患者就医参与行为研究:维度、动机及其对策

通过调查研究患者就医参与行为的维度与动机, 为医疗机构提供患者管理对策建议。采用问卷调查266位患者。研究表明, 患者参与行为包括四个维度:患者参与患者安全行为、遵医配合行为、就医前信息搜集行为与医患互动交流行为。患者参与动机包括:增加对医疗服务过程和结果的心理控制感, 降低医疗风险, 保障医疗效果, 提升维权能力。建议医疗机构掌握患者就医参与特征并鼓励患者参与, 差别对待不同患者的参与能力与参与意愿, 关注患者参与行为对医方的双向影响。     

基于不对称信息的医患关系演化路径及对策研究

医患关系是医疗活动中最基本的关系,直接关系到患者感知下的公立医院公益性的实现,然而近年来医患矛盾频发,医患关系成为了人们关注的热点问题。根据医患之间信息不对称的特点以及医患双方策略行为相互作用的动态性特点构建了医患博弈模型,应用演化博弈思想分析医患双方策略选择的动态演化趋势和路径,并探析对这些演化趋势起重要影响作用的因素,最后提出医患关系改善的建议以期能对当前医患关系恶化的演化趋势起到及时干预的作用。     

鼻咽癌诊疗过程中医患共同决策的运用

鼻咽癌患者在选择治疗方案时,医生、患者、家属三方常面临较多分歧。讨论医患共同决策在鼻咽癌诊疗过程中的应用,并以三名不同分期的鼻咽癌典型病例为例,分析了主诊医生如何结合每位患者的年龄、性别、性格特征、经济现状、家庭状况等多种因素,通盘考虑并和患者及家属充分沟通后,制定个体化治疗方案。鼻咽癌的综合治疗,需要肿瘤内科、耳鼻咽喉-头颈外科、放疗科以及心身医学科等多学科医生的参与,医患共同决策的运用有利于制定出最适合可行的治疗方案。

     

认知不公正：认知维度下理解医患互动的视角

从认知不公正的理论视角出发对医患互动予以重新审视。研究发现,医患间的认知不公正不仅阻碍医患间证言知识的有效传递,凸显二者在认知预期与互动意愿上的差异,而且呈现出波动性、形态多样性和伤害间接性的特点,加速医患互动工具化的同时,加剧双方弥合信任的难度。尽管医患主动采取“理直气和”与“关系就医”的调适策略,但医患关系的改善以及认知不公正的消除不仅是医疗领域内医患双方的合作问题,还需要从更广泛的社会维度出发,迈向扩大的医患共同体。

     

人工智能辅助决策如何影响医患信任？——以技术不确定性为中心的考察

明确的惩罚机制、清晰的风险受益比、积极的信任倾向是建立医患信任所必要的确定性依据。人工智能辅助决策因为技术本身不确定、技术认知不确定、技术制度不确定等,冲击着医患信任的确定性基础,加剧医患信任危机。为降低辅助决策的不确定性,在新的技术条件下增进医患之间互相信任,应针对技术本身的不确定,增强辅助决策的可解释性;针对技术认知的不确定,推动辅助决策的民主化设计;针对技术制度的不确定,渐次推进伦理结构化。

     

医疗剧之于医患沟通

医疗剧作为一种大众传播媒介,容易被社会群体所接受,具有不可替代的社会职能。近年来我国医疗剧客观地呈现了医患关系现状及存在的问题,医疗剧的热播引起了社会关于医患关系的热议。医患沟通是良好医患关系的重要因素,中外医疗剧用艺术的方式架起了医院和社会沟通的桥梁。从医疗剧在医患沟通中所承担的社会责任来剖析医患之间的误解,探讨医疗剧在医患沟通中的意义,真实促进医患了解,真诚促成医患理解,沟通促成医患和解。     

Advocating Worker Justice

Catholic moral theology possesses a number of tools that can be employed to promote worker justice. Some of these tools, such as Catholic social teaching on solidarity and workers’ rights, have been used to this end before. However, advocates of workers’ rights have seldom utilized other concepts, such as cooperation in evil, scandal, and evangelization. This essay provides a theoretical introduction to several tools in the “toolkit” of Catholic ethicists, engaging contemporary scholarship on them. It then applies the concepts to two cases in order to demonstrate their usefulness in the struggle for worker justice. Both cases involve Catholic universities, which means the ethical concepts introduced from the Catholic moral tradition should have normative status for these institutions. The first case entails a divestment campaign at the University of Notre Dame. The second case confronts the unjust treatment of adjunct faculty members at Catholic colleges and universities.     

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.     

Commitment and self-control in a prisoner's dilemma game

Humans often make seemingly irrational choices in situations of conflict between a particular smaller-sooner reinforcer and a more abstract, temporally extended, but larger reinforcer. In two experiments, the extent to which the availability of commitment responses-self-imposed restrictions on future choices-might improve self-control in such situations was investigated. Participants played a prisoner's dilemma game against a computer that played a tit-for-tat strategy-cooperating after a participant cooperated, defecting after a participant defected. Defecting produced a small-immediate reinforcer (consisting of points convertible to gift cards) whereas cooperating increased the amount of subsequent reinforcers, yielding a greater overall reinforcer rate. Participants were normally free to cooperate or defect on each trial. Additionally, they could choose to make a commitment response that forced their choice for the ensuing five trials. For some participants, the commitment response forced cooperation; for others, it forced defection. Most participants, with either commitment response available, chose to commit repeatedly despite a minor point loss for doing so. After extended exposure to these contingencies, the commit-to-cooperate group cooperated significantly more than a control group (with no commitment available). The commit-to-defect group cooperated significantly less than the control group. When both commitment alternatives were simultaneously available-one for cooperation and one for defection-cooperation commitment was strongly preferred. In Experiment 2, the commitment alternative was removed at the end of the session; gains in cooperation, relative to the control group, were not sustained in the absence of the self-imposed behavioral scaffold.     

Making IBM's Computer, Watson, Human

This essay uses the recent victory of an IBM computer (Watson) in the TV game, Jeopardy, to speculate on the abilities Watson would need, in addition to those it has, to be human. The essay's basic premise is that to be human is to behave as humans behave and to function in society as humans function. Alternatives to this premise are considered and rejected. The viewpoint of the essay is that of teleological behaviorism. Mental states are defined as temporally extended patterns of overt behavior. From this viewpoint (although Watson does not currently have them), essential human attributes such as consciousness, the ability to love, to feel pain, to sense, to perceive, and to imagine may all be possessed by a computer. Most crucially, a computer may possess self-control and may act altruistically. However, the computer's appearance, its ability to make specific movements, its possession of particular internal structures (e.g., whether those structures are organic or inorganic), and the presence of any nonmaterial "self," are all incidental to its humanity.