1 The basic model of doctor-patient relationship The early model of doctor-patient relationship was that patients depended on doctors' professional authority. In the second half of the 2th century, the doctor-patient relationship developed in the direction that doctors and patients shared responsibility. The doctor-patient relationship in medical activities consists of two parts: 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 and patients have initiative. Medical advice is respected, but patients can have questions and seek explanations.
1.3 *** is equal to participatory medical care and patient's initiative, and * * * is equal to participation in medical decision-making and implementation. The opinions of medical treatment at this time often involve the adjustment of patients' living habits, ways and interpersonal relationships, so it is particularly important for patients to cooperate and complete treatment on their own.
2 Current status and tendency of doctor-patient relationship
2.1 The contradiction between doctor-patient relationship is sharp and conflicted. At present, the doctor-patient relationship is harmonious in general, but there are some minor disharmonies in the great harmony. On the whole, the whole society is permeated with a kind of negative emotion towards doctors and hospitals; The public and individuals generally have different opinions or opinions on the status and quality of medical services, and medical disputes are increasing year by year. From the investigation of the Rights Protection Department of Chinese Hospital Management Association, we can clearly see that among the 326 hospitals surveyed, the incidence of medical disputes in 2 was 98.47% [2].
2.2 Extremely violent incidents frequently occur, such as smashing hospitals, insulting, injuring and killing medical staff. Taking large and medium-sized hospitals in Beijing as an example, in the past three years, there have been 52 incidents of injuring medical staff [3]; According to the statistics of the health department, in 21, the amount of medical claims in China reached more than 4 million, and medical personnel were disabled and even died more than 2 times [3]; The Chinese Hospital Management Association surveyed 326 hospitals in China. After medical disputes, 73.5% of patients and their families had excessive behaviors that disturbed the work order of hospitals, and 43.9% of them developed into smashing hospitals. 35.6% of these excesses directly damaged hospital facilities, and 34.6% caused injuries to medical staff [3].
2.3 color and tendency of commercialization of doctor-patient relationship With the change of hospital management system, privatization of hospitals and self-financing of public hospitals, hospitals should consider how to obtain the maximum economic benefits to maintain their survival, competition and development, so that clinical diagnosis and treatment will be alienated to high-end consumption and inappropriate consumption, which is characterized by excessive medical treatment characterized by inappropriate increase in medical expenses and inappropriate and widespread use of high-end equipment and equipment (disposable items).
2.4 the tendency of legal litigation with the progress of society and the improvement of legal system, in recent years, more and more cases have been identified by medical associations, accepted autopsies and resolved medical disputes through legal proceedings. 2.5 The public's contradictory feelings and psychological clinical practice towards doctors and hospitals show that people in any society and economic class have great psychological respect and trust for 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, for example, the clinical effect does not reach the expected effect or there are adverse consequences, and after many twists and turns, they accept many expensive medical treatment measures that are beyond their endurance, and finally their personality is not respected and their spirit is not comforted. As a result, patients and the public have gradually become afraid and dissatisfied with hospitals and doctors, and some long-standing medical disputes often appear in the media, which has caused widespread indignation and indignation.
3 Ways to build a harmonious doctor-patient relationship
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 conflicts between doctors and patients, which will not happen overnight. It requires 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 for 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 the fairness of the whole patient group be guaranteed, as well as the fairness of medical institutions and medical staff, which can be conducive to the development of the whole medical cause. Resolving the contradiction between doctors and patients can't be completed only by the introduction of some rules and regulations or insurance by the medical administrative department. As the main body of the contradiction, the role of patients in resolving disputes can't be ignored. To achieve this, it is difficult to rely on patients' own knowledge level. It requires medical institutions and medical staff 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 understand its risks and special situations that may occur in the process of disease occurrence and development, and ask them to understand the possible special physique of individuals and the limitations of existing medical technology.
3.2 changing ideas medical services will inevitably be impacted by market economy, and medical institutions must pay attention to the influence of market economy on medical services and educate medical staff to change their ideas and service consciousness. The hospital should set up an ethics committee to make moral and professional judgments on doctors' behaviors and work, and formulate corresponding standards for restricting conflicts of interest, so as to minimize conflicts of interest among doctors in clinical practice and reflect scientific, timely, low-consumption, efficient and affordable medical services. We should be people-oriented, 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 as parents treat children, or pretend to be "experts" all the time. They must change the paternalistic medical style, actively listen to the constructive opinions put forward by patients, and advocate that both doctors and patients should study treatment plans together.
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 bench and argue with patients. Hospitals should conscientiously sum up experiences and lessons, find out 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 show affection for others. On the other hand, we should also strengthen the education of medicine, morality and the rule of law, so that people can understand medicine, respect medicine and doctors, and learn to use law to solve disputes rationally. 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 time for doctor-patient conversation in outpatient department, emergency department and ward. Hospitals should establish long-term contact with chronic patients, and provide continuous medical care services for patients through telephone follow-up, internet, letters and visits, so as to ensure regular and stable communication channels between doctors and patients, so that doctors can understand patients and patients can respect medicine and medical staff.
3.4 strengthening the communication between doctors and patients requires that every medical staff should have a high sense of responsibility and compassion, be loyal to their duties, be full of love, have good emotional adjustment and self-control, and keep themselves optimistic, positive and good at interpersonal communication. During the hospitalization of patients, medical staff should truly be "patient-centered", add humanistic spirit to medical technology, integrate feelings, and have a warm and kind language. Say a few simple words to patients, explain the profound truth to patients in popular language, and try to narrow the scientific distance between doctors and patients; Listen to a few more words from patients, support their confidence with sincerity and patience, and induce them to talk. 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 the needs of patients, we should master and apply communication skills flexibly.
3.5 respecting patients' right to know, medical personnel should respect the choices of patients and their families, rather than going their own way. Any decision against the wishes of patients and their families is often the bane of medical disputes. Patients have the right to know about their diseases and the right not to know. As a medical staff, when considering whether to tell the patient the truth, we should first try to understand whether the patient has a strong motivation to understand the condition, how much the patient wants to know, and 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 of the patient. The doctor's service may not reach the expected result of the patient. Therefore, patients and their families should be made aware of everything possible, the management system and regulations in the hospital should be made public, the principle of informed consent should be implemented, patients' autonomy should be respected, honesty should not be cheated, what should be said should be clear and concise, and patients should not be allowed to make meaningless guesses with ambiguous words.
3.6 Strengthen social supervision. The public is paying attention to patients' rights and interests. The doctor-patient relationship is an extremely important one in the complicated social relations at present, which needs the attention of the whole society and the public. Only by taking care of it and managing and supervising it from different ways can we gradually build a trust and harmonious doctor-patient relationship, 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, and doctors always determine the fate of patients and dominate their medical consumption to some 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 tense and lack of trust between doctors and patients is not good for patients, hospitals and society. Therefore, both medical and health departments, patients or all walks of life should cooperate and understand each other, so as to form a trust and harmonious doctor-patient relationship and reduce the occurrence of medical disputes and lawsuits.