The doctor-patient relationship is the relationship between patients and doctors or medical institutions in the process of medical practice, the medical ethical relationship between doctors and patients in the process of treating and preventing diseases, and the most basic, important and active interpersonal relationship in medical activities. "The doctor-patient relationship is tense" is a topic of great concern in recent years. From July to August of 20 12, the research group visited medical workers and patients in five provincial hospitals, eight municipal hospitals and 20 township community hospitals, including Golden Township Health Center in Changsha. More than 300 questionnaires were distributed and 30 doctors, nurses and patients were interviewed. Through the analysis of questionnaires and the arrangement of interview materials, the present situation of doctor-patient relationship in Changsha is as follows.
1. The patient's dissatisfaction has increased. First of all, it is difficult to see a doctor. Due to the unreasonable distribution of medical resources in China, a considerable number of medical resources are concentrated in large hospitals with good conditions in big cities, while community hospitals, small and medium-sized hospitals and health centers are in poor conditions. Most patients are willing to go directly to large hospitals, which leads to the higher the level of hospitals, the greater the workload of doctors. Through investigation, it is found that the workload of doctors in several top-three hospitals we investigated is 2 ~ 3 times that of doctors in small and medium-sized hospitals on average. A doctor in a 3A hospital has to see 30 or 40 patients in one morning, and the average time for each patient is only five or six minutes. These hospitals are often overcrowded, and patients seem to catch up with the market in the hospital every day; Especially when going to these hospitals to see experts, patients often have to wait in line for several hours, and some even have to wait for a few days or even longer; Under such a heavy workload, doctors are often too tired to answer patients' questions and make necessary explanations. Secondly, seeing a doctor is expensive. The survey found that 62% of families spend more than 3,000 yuan on medical care every year, and 10% of families spend more than 5,000 yuan. Moreover, in the past eight years, the average annual growth rate of per capita outpatient and inpatient expenses was 13% and 1 1% respectively, which was significantly higher than the average growth rate (8.9% in cities and 8.9% in rural areas). Moreover, most large and medium-sized hospitals were expensive in medicine and examination, and the application of new technologies and sophisticated equipment such as organ transplantation and interventional therapy was expensive. Finally, it is manifested in seeing a doctor and getting angry. According to the survey, less than 20% of the frequent conflicts between doctors and patients are due to technical reasons, and the remaining 80% are due to medical ethics and hospital management problems. In the process of medical treatment, patients are gradually positioning the current doctor-patient relationship with new ideas, and more and more doctors and patients are required to be equal subjects, respectful and cooperative. However, some doctors often pretend to be "parents" in the process of treatment, lacking full respect for patients' rights, and lacking active awareness and behavior in improving the relationship between doctors and patients and preventing medical disputes. Once there is a contradiction between doctors and patients, it will be solved by cold method.
2. Lack of trust between doctors and patients. Due to the market economy behavior of hospitals, both doctors and patients lack trust more and more, mainly in the following aspects: First, patients do not trust doctors. The survey found that 55% patients did not trust doctors, and only 22% patients trusted doctors completely. In the period of social transformation, traditional social trust has encountered challenges, which is also reflected in the relationship between doctors and patients. For example, the doctor's normal examination, from the examination measures and diagnosis to the prescription prescribed by the doctor, is mistaken for the doctor inducing the patient to consume, and is considered as an unnecessary examination conducted by the doctor in order to overcharge. Second, due to the current medical law, when medical disputes are brought to court, both doctors and patients need to give evidence, and doctors often add some unnecessary examination and diagnosis measures to protect themselves, which further increases the distrust of both sides. What's more, some patients take a voice recorder and a video camera to record everything the doctor says and does, so that they can "go to court" at any time. Some patients don't believe the prescription and treatment plan prescribed by the doctor from the beginning, and then don't cooperate with the doctor's treatment.
Second, the main reason for the current tension between doctors and patients is 1. From the patient's point of view, the main manifestations are as follows: (1) Patients have too high expectations for medical effects. The medical field is full of unknowns and variables. For complex patients and medical staff, there will be more or less differences in the cognition of diseases and the application of medical technology. Even with the rapid development of medicine today, the diagnosis rate of diseases at home and abroad is only 70%, and the success rate of emergency rescue is only 70% ~ 80%. Therefore, it is impossible for any hospital or doctor to cure white disease. However, many patients don't know enough about the medical industry and medical science, and they have little knowledge about medical knowledge. They regard going to the hospital as a simple commodity consumption, and often can't get the equivalent return after paying, which naturally leads to the escalation and deterioration of contradictions. (2) Patients have distrust. Patients want senior doctors to treat them, and once they are dissatisfied, they are determined to be caused by young doctors, which leads to disputes. Other patients are preconceived in the process of diagnosis and treatment, and they are skeptical or antagonistic when something is wrong. Because many of them were wary of doctors from the beginning, they even had a strange phenomenon of recording or videotaping their conversations and diagnosis and treatment measures, and wanted to use their records as "evidence" to blackmail doctors. These behaviors bring great pressure to doctors in the process of diagnosis and treatment. 2. From the point of view of medical personnel, there are some factors as follows: (1) There are weak links in medical quality, such as lax implementation of rules and regulations, resulting in errors and accidents; Or the low technical level leads to misdiagnosis and mistreatment. (2) Problems existing in the construction of hospital atmosphere. Because the normal income can't meet the material needs of doctors objectively, a few doctors have low professional ethics, inadequate services, careless treatment of patients, "cold, hard, push" and other phenomena, accepting red envelopes and kickbacks, which has caused adverse effects and led to patients' distrust of medical staff. (3) Medical workers can't adapt to the changes of modern medical model, and still put diseases in the first place, ignoring patients' physiological and psychological feelings, only paying attention to the improvement of their own medical level and ignoring the relationship with patients.
Communication, ignoring the study of humanistic knowledge and the improvement of communication ability with society, improper language, resulting in misunderstanding of patients. Third, measures to improve the current doctor-patient relationship
1. Strengthening doctor-patient communication is an important way to improve the doctor-patient relationship. (1) Strengthen communication between doctors and patients' families. Knowing the patient's condition is the minimum requirement, and medical staff have the obligation to inform the patient and his family. After telling the real condition, you can win the cooperation of patients or the support of family members, so that the treatment can achieve better results. Doctors should selectively inform different patients about possible situations such as medication, examination, and changing treatment plans, which not only respects patients, but also draws closer relations and avoids possible contradictions. (2) Strengthen the communication between doctors and patients. In medical service, it is an inevitable trend for medical staff to strengthen communication with patients, show care, patience, care and love for patients at all times, and show humanized service for patients everywhere. 2. Constantly improve health laws and regulations. Because of the monopoly of medical services, doctors are in a dominant position in the relationship between doctors and patients, which is what medical services need. This doctor-patient relationship is different from the subject-object relationship in civil laws and regulations. Therefore, civil laws and regulations cannot be used to regulate the doctor-patient relationship. On the premise of improving the quality of medical staff and strengthening medical management, we should introduce advanced foreign management models in a targeted manner, and constantly improve and improve the applicability of existing health laws and regulations in dealing with doctor-patient disputes in China. Formulate unified, persuasive, fair and authoritative laws and regulations that can really bind both doctors and patients and solve contradictions. This is the legal basis to ensure the quality of medical services, and it can also alleviate the contradiction between doctors and patients to a great extent. In addition, effective laws and regulations should be strictly enforced, and illegal medical groups in society should be severely cracked down to ensure normal medical order.
3. Change the service concept, enhance the service awareness, and coordinate the doctor-patient relationship. Due to the change of medical model. Expanded the scope of clinical work and put forward higher requirements for medical staff. Therefore, we should change our concepts and update our knowledge. As medical staff, it is not enough to know only what diseases patients have, but also who they are and under what circumstances they are prone to get sick. It is necessary to analyze and study the problems encountered in medical services with a systematic concept to meet the medical, preventive and health care needs of various patients. At the same time, broaden the scope of service functions, and carry out commitment services, convenience services, medical guidance services, and consulting services. To meet the needs of patients and close the relationship between doctors and patients. 4. Improve the construction of social health service system. Expensive medical care is a very important factor that causes the tension between doctors and patients at present, which has become the carrier of this tension, making "difficult to see a doctor" and "expensive to see a doctor" a very prominent social problem. As far as the current situation is concerned, before the establishment of the social health service network, about 80% of patients went to large hospitals, and only 20% of patients went to small hospitals at the grass-roots level, resulting in no one interested in small hospitals and overcrowding in large hospitals. To solve these problems fundamentally, we must establish and implement Scientific Outlook on Development, deepen the reform of medical and health system, completely change this unbalanced state of resource allocation, and establish and actively improve the construction of community health service system.