醫師多元文化能力對診間醫病關係的影響

Influence of Cultural Competence of Medical Professionalism on the Doctor-Patient Relationship at Out-patient Department

林育志(Yuh-Jyh Lin) ； 陳偉權(Wei-Chuan Chen)

《南臺灣醫學雜誌》 17卷1期 (2021/06) Pp. 13-26

https://doi.org/10.6726/MJST.202106_17(1).0003

摘要

目的：為更深一層了解醫病關係，本研究嘗試從醫療社會學之多元文化觀點，來探究醫師專業素養之多元文化能力，對診間醫病關係的影響。方法：研究者採用量性問卷調查、與質性訪談研究兩個方法以增進研究效度。問卷內容包含背景因素：醫病關係之多元文化感知、權力／知識、責任倫理、關懷倫理，與素養因素：包括「覺知」與「知識」。結果：感知以「權力／知識」最低、背景因素會影響多元文化感知與能力的差異。醫病關係之多元文化感知與能力各層面間的相關性為低度正相關。然而，多元文化能力之「知識」與醫病關係之多元文化感知「權力／知識」為負相關。「覺知」與「知識」對背景因素之於「主體性、權力／知識、責任倫理、關懷倫理」感知均不具有調節效果。結論：成人教育方法型塑多元文化能力，作為醫病關係改變與實現自由之可能取徑。為建立醫師全人醫療照護的態度與信念，建議將多元文化納入醫學專業素養之課程，以提昇醫師之多元文化能力，促進醫病關係。

關鍵字

專業素養 ； 多元文化能力 ； 醫病關係多元文化 ； 權力／知識

並列摘要

Objective: In order to further investigate the doctor-patient relationship, this study explores the influence of the doctor's cultural competence of professionalism on the doctor-patient relationship from the perspective of multiculturism at out-patient department. Methods: In addition to quantitative questionnaire survey, the researcher also used qualitative interview to improve validity. Structural questionnaire includes factors of background, domains o f subjectivity, power/knowledge, ethic of responsibility, ethic of care and cultural competence of medical professionalism. Results: The quantitative results showed patient perception was highest in ethic of responsibility and lowest in power/ knowledge. The factors that influence the perceived differences in perspectives of multiculturism were as follows: gender, ethnic group, class and religious belief on ＂subjectivity＂; gender on ＂power / knowledge＂; age on ＂ ethic of responsibility ＂; marital status and seniority on ＂ethic of care＂. The factors that influence the difference in ＂awareness＂ of cultural competence is income and those of age, place of residence, religion, seniority and hospital level in ＂knowledge＂ of cultural competence. The correlation between perception and cultural competence at all levels reached a significant level, and both were less positively related except that multicultural knowledge and power / knowledge are negatively correlated. Only of multicultural knowledge has anregulatory effect on correlation of age to subjectivity and power/knowledge but no regulatory effect on age to ethic of responsibility and care. Conclusion: This study suggests that integrating multiculturism into medical professionalism can reinforce culture competence to improve doctor-patient relationship.

並列關鍵字

professionalism ； cultural ； competence doctor-patient relationship multiculturism ； power/knowledge