小兒科醫師與病患家屬之語言與非語言溝通互動分析:以北縣某區域醫院一位小兒科醫師為例

The Study of Verbal and Nonverbal Communication between the Pediatrician and Patient's Relatives at Outpatientient Practices at Regional Hospital in Taipei County

林芳如(Lin Fang Ru)

指導教授 ： 高美英

臺北醫學大學/醫學院/醫學人文研究所/碩士(2005年)

摘要

摘要 在近兩年經媒體曝光之醫療糾紛案於國內引起的軒然大波下，國內「醫病關係」議題日漸引起重視，「醫病溝通」更是其中欲探究的問題之一。在醫療體系內，小兒科門診醫師在面對病童的同時，也必須面對病童家屬此角色在診療過程中的涉入；此種特殊的醫病溝通型態在進行的過程中，是否隱藏了某些可能導致醫療糾紛的溝通障礙與因素？由此問題發展，本研究欲探討小兒科門診醫師在面對各種不同社會人口特徵之病患家屬時，其溝通時所使用之語言型態與非語言型態之差異；從其中探討可能對小兒科醫病溝通所產生之障礙。 本研究於台北縣某私立醫院小兒科門診中進行參與觀察以取得診療過程中醫病間之語言與非語言活動之紀錄，輔以問卷調查獲得病患及家屬之基本社會背景資料，共獲44個有效樣本。分析結果顯示，醫師在診療過程中已幾乎不使用艱澀之醫學專有名詞，於「症狀描述」及「病名診斷」方面皆會轉換使用不同語詞來描述同一種病症，在「藥物使用」方面之醫囑，其專業醫學藥名則明顯的會以特殊之「替代用語」來代替以告知家屬服用之藥物種類。醫師之診療過程明顯趨於形式化，使醫師之語言形式因病患主訴差異不大之影響而隨著診療四步驟形成一套固定語言公式。醫師在診斷與解釋病症方面對男性家屬釋放較多的訊息；對年輕者家屬採開放式問診，對年長之家屬則採封閉式問診；在「藥物使用」醫囑方面，教育程度於高中職以上及職業為專業人士之家屬較能獲得醫師更多之資訊；且醫師與家屬所釋出訊息之多寡呈現對等之關係；而眼神接觸(eye contact)方面，在平均近兩分半鐘的診療過程中，醫師平均花費81.80秒將其眼光放於電腦上，對家屬之眼光接觸平均為32.34秒，對病患則平均為3.64秒，電腦的使用似乎已嚴重分散醫師對病患及家屬之注意力。 醫師不使用艱澀之醫學專業名詞將可促進醫病溝通之順暢，但在「藥物使用」之醫囑方面，也可能暗藏著引起醫藥糾紛之危機；而本研究也發現了因受社會性別結構影響以及隨著社會變遷而改變的醫病關係。

關鍵字

醫病溝通 ； 醫病關係 ； 語言溝通

並列摘要

ABSTRACT The repercussion of medical disputes exposed by the medias in the last two years has brought up the debate of “Doctor-Patient Relationship” in our country, and “Doctor-Patient Communication” is one of the issues that are under fervent debate. In the medical system, while treating the child, the pediatrician must also involve the family of the child in the treatment process; during the process of this special doctor-patient communication, is there any hidden communication obstacles and factors that may cause medical disputes? Begin with this question, this research would like to discuss the differences in the verbal or non-verbal communication used when the pediatrician is facing the patients’ families with different social characteristics; and from there on, we want to discuss the possible obstacles created from Pediatrician-patient communication. This research recorded the verbal and non-verbal activities between the doctors and patients through observation during the treatment process at the pediatric out patient service of a private hospital in Taipei County, and obtained 44 valid samples with the assistance of the questionnaires containing the basic social backgrounds of the patients and their families. The analyzed result shows that the doctors almost stopped using the medical terms that are hard to understand during the treatment process, and they used different terms to describe the same illness on the “Symptom description” and “Illness diagnosis”. As for the prescription on the “Medication use”, they use “alternative terms” to notify the family the type of medication used instead of using its scientific terms. Doctor’s treatment process becomes increasingly formalized, and the doctor’s verbal style has formed a fixed formula along with the four steps of the treatment process because there is not much of difference in patient’s description. For male family relatives, the doctors tend to release more information about the diagnosis, and explain the symptoms of the illness; for the younger family relatives, they tend to use open interviews, and for the older family relatives, they tend to use closed interview. As for the prescription on the “Medication use”, the family relative whose education level is higher than high school and has professional occupation obtains more information from the doctors; as far as for the eye contact, during the average two and half minutes treatment process, the doctor tends to make the eye contact on the computer for 81.80 seconds, and make the eye contact with the patient’s relative for 32.34 seconds, and with the patient for about 3.64 second; the use of the computer seems to have seriously distracted the attention the doctor spends on the patients and their relatives. With the doctor stopped using the medical terms that are hard to understand, it can smooth the communication between the doctor and the patient, however, on the prescription of the “medication use”, it may have hidden crisis that can cause medical dispute; and this research discovered the doctor-patient relationship that is affected by the gender structure of the society and social change.

並列關鍵字

doctor-patient communication ； doctor-patient relationship ； verbal communication

參考文獻

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