住院病人與照護主治醫師對於醫病溝通認知差異之研究

Communication and Cognitive Gaps between Inpatients and Attending Physicians

匡勝捷(Sheng-Chieh Kuang) ； 郝宏恕(Horng-Shuh Hao)

《醫學與健康期刊》 9卷1期 (2020/03) Pp. 61-72

摘要

目的：探討病人住院期間與主治醫師在照護溝通上認知差異的面向與程度。藉由發現醫病雙方在溝通上認知的差異，尋找合適的方法加以補救。方法：以橫斷面問卷調查的方式，測量出院病人與照護主治醫師對醫病互動的認知差異。結果：共收集132位病人問卷及132份主治醫師問卷。病人住院期間主治醫師與病人在資訊的傳達、互動的感受及醫療決策的參與方面都存在有統計學上明顯的認知差異，而且醫師在問卷各題項的平均分數均低於病人的分數。特別是在病人是否希望更多參與醫療決策認知方面，醫師的認知明顯低於病人的期望。結論：病人與醫師在醫療照護過程中的認知差異，對於醫病關係是一項重要的關鍵。醫師缺乏對於醫病認知差異的了解及警覺，將會降低以病人為中心的醫療水平，並增加醫療糾紛的風險，值得醫界加以進一步關切。

關鍵字

醫病關係 ； 醫病溝通 ； 認知差異 ； 醫病共享決策

並列摘要

Objectives. To investigate communication and cognitive differences between attending physicians and hospitalized patients. Methods. Using cross-sectional questionnaires, we assessed both the patients' and attending physicians' perception of the physician-patient communication. Results. A total of 132 patient questionnaires and 132 attending doctor questionnaires were collected. The average scores obtained by doctors in each category were significantly lower than those obtained by the patients, particularly, the doctors' perceptions of whether the patients wanted to be more involved in the medical decision-making process were significantly lower than the patients' perception. Conclusion. The differences in perception between patients and doctors interaction during the course of medical care contribute greatly to the physician-patient relationship. A lack of knowledge and awareness of cognitive differences between patients and doctors interaction interfere with quality of patient-centered medical care and increase the risk of medical disputes, and thus deserves further attention.

並列關鍵字

Physician-patient relationship ； Physician-patient communication ； Cognitive gap ； Shared-decision making

參考文獻

衛生福利部醫事司：訴訟性質統計表。https://dep.mohw.gov.tw/DOMA/dl-14137-799745c6-5cc4-4ddc-9684-706f5226f71f.html。引用8/29/2017。Department of Medical Affairs, MOHW: Litigation property statistics. Available at : https://dep.mohw.gov.tw/DOMA/dl-14137-799745c6-5cc4-4ddc-9684-706f5226f71f.html. Accessed August 29, 2017. [In Chinese]

江偉芬：關注醫師人力失衡議題-從醫師人力分布數據看起。https://portal.stpi.narl.org.tw/index/article/71。引用8/29/2017。Chiang WF: The issue of physician's manpower imbalancefrom the doctor's manpower distribution data. Available at: https://portal.stpi.narl.org.tw/index/article/71. Accessed August 29, 2017. [In Chinese]

蔡秀男：99%醫療糾紛都是可以避免的。台北：貓頭鷹出版社，2014。Tsai HN: 99% medical disputes can be avoided. Taipei: Owl Publishing House, 2014. [In Chinese]

廖士程、李明濱、李宇宙等人：身體疾病住院患者之醫病溝通分析。醫學教育 2000；4：38-48。Liao SC, Lee MB, Lee YJ, et al.: Analysis of the physicianpatient communication in medically ill in-patients. J. Medical Education 2000;4:38-48. [In Chinese]

財團法人醫院評鑑暨醫療品質策進會：106年度醫院評鑑基準及評量項目。https://www.tjcha.org.tw/admin/UserFile/file。引用8/29/2017。Joint commission of Taiwan: 2017 hospital accreditation. Available at : https://www.tjcha.org.tw/admin/UserFile/file. Accessed August 29, 2017. [In Chinese]