1 Basic model of doctor-patient relationship
The early model of doctor-patient relationship is that patients rely on the professional authority of doctors. In the second half of the 20th century, the relationship between doctors and patients developed in the direction of sharing responsibility between doctors and patients. The doctor-patient relationship in medical activities consists of technical relationship and non-technical relationship. There are three basic modes of technical doctor-patient relationship:
1. 1 active-passive medical treatment is completely active and patients are completely passive; There is no doubt about the authority of doctors, and patients will not raise any objections.
1.2 guidance-cooperative medical care, patients have the initiative. The doctor's advice is respected, but patients can have questions and seek explanations.
1.3 *** is equivalent to participatory medical care and patient initiative, and * * * is equivalent to participation in medical decision-making and implementation. At this time, medical advice often involves the adjustment of patients' living habits, ways and interpersonal relationships, so it is particularly important for patients to cooperate and complete the treatment on their own.
2 the status quo and trend of doctor-patient relationship
2. 1 Sharp conflict between doctors and patients. At present, the doctor-patient relationship is harmonious on the whole, but there are some minor disharmonies in the great harmony. Generally speaking, the whole society is filled with a negative emotion towards doctors and hospitals; The public and individuals generally have different opinions or opinions on the present situation and quality of medical services, and medical disputes are increasing year by year. From the investigation of the Rights Protection Department of China Hospital Management Association, it can be clearly seen that the incidence of medical disputes in 2000 was 98.47% among the 326 hospitals surveyed [2].
2.2 Extremely violent incidents occur frequently, such as smashing hospitals, insulting, injuring and killing medical personnel. Taking large and medium-sized hospitals in Beijing as an example, in the past three years, there have been 502 incidents of injury to medical staff [3]; According to the statistics of the health department, in 200 1 year, the amount of medical claims in China reached more than 400 million, and medical personnel were beaten, disabled and even died more than 20 times [3]; China Hospital Management Association conducted a survey of 326 hospitals in China. After the occurrence of medical disputes, 73.5% of patients and their families had excessive behaviors that disturbed the work order of the hospital, and 43.9% of them developed into smashing the hospital. Among these excesses, 35.6% directly damaged hospital facilities and 34.6% caused injuries to medical staff [3].
2.3 The color and tendency of commercialization of doctor-patient relationship With the change of hospital industry management system, privatization of hospitals and self-financing of public hospitals, hospitals should consider how to obtain the greatest economic benefits to maintain the survival, competition and development of hospitals, so that clinical diagnosis and treatment will be alienated into high-end consumption and inappropriate consumption, which is manifested in the improper increase of medical expenses and the inappropriate and extensive use of high-end equipment and equipment (disposable items) for excessive medical treatment.
2.4 Legal Litigation Tendency With the progress of society and the improvement of the legal system, in recent years, more and more cases have been recognized by medical associations, accepted autopsies and resolved medical disputes through legal proceedings.
2.5 The public's contradictory feelings towards doctors and hospitals and psychological clinical practice show that people of any social and economic class have great psychological respect and trust in doctors and hospitals, and they all hope that doctors and hospitals can provide timely, efficient, convenient, warm and affordable medical services. However, many patients' medical experience is not pleasant, such as the clinical effect can not reach the expected effect or adverse consequences, and after many twists and turns, they have accepted many expensive medical measures beyond their ability, and finally their personality is not respected and their spirit is not comforted. As a result, patients and the public have gradually developed fear and dissatisfaction with hospitals and doctors, and some long-standing medical disputes often appear in the media, causing widespread indignation and resentment.
3 methods to establish a harmonious relationship between doctors and patients
3. 1 Share medical risks and resolve conflicts between doctors and patients. In the current medical field, the key to building a trusted and harmonious doctor-patient relationship is to solve the contradiction between doctors and patients, which will not be achieved overnight. It needs mutual understanding, mutual support, mutual cooperation and joint efforts among hospitals, medical staff, patients and insurance companies. Hospitals cooperate with insurance companies to establish a socialized sharing mechanism of medical risks. Be fair and just. While protecting the rights and interests of patients, we should also protect the rights and interests of medical institutions and medical personnel. Medical risks should be borne not only by medical institutions and doctors, but also by patients. Only in this way can we ensure the fairness of the whole patient group, as well as the fairness of medical institutions and medical personnel, and be conducive to the development of the whole medical cause. Solving the contradiction between doctors and patients can not be completed only by the introduction of some rules and regulations or insurance by the medical administrative department. As the subject of contradiction, the role of patients in resolving disputes can not be ignored. To do this, it is difficult to rely on the patient's own knowledge level. It requires medical institutions and medical personnel to carry out relevant knowledge training in various related occasions. Medical staff should not only let patients know the scientific, practical and technical nature of medicine, but also know the risks and special situations that may occur in the process of disease occurrence and development, and ask them to know the special physique that may appear in individuals and the limitations of existing medical technology.
3.2 Changing the concept of medical services will inevitably be impacted by the market economy. Medical institutions must attach importance to the influence of market economy on medical services and educate medical staff to change their concepts and service consciousness. Hospitals should set up ethics committees to make moral and professional judgments on doctors' behaviors and work, and formulate corresponding standards to limit conflicts of interest, so as to minimize conflicts of interests of doctors in clinical practice and embody scientific, timely, low-consumption, efficient and affordable medical services. We should put people first, take patients as God, and serve patients and society in an all-round way. Medical institutions and medical staff must put themselves in the patient's shoes. They can't simply treat patients as helpless "patients", treat patients like parents treat their children, or pretend to be "experts" all the time. They must change their paternalistic medical style, actively listen to the constructive opinions put forward by patients, and advocate that both doctors and patients jointly study treatment plans.
3.3 Strengthen hospital quality management, strengthen the rule of law and medical education. In the face of disputes between doctors and patients, hospitals can't just stand on the litigation table and argue with patients. Hospitals should conscientiously sum up experiences and lessons, find loopholes in quality management, strengthen hospital quality management, and prevent accidents and disputes. Moral and legal education, on the one hand, should strengthen the education of medical ethics and health legal system, and truly practice medicine according to law, treat people with affection and treat people with affection. On the other hand, we should also strengthen education in medicine, morality and the rule of law, so that people can understand medicine, respect medicine and doctors, and learn to use law rationally to solve disputes. Hospitals should do less advertising or advertising consultation and do more popularization of medical knowledge. Strengthen the rational and scientific allocation of medical resources to ensure the dialogue time between doctors and patients in outpatient, emergency and ward. Hospitals should establish long-term contact with patients with chronic diseases, provide continuous medical care services for patients through telephone follow-up, internet, letters and visits, ensure the regular and stable communication channels between doctors and patients, let doctors know about patients, and let patients respect medicine and medical personnel.
3.4 To strengthen the communication between doctors and patients, every medical staff is required to have a high sense of responsibility and compassion, be loyal to their duties, be full of love, have good emotional adjustment and self-control, keep themselves optimistic and positive, and be good at interpersonal communication. During the hospitalization of patients, medical staff should truly "take patients as the center", add humanistic spirit into medical technology, integrate feelings and have warm and cordial language. Say a few simple words to patients, explain profound truth to patients in popular language, and try to narrow the scientific distance between doctors and patients; Listen to the patient's words, support their confidence with sincerity and patience, and induce them to speak. In the process of listening, we should fully show our concern for patients, don't look around casually, and don't interrupt patients' conversation at will, and adopt a non-critical attitude. To understand the information conveyed by patients' eyes and expressions and truly understand patients' needs, it is necessary to master and flexibly use communication skills.
3.5 Respect patients' right to know. Medical staff should respect the choice of patients and their families, and cannot go their own way. Any decision against the wishes of patients and their families is often the bane of medical disputes. Patients have both the right to know and the right not to know about their diseases. As a medical staff, when considering whether to tell the patient the truth, we should first try to find out whether the patient has a strong motivation to understand the condition, how much the patient wants to know, what kind of patients should be told, what kind of patients should not be told, to what extent and how to say it. After the patient makes a choice, it is necessary to ensure the best quality of life for the patient. Doctors' services may not achieve the expected results of patients. Therefore, we should let patients and their families know everything as much as possible, publicize the management system and regulations in the hospital, implement the principle of informed consent, respect patients' autonomy, not deceive patients' integrity, be concise and to the point, and do not allow patients to make meaningless guesses with ambiguous words.
3.6 Strengthen social supervision. The public is concerned about patients' rights and interests. The doctor-patient relationship is an extremely important relationship in the current complex social relations, which needs the attention of the whole society and the public. Only by taking care of and supervising them in different ways can we gradually establish a trust and harmonious relationship between doctors and patients, so that medical staff can serve patients with peace of mind and patients can get value-for-money medical services. No matter how high the development of social civilization is, it is impossible to completely eliminate the asymmetry between doctors and patients in medicine and information. At present, most patients still entrust their right to choose and decide to doctors and hospitals. Doctors always decide the fate of patients and dominate their medical consumption to a certain extent. Hospitals should not evade supervision and do whatever they want because of the actual inequality between doctors and patients. It is necessary to gradually establish a "medical management system", play its due role, effectively avoid medical accidents and medical risks, and promote the harmony between doctors and patients. In a word, trusting and harmonious doctor-patient relationship is an intangible asset in hospital competition, an important foundation for hospitals to be invincible, and an indispensable fundamental guarantee for safeguarding the rights and interests of both doctors and patients. Today, with the construction of a harmonious society and the implementation of people-oriented, the tension and lack of trust in the doctor-patient relationship are unfavorable to patients, hospitals and society. Therefore, whether it is medical and health departments, patients or all walks of life, they should cooperate and understand each other, form a trust and harmonious doctor-patient relationship, and reduce the occurrence of medical disputes and lawsuits.