicate that respondents highly valued benevolence, self-direction, achievement, and universalism indicating a strong pattern of concern for the welfare of others. They placed considerably less value on stimulation, tradition, and power, which reflect personal interests. Respondents who reported practicing a religion scored significantly lower on stimulation and hedonism and higher on tradition and spirituality than those not practicing; married respondents and parents scored significantly lower on stimulation and achievement; and males scored higher on power than females. The value types are described, and training and research recommendations are provided.     

Intervenir en clinique de l’activité sur la qualité du travail dans l’organisation. Le cas du service de propreté d’une grande collectivité

This article aims to inform the intervention process and the institution of conflictuality around the criteria on quality of work in an Activity Clinic perspective. From the example of a recent intervention in sanitary service of a big city, this article instructs this process when the conflictuality around the criteria of quality of work can be instituted in the organization. When field professionals can do more authority on their activity in the organization, we then witness in action a modification of their role in decision process, regarding their own work. The article concludes with the contribution of the results produced to current reflections on the union work actuality.     

Examining Relationships Between Physicians and Their Patients: A Psychoanalytic Model

This is a study of a group of physicians' reflections about their communication with patients. Using an applied psychoanalytic framework for self-inquiry in groups, the authors summarize their findings and provide a model for others to use. They describe their method of conducting and studying three physician groups. The authors identify six essential dynamics within groups and illustrate the dynamics with examples of physician reflections. They summarize further their observations about the composition, dominant themes, and phases of development for each group. The intent of the self-inquiry groups—to clarify physicians' habits and thought patterns about patients—is upheld in the report's conclusion, in which the authors report participants' evaluation of their learning experience. Recommendations are made for analysts to apply the model in work with general physicians.     

The dark and the bright sides of proactive work behaviour and situational constraints: Longitudinal relationships with task conflicts

We investigated relationships of a job stressor (situational constraints) and specific proactive behaviours with change in task conflicts over time. We introduced two distinct types of proactive work behaviour (promotion-oriented initiative and prevention-oriented initiative) and examined their positive but also negative relationships with change in task conflicts. Study 1 supported the construct validity of promotion-oriented initiative and prevention-oriented initiative for 363 student assistants: Confirmatory factor analyses indicated that both types of proactive behaviour were distinct constructs and also distinct from active coping; patterns of correlations were similar to those of a prior concept of proactive behaviour. Study 2 was a longitudinal online survey with 197 employees over 3 weeks. Consistent with our hypotheses, situational constraints and promotion-oriented initiative predicted an increase in task conflicts, whereas prevention-oriented initiative predicted a decrease in task conflicts.     

Children's behavioural reactions to marital conflict as a function of parents' conflict behaviours and alcohol problems

This paper examines how children's previous exposure to destructive marital conflict and parental problem drinking relate to children's immediate and specific behavioural reactions to marital conflict. Data are from 215 second-graders and their families participating in a larger study. Children watched analogues of marital conflict and indicated their behavioural response. Parents completed questionnaire measures of marital conflict and drinking problems. Children's exposure to marital stonewalling was associated with increased child intervention in conflict and decreased avoidance of conflict. Exposure to maternal drinking was related to child caretaking responses to escalated conflict. Exposure to paternal drinking was related to child mediation and avoidance of child-related conflict, but inactive response to escalated conflict. Boys were more likely to mediate and less likely to avoid escalated conflict.     

内科实习医生医患沟通经历的调查分析

实习医生在医院里扮演着特殊角色,既要作为学生在临床实践中学习医学知识,又要作为医生在患者面前从事医疗工作。因此,培养医学生医患沟通能力,引导其建立和谐的医患关系,成为临床带教老师面临的一项严峻而又刻不容缓的任务。本研究针对内科实习医生在医院沟通中的典型案例进行了调查,从而了解实习医生在医患沟通中的经历,以及他们对原因的分析、处理方法及对自身的影响,进而了解实习医生对沟通技能培训的需求。     

集体自恋：群际冲突的催化剂

集体自恋是将自恋延伸到群体水平的一个经典构念, 目前被界定为对于“自身所属群体是卓越的并值得优待, 却未充分被他者承认”的信念。现有研究发现它对群际敌对性有较强解释力, 因为集体自恋者对内群体形象、地位或身份所受威胁高度敏感, 容易高估威胁和怀疑外群体, 而缺乏自我价值感及控制感是集体自恋的重要根源。鉴于现有研究一般都预设了集体自恋的脆弱性和消极性, 而集体自恋的属性不必然如此, 未来研究应在充分厘清集体自恋内涵及结构的基础上探索其消极与积极后效, 揭示其多元成因及干预方法, 并推进跨文化研究。     

Yielding behavior and traffic conflicts at cyclist crossing facilities on channelized right-turn lanes

Channelized right-turn lanes (CRTLs) improve traffic flow efficiency, enabling right-turning drivers to bypass traffic lights at signalised intersections (for right-hand drive countries). Many CRTLs provide crossing facilities for pedestrians and cyclists. Previous studies examining the safety performance of CRTLs indicate that they increase overall safety levels but hint that safety issues regarding vulnerable road users exist. This study investigated these issues through site-based observations of yielding behavior and evaluated the effect of the priority rule on cyclists’ safety in two CRTL designs. Four locations in Belgium were selected for video observations: two where the priority rule favoured cyclists and two where motorists had priority.With regard to yielding, four types of crossing behavior were identified and defined. Independent of the priority rule, cyclists crossed the conflict zone first in most interactions without taking the initiative to cross first. Underlying reasons for motorists willingly giving away their right-of-way could not be determined, but possible courtesy or fear of inflicting injuries at vulnerable road users might be at hand. A safety evaluation was performed using two traffic conflict indicators (TTC_min and the TA value). High correlations between the two indicators were found (r² > 0.83), but no conclusions about the safest priority rule for cyclists could be drawn. The results hinted, however, that locations with motorist priority and cyclists crossings from right to left (from the driver’s point of view) yields the highest proportion of safety critical events.