醫病關係：一種信任問題的考察

葉永文

《台灣醫學人文學刊》 13卷1＆2期 (2012/05) Pp. 77-103

https://doi.org/10.30097/FJMH.201205.0006

摘要

本文試圖以「信任」做為討論醫病互動的主軸，描述社會變遷過程所造成人們對醫生和醫療體系的信任轉化，進而指出今日醫病關係之問題所在。首先，我們必須在理論層次上釐清信任的意義，同時建構出人際信任和體系信任兩種分析模式，並且闡述這兩種信任模式在傳統與現代社會裡所佔有不同的影響程度，接著再針對體系信任中的醫病關係進行分析，最後我們將這兩種信任模式放進台灣醫療發展的脈絡中，來考察從過去以鄉鎮村落為主體的傳統社會到今日以都市為主體的現代社會之醫病互動的變化。根據我們初步的觀察，由於醫療知識和科技的發展，今日的醫病互動基礎係偏向於體系信任，同時弱化了傳統社會之堅實扭帶的人際信任，導致醫病關係產生了很多問題，而醫療糾紛亦經常耳聞。本文認為要解決今日醫病關係的問題，可能必須去提高人際信任的程度，重建病人對醫生的信任感，而不是只對醫療體系的信任。

關鍵字

醫病關係 ； 信任 ； 人際信任 ； 體系信任

並列摘要

This study attempts to make use of trust as the main approach to discuss the doctor-patient interaction in Taiwan. First, we must clarify the key concepts and definition of trust in the theoretical level. Further, two analytical models are constructed, namely, interpersonal trust and system trust in order to understand how both models bring different impacts on traditional and modern societies. Then, we will put both trust models in the context of medical development in Taiwan to examine past and present changes in the doctor-patient interaction. According to our preliminary observations, the study finds that today's doctor-patient interaction is in favor of system trust which has led to many problems in doctor-patient relationship. This study proposes that to solve today's doctor-patient relationship obstacles, it is necessary to enhance the interpersonal level of trust and rebuild the patient a sense of trust in doctors, rather than trust in the healthcare system only.

並列關鍵字

doctor-patient relationship ； trust ； interpersonal trust ； system trust