I. The development trend of doctor-patient relationship
Since the 1990s, the doctor-patient relationship has undergone significant changes, are closely related to scientific and technological progress, conceptual updating and people's sense of autonomy, participation in the awareness of the enhancement of the broadly four aspects.
(a) doctor-patient relationship "man-machine" trend: since the 1990s, medical high technology has been widely used in clinical diagnosis and treatment, diagnosis, treatment, care has undergone a major change, especially in large hospitals, automation, information technology, remote control means of diagnosis and treatment are commonly used, doctors through machines, instruments, equipment and other high-tech service facilities to obtain the patient's physiological and physical conditions. High-tech service facilities to obtain the patient's physiological indicators, biochemical indicators and other data, and has a high degree of sensitivity, accuracy, rapidity and other characteristics of the diagnosis and treatment to provide an important basis. This tendency to replace people with machines has diluted the exchange of ideas between doctors and patients, aggravated doctors' dependence on high-tech facilities, and neglected the influence of patients' social and psychological factors on diseases.
(2) doctor-patient interaction "economic" trend: due to China's large population, the existing health resources are still unable to meet the growing demand for medical and health care of the general public, there is a "difficult to see a doctor, difficult to hospitalization, difficult to surgery," and other conditions. In the face of the contradiction between supply and demand, liberal policies have been implemented, such as allowing various forms of hospitalization, pilot operations on a trial basis, and paid services for amateurs, which have eased the "three difficulties" and met certain needs of the masses. However, in some places in fact appeared the tendency of commodification of medical services, in the doctor-patient relationship with the trend of economic, the principle of equal exchange of the commodity economy has permeated the doctor-patient relationship, and even the emergence of power and money transactions and other unhealthy practices.
(3) doctor and patient requirements of the "diversified" trend: in the reform and opening up, the development of the socialist market economy, the pluralistic tendency of people's values is also reflected in the doctor-patient relationship. Doctors require patients to take the initiative to cooperate with the diagnosis and treatment, the doctor-patient relationship should be "guidance - cooperative" or "*** with the participation of the type", try to avoid uncooperative or conflict type; patients on medical and health care requirements at the level, The patient's requirements for medical and health care in the level and grade are also different, showing a diversified tendency. Some patients pursue high-quality services, require high-grade wards and even non-medical services; some patients only require basic health care; some patients even the most basic health care is difficult to achieve. (D) the doctor-patient relationship on the regulation of the "legalization" trend: the doctor-patient relationship mainly relies on the regulation of morality, however, when the moral norms of doctor-patient relationship to the legal system, the medical order is more perfect. Nowadays, doctors and patients of autonomy, participation in the enhancement of consciousness, the protection of their respective rights and interests and consciously fulfill their respective responsibilities of the concept of increasingly strong, for health legislation provides the ideological basis. In addition, the clinical application of high technology has led to a series of social and ethical issues, there is also an urgent need for health legislation to solve, such as the use of high technology for gender identification; artificial insemination, in vitro fertilization, brought about by the family moral and social issues; organ transplantation in the source of donor and the distribution of health resources in the fairness of the issue, etc., are directly involved in the relationship between patients and doctors, rely only on the morality of the regulation is not enough, it is necessary to regulate the system through the legal system, which has been the It is imperative to regulate through the legal system. Second, the factors affecting the doctor-patient relationship
(a) the medical view of doctors and patients: today's biomedical model has shifted to biopsychosocial medicine model, people's view of health,
Medical view of the important changes that have taken place, however, some medical personnel still adhere to the traditional biomedical model, do not see or do not pay attention to the emotional, ideological, social factors such as consciousness and psychological factors and the impact of treatment, coupled with the application of high technology, the doctor-patient relationship has become a major challenge for the medical profession, the doctor-patient relationship.
In addition to the application of high technology, the doctor-patient relationship, "human-computer" trend, encouraging some medical personnel purely technical point of view, while the general public, the patient in accordance with the new medical model requires medical personnel to perform their duties, will inevitably result in the expectations of doctors and patients with each other on the larger gap between the impact of the doctor-patient relationship.
(2) the moral cultivation of doctors and patients: moral cultivation is a two-way, the doctor to talk about medical ethics, the patient also need to talk about medical ethics. In real life, a small number of medical personnel medical ethics is not enough, the lack of wholeheartedly for the spirit of patient service, irresponsible work, manifested in the following: unclear boundaries of the disease or composite disease patients, shirking each other, resulting in delays in the diagnosis and treatment; emergency patients or difficult patients for fear of taking responsibility, a push away; patients with a hardened attitude, disregard for patients' right to medical treatment, etc., although it is a minority of direct harm to the image of the angel in white. Although it is a small number, it directly damages the image of white angel and affects the doctor-patient relationship. A small number of patients do not speak of medical ethics, do not comply with the rules and regulations of the hospital, do not respect the personality and dignity of medical personnel, a little less than desired to blame, abuse or even assault on medical personnel phenomenon, interfering with the normal order of medical care, harming the doctor-patient relationship.
(3) management problems: from the micro-management point of view, there are a lot of problems in hospital management, such as hospital management ideas are not correct enough, the education of medical personnel, management is not effective, there is a "big prescription", "repeat inspection" or "unnecessary inspection" and other economic tendencies, increase the number of medical personnel. Unnecessary checks and other economic tendencies, increasing the unreasonable burden on patients; hospital management is not scientific enough, the implementation of the system is not effective, the quality of medical care is not high, medical defects and even medical accidents have not yet been controlled, and quality of service is a certain distance, resulting in the credibility of the hospitals and doctors in the public to reduce the relationship between doctors and patients is also affecting.
From the macro-management point of view, health regulations are not sound enough, especially to regulate medical behavior, doctor-patient relations, hospital law, physician law, nurse law has not yet been introduced, which regulates the doctor-patient relationship, maintaining normal medical order, civilized practice of medicine and civilized medical is not conducive.
Three, improve the doctor-patient relationship countermeasures
(A) to create a good social environment: to the whole society "civilization, a new wind" activities carried out in depth, under the conditions of the market economy, the inheritance and carry forward the fine traditional virtues of the Chinese people, carry forward the socialist morality, to improve the ideological and moral quality of the whole nation, scientific and cultural quality, to create a good environment, to improve the quality of the people, and the quality of science and culture. The scientific and cultural quality, to create a favorable social environment, undoubtedly medical staff to speak of medical ethics, patients to speak of medical ethics, to improve the doctor-patient relationship has an important practical significance.
(2) deepen health reform: in the past, due to the lack of health funding, medical supply and demand is very prominent, which is the material basis for the impact of the doctor-patient relationship. In the future, in deepening health reform, the state will gradually increase the investment in health funds, to solve the medical and health sector of professional and technical personnel, shortage of funds, equipment and other contradictions, to alleviate the "three difficulties" situation. At the same time, it is necessary to strengthen scientific management, broaden the way to run a medical institution, establish and improve the management system and various rules and regulations, deal with the relationship between social and economic benefits, insist on putting social benefits in the first place, and rectify the direction of running a hospital; earnestly sum up, implement and improve the comprehensive target responsibility system, which embodies a combination of responsibilities, rights and benefits; and improve the quality control, implement standardized quality control, and continuously improve the quality of medical care and service level; To encourage and support the majority of medical staff to learn professional knowledge, study medical skills, and constantly improve the level of medical technology, to achieve quality service, to improve the doctor-patient relationship to create favorable conditions.
(3) to strengthen the construction of medical ethics: in the deepening health reform, strengthen the socialist market economy under the new situation, to strengthen the construction of medical ethics, to deal with utilitarian choice and moral choice, economic benefits and responsibility indicators, short-term behavior and long-term interests of the contradiction, and the resulting tendency to the commodification of medical services and the relationship between doctors and patients to dilute the problem. To establish a dual mechanism of self-development and self-restraint in hospitals, the self-development mechanism is to improve the doctor-patient relationship, quality service for the purpose of enhancing self-compensation, incentives; self-restraint mechanism, including the spirit of self-discipline, regulatory control, legal and disciplinary supervision, social supervision, etc., aimed at the implementation of the code of ethics, improve the doctor-patient relationship, and to promote the construction of medical ethics and medical practice. Hospitals with the conditions to gradually establish hospital ethics committees to study, monitor and check the problems in the construction of medical ethics, medical ethics construction in-depth.
(4) improve health regulations: regulation and coordination of doctor-patient relations, on the one hand, the use of education, diversion of ethical ways, which is the main and regular work. On the other hand, the doctor-patient relationship into the standardization, legalization track, the use of legal means to regulate the doctor-patient relationship, to solve its conflictual problems is very necessary. With the development of high-tech and life sciences, to the doctor-patient relationship has brought many new problems, there is an urgent need to strengthen health legislation, as soon as possible to formulate hospital law, physician law, nurse law, medical law, medical high technology implementation of the law, etc., to clarify the rights and obligations of the two sides of the doctor and the patient, to regulate the doctor and the patient's behavior, the maintenance of positive ;
Common medical order, and to promote the development of health undertakings is of great significance. In addition, it is also necessary to do the law, illegal, strengthen the rule of law, punishment of lawlessness, which is to maintain stability and unity, and promote a harmonious, good doctor-patient relationship are of practical significance.