台灣的醫病關係：權力與角色變遷之研究

The Doctor-Patient Relationship in Taiwan: A Study on the Change of Authority and Role

陳惠雁(Chen Huiyen)

指導教授 ： 張清富

國立臺北大學/社會科學學院/社會學系/碩士(2013年)

摘要

生、老、病、死是人生必經的歷程，因此醫病關係是每個人一生中極為重要的人際關係。每個人同樣會經歷這些歷程，但是個人在對醫療健康上卻有不同想法與發展。過去醫師常直接以權威性命令來給病人治病，僅以單純單向方式進行醫療，很少有彼此的互動。現在的醫療體系則是團體的，以一個醫療群體來照護病人；包含其他的醫療工作者與家屬，特別是藥師最近幾年已成為備受矚目的醫療角色之一。醫療行為與生命直接相關的特性造成了醫病互動有別於其他專業關係的重要性；只是雙方在達成目標的方法上、認知及互動的態度上都有明顯的差異與矛盾。而這些矛盾就是本研究所要探討的議題，也就是分析醫療角色關係的改變因素與原因，藉以呈現顯出醫病關係的惡化。本論文訪談14位醫療工作者與3位病患。從深度訪談與田野探索的方式討論醫師、病人、藥師與醫療從業人員的行為邏輯與角色之間的差異性。
研究結果，傳統的「父權模式」還是存在於現在的醫療環境裡，只是因社會結構與環境改變(教育水準、權利意識提高)因而變得薄弱；醫療角色之間互相有衝突、互助、權威關係；國家醫療政策也是改變醫病關係中一個重要因素，如總額預算、藥價差；其他還包含了資訊進步、社區藥局興起、醫療糾紛嚴重，皆對醫病關係造成影響。

關鍵字

醫療角色、醫病關係、醫師、藥師、權威

並列摘要

In life, one has to go through the course of birth, aging, sickness and death; and in this course, the doctor-patient relationship will become an indispensable interpersonal relationship. Everyone will experience this course, although each and everyone will have his own ideas and involvement in the medical health. In the past, doctors often used authoritative command in treating a patient; it was a simple one-way medical care with very little interaction between them. Nowadays, the health system consists of a multidisciplinary team, with a group of medical staff looking after the patients. The medical roles consist of many health workers and the family members of a patient. Especially, a pharmacist has recently become one of the high-profile medical roles. Life is directly related to the characteristics of the medical behavior which makes doctor-patient interaction so important as compared to other professionals’ relationships. There are obvious differences and contradictions between a doctor and a patient in achieving their methods of the common goal, cognition and interactive attitudes. These contradicting issues are explored in this research. It is the aim of this study to illustrate the factors and reasons that cause the change in the relationships between the medical roles resulting in deteriorating doctor-patient relationship. Fourteen medical workers and three patients are interviewed in this study. Using in-depth interview and field research, the behavioral logic and the differences among doctors, patients, pharmacists and medical practitioners are discussed.
The result of the study reveals that the traditional ‘patriarchy practice’ still exists in the current healthcare environment, but it has been weakened by the change in modern social structure and the environment (level of education and awareness of one’s rights). Secondly, in the medical role, there is conflict, mutual aid, and authority relations. Thirdly, the national health policy is also an important factor in influencing the doctor-patient relationship, such as the policy’s total budget and the differences in drug prices. Other results include the influences on the doctor-patient relationship by the improvement of technology, the rise of community pharmacies and medico-legal disputes.

並列關鍵字

Medical roles, Doctor-patient relationship, Doctor, Pharmacist, Authority

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