醫病互動對失眠者使用藥物行為的影響

Effect of Doctor-Patient Interactions on Medication Use for Insomnia Patients

郭淑珍 ； 吳筱筑

《人文社會與醫療學刊》 3期 (2016/05) Pp. 177-201

https://doi.org/10.6279/JHSSM.2016.3(1).07

摘要

本研究從長期服用安眠藥物者的角度出發，檢視失眠者的求醫過程中，醫病互動模式如何引發失眠者有不同的用藥行為。本研究訪問了20位長期用藥者，根據訪談結果，失眠者與醫師互動的模式分為：「主動-被動」、「指導－合作」、「相互參與」、「病人自主」等。「主動－被動」模式中，醫師只以藥物來定義病人，有些病人因感到疏離而自行停藥或加藥，甚至終止醫病關係。但是對於某些病人來說，因為相信藥物的科學機制，覺得醫師給藥是最好的治療。「指導－合作」模式中，雖然仍是以開藥為主要的互動，但醫師會定期追蹤服藥情況，擬定服藥、減藥、停藥計畫，讓病人知道自己的狀況可以慢慢改變。「相互參與」模式中，醫師願意花時間瞭解病患，包括引發失眠的具體事件，病人感受有動力能以非藥物方式來改善睡眠。「病人自主」模式中，病人以拿到藥物為目的，認為自己很瞭解藥物，醫師只是一個合法領藥的管道。受訪者與醫師的互動，大多仍是一種不平等的權力關係；另一方面，消費意識的影響，網路的發達，讓醫療資訊獲得和病友之間的分享變得容易，加上健保制度提高就醫的方便性，使得病人自主性與選擇權增加。政策管制如果只著重於藥量的控管，忽略健保給付造成門診時間短、病人多、醫病互動時間有限，也無法鼓勵其他治療體系的發展，對於失眠者減低用藥量的成效可能有限。

關鍵字

失眠 ； 藥物 ； 醫病互動

並列摘要

This study examines how doctor-patient interactions affect the use of prescribed drugs from the perspective of chronic insomnia patients. We interviewed a total of 20 participants who had been referred by our friends. The types of doctor-patient interactions identified by the participants were categorized as follows: activity-passivity, guidance-cooperation, mutual participation, and patient autonomy. For the activity-passivity type, doctors prescribed drugs to patients with little inquiry into their life habits. Because of this, some patients felt alienated, voluntarily withdrew from or increased the dose of drugs, or even stopped the doctor–patient relationship. By contrast, some patients believed that the prescribed drugs were the optimal treatment on the basis of scientific research. For the guidance-cooperation type, doctors regularly tracked the patients’ use of prescribed drugs. They also planned the intake, reduction, or withdrawal of medication, informing patients about potential improvements in their conditions. For the mutual participation type, doctors took the time to understand their patients, including exploring the specific events that might have caused the insomnia, so that patients felt motivated to solve the problem without prescription drugs. For the patient autonomy type, the patient’s goal was to obtain prescription drugs. They believed that they knew which drugs they needed and considered doctors as a legitimate source to obtain them. In most cases, the doctor–patient relationship remained unequal in power. Yet, the rise of consumerism and Internet use has made it easier to obtain and share medical information. In addition, the health care system makes the search for medical advice more convenient, delegating more autonomy to patients. If medical policy only focuses on the amount of drugs and ignores the problems of current health insurance system practices (such as too many patients, and the limited time for outpatient services and doctor–patient interactions), other treatment methods will not be developed, which may restrict the effect of a dosage reduction in insomnia patients.

並列關鍵字

insomnia ； medication ； doctor-patient interaction