The doctor-patient relationship ismedical staffAndpatientThe specific medical relationship generated in the medical process ismedical careInterpersonalcrux。The famous medical historian Siglis once said: "Every medical action always involves two types of parties: doctors and patients, or more generally, medical groups andSociology，Medical ScienceIt is nothing more than the multifaceted relationship between these two groups of people.
This passage brilliantly clarifies that the most essential connotation of the whole medicine is the relationship between doctors and patients.modern medicineThe high level of development of the "doctor" has expanded this concept. The "doctor" has expanded from a simple medical staff to all institutions and personnel involved in medical activities;The "patient side" has also expanded from a simple patient to every kind of social relationship related to the patient.
The doctor-patient relationship is formed objectively in medical service activities and is closely related to the interests of both doctors and patientssocial groups And the interaction between individuals."Medical staff" refers to a group of medical staff including doctors, nurses, drug inspection and management personnel, and "patient" refers to a group including patients or their relatives, guardians who have direct or indirect contact, and their work departments and units.
Since 2000, doctor-patient disputes have occurred frequently.
In February 2001, the relatives of patients in Guangshui, Hubei Province, took the ambulance and medical staff of Union Medical College Hospital who sent them home as hostages and demanded 300000 yuan in compensation.
On September 4, 2003, in the Second Hospital of Chengdu City, Sichuan Province, the pregnant nurse was beaten by the family members of patients in the cadre ward, resulting in miscarriage, and her husband was also beaten and may be disabled. Thousands of people signed their names to demand that the murderer be severely punished.
On July 10, 2009, Chenxi County Hospital of Traditional Chinese Medicine in Hunan Province, more than 100 medical workers occupied the outpatient hall of the hospital, blocked and smashed the hospital.
According to the professional exchange website of Chinese medical professionals“Clove garden”According to incomplete statistics, in 2011 alone, there were 10 cases of medical staff being hacked and killed. In August 2011, a patient in Dongguan Chang'an Hospital killed a doctor with a kitchen knife because of the unsatisfactory treatment effect.
On March 23, 2012, a man rushed into the office of a doctor in the Department of Immunology of the First Affiliated Hospital of Harbin Medical University and committed an attack, killing one medical staff and injuring three.Not long ago, a dynamic picture of a nurse slapping a baby's face again focused the focus of society on the doctor-patient relationship.
At about 9:00 a.m. on July 19, 2016, a nurse in Nanjing Children's Hospital was carrying out intravenous puncture for a 3-year-old child. Because the child was crying and uncooperative, the first puncture was unsuccessful. When the nurse was preparing for the second puncture, she waited for the mother of the child who was outside to rush into the treatment room and hit the nurse's forehead directly with an iPad, causing a wound up to 2cm deep and periosteum.[1]
At about 10:00 a.m. on November 22, 2016,Shanxi Changzhi Medical CollegeA case of violent injury occurred in the affiliated Peace Hospital.A doctor from the Infectious Diseases Department was attacked by a man with a knife on the way to the hospital consultation. The victim suffered nine stab wounds, one of which punctured the heart, leading to heart rupture and cardiac tamponade.[2]
Basic mode
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There are three basic models of technical doctor-patient relationship.
1. Active and passive: Physicians are completely active and patients are completely passive;The authority of doctors is not doubted, and patients will not raise any objection.
2. Guidance and cooperation:Both doctors and patients have initiative.Doctors' opinions are respected, but patients can have questions and seek explanations.
3. Joint participation:Physicians and patients share the same initiative and participate in medical decisions and implementation.The doctor's opinion at this time often involves the adjustment of the patient's living habits, ways and interpersonal relationships. The patient's cooperation and self completion of treatment are particularly important.
importance
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The technical doctor-patient relationship is based on the patients' diagnosis and treatment interests in the medical process, and plays an important role in the medical effect.
follow a principle
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In order to establish a good doctor-patient relationship, doctors should follow the following principles:
doctor-patient relationship
① Believe that doctors and patients can establish a relationship of mutual trust, and patients can communicate;
② Do not judge patients' values and life attitudes based on doctors' own value orientation, and respect patients' personality, beliefs and culture;
③ Starting from the physiological psychological social medical model, fully understand the patient's disease behavior and emotional response;
④ In the process of diagnosis and treatment, provide practical medical help to patients with a humanistic attitude;
⑤ Understand that the doctor-patient relationship is a dynamic relationship, and doctors should make timely adjustments according to the situation;
⑥ The doctor-patient relationship is formed around the diagnosis and treatment of diseases, and should only be limited to the process of seeking medical care and providing medical assistance. It cannot develop any interpersonal relationship beyond this scope.
stayPsychiatry DepartmentIt is particularly important to establish a good doctor-patient relationship.Due to the lack of reliable objective diagnostic indicators, the determination of clinical diagnosis in psychiatry largely depends on complete and true medical history and comprehensive and effective mental examination, from which valuable information can be obtained.Some patients with mental disorders lack sufficient insight into their mental status, and they reject or even refuse psychiatric treatment.The trust and supportive doctor-patient relationship helps patients enter and maintain in the treatment process.Establishing a close and cooperative relationship with the patient's family will also help to form a broad treatment alliance and improve treatment compliance.Almost all mental disorders will damage the interpersonal relationship of patients and cause difficulties in interpersonal communication. Good doctor-patient relationship can provide a good learning model for patients, so that patients can learn the general principles of interpersonal communication, learn to communicate with others, and develop a sense of trust in their interactions with doctors.Therefore, a good doctor-patient relationship is also a therapeutic relationship.
Mental disorders are characterized by impairment of mental function and abnormal behavior, resulting in mental pain and decline of social function.Due to the lack of laboratory examination means to make qualitative or quantitative assessment of brain structure and function abnormalities that cause mental disorders, psychiatrists become indirect receivers of patients' mental pain and direct observers of behavior abnormalities.It can be said that psychiatrists themselves are the most reliable diagnostic tool and the most effective treatment tool;Its diagnostic and therapeutic effects are realized by establishing a good doctor-patient relationship.
concept
The doctor-patient relationship refers to the relationship between "doctor" and "patient"."Medicine" includes medical institutions and medical personnel;"Patient" includes the patient, the patient's family members and the patient'sguardian(Sometimes called "patient side").
"Medicine" here mainly refers to medical units and their medical workers.It not only includes hospitals at all levels, township hospitals, sanatoriums and outpatient departments, but also various clinics, health centers, medical clinics, etc.Medical workers are also a broad overview.It mainly refers to doctors at all levels and in all departments. It is caused by factors such as doctors' service attitude, medical skill level, and sense of responsibilityMedical disputesMost common.Secondly, nurses are often involved in medical disputes. They are responsible for the specific operation and nursing work of treatment. If they are careless, misoperation, and absent without leave, they are also likely to lead to medical disputes.In addition, the management personnel of medical units sometimes become the "troublemakers" of medical disputes. The common problem is that the management work fails to fulfill its responsibilities, which makes the medical links out of gear and causes damage to patients;Or the leader of the medical unit gave a blind command and forced the attending doctor to use or not to use certain drugs and diagnosis and treatment measures, resulting in undesirable harmful consequences.
The "patient" here refers to the patient receiving diagnosis and treatment.If the diagnosis, treatment and nursing process did not lead to the death of the patient, the patient must apply for the settlement of the medical dispute.Of course, according to the law, patients can entrust their families, relatives, friends, lawyers and others as agents to solve medical disputes in the name of patients.If the patient dies in the process of diagnosis, treatment and nursing, his stakeholders can replace the patient and become the subject of medical disputes.The spouse, children and parents of the deceased can all become stakeholders.
essence
The essence of doctor-patient relationship is“Community of interests”。Because "medicine" and "patient" not only have the common goal of "conquering the disease and recovering as soon as possible", but also rely on both doctors' superb medical skills and patients' confidence and active cooperation to overcome the disease.It is the common responsibility of both doctors and patients to fight against diseases. Only through the joint cooperation and active treatment of both doctors and patients can better therapeutic effects be achieved.Both doctors and patients are in a key position in the process of resisting and treating diseases. The desire of patients to recover should be realized through the doctors. The doctors also deepen their understanding and understanding of medical science in the process of diagnosing and treating diseases, and improve their diagnosis and treatment skills.In the face of disease, doctors and patients are allies and the united front. They should encourage each other to fight against disease together.
To maintain the good relationship between doctors and patients, which is a community of interests, requires the joint efforts of both doctors and patients.An interesting folklore can be used as a footnote.Medicine King of Tang DynastySun SimiaoWhen I went out to collect herbs, I met a female tiger who opened her mouth and blocked the way. The attendants thought that the tiger was going to bite people and fled. Sun Simiao saw that the tiger had an unspeakable disease.It turned out that the female tiger was stuck in her throat by a long bone and came to block the way for medical treatment.Sun Simiao took out the foreign body for him, and the tiger left happily.A few days later, Sun Simiao passed here on the way back, and the tiger and its cub waited by the roadside to greet him.This story explains at least two reasons: First, even if a man eating tiger is ill, doctors should treat it with benevolence and righteousness, not to mention the sick people;Second, even the man eating tiger is grateful to the doctor who has relieved its pain and responds politely.In a sense, mutual respect, cooperation and interdependence are the most basic characteristics of doctor-patient relationship.
reason
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Lack of good relationship between doctors and patientscommunicate。Most medical staff and patients believe that the communication between doctors and patients is generally or basically no communication.This, to some extent, indicates that there is a lack of basic trust between doctors and patients, and that medical staff have not fulfilled their obligations of informing and caring, which can be attributed to both sidesTrustThe main reasons for the decrease.Both patients and medical staff believe that the doctor-patient relationship is not harmonious.
1、 China's current medical security system and related laws and regulations have not kept up with the pace of the market economy in time.The government's investment in hospitals is seriously insufficient, and the system of hospitals assuming sole responsibility for their own profits and losses has prompted patients to bear excessive costs for diagnosis and treatment.At the same time, the problem of social polarization between rich and poor and the intensification of contradictions has been intensified in the process of costly diagnosis and treatment.
2、 The lack of communication between doctors and patients and the increase of medical disputes are important factors in the disharmonious relationship between doctors and patients.Grass roots medical resources are insufficient, the level is insufficient, and the phenomenon of misdiagnosis often occurs, which makes patients focus on the tertiary hospitals in big cities for reliable diagnosis and treatment.The overloaded work of doctors makes them unable to improve their communication with patients.At the same time, the medical education system does not give students intensive training in doctor-patient communication skills, which makes doctors lack good communication skills.
3、 The lack of humanistic care in the medical process has aggravated the disharmony between doctors and patients.Healing and saving people were originally integrated, but some doctors only paid attention to "disease" and did not pay attention to people. Similarly, the rights and interests of doctors were not adequately protected. Sometimes doctors did not even have a place and time to rest. There was no empathy between the two. Patients often did not understand doctors' diagnosis and treatment, and evenViolent injuriesevent.
4、 The direct reason affecting the doctor-patient relationship is that the channels for patients to appeal and safeguard their rights and interests are not unblocked.Although our country has implemented the new《Regulations on Handling Medical Accidents》However, after the occurrence of medical accidents, the cost of accident identification alone is as high as several thousand yuan, and the cost of protecting the rights and interests of patients is too high.
5、 Lack of trust between doctors and patients is an important reason for the contradiction between doctors and patients.Inadequate detailed reporting by the news media has led to a lack of trust, understanding and empathy between doctors and patients.Some medical staff did not put themselves in the patient's shoes, but considered the interests of medical institutions and themselves more.Some patients also lack understanding of medical staff and the complexity of medicine.
significance
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The increasingly tense doctor-patient relationship is not only seriously impacting the medical service market, but also has become a factor of social disharmony.currentHarmonious doctor-patient relationshipMore and more attention has been paid to the medical staff, who simultaneously assume the multiple roles of manager, communicator, caregiver, spokesperson, protector and educator.Therefore, medical workers should not only have good political quality and psychological quality, but also have profound professional quality and extensive humanistic quality.Informed, consent, freedom, non harm and optimization are the most basic principles of medical ethics recognized by the international community. People should treat the doctor-patient relationship with gratitude.[3-4]
