身體疾病住院患者之醫病溝通分析

Analysis of the Physician-Patient Communication in Medically Ill In-patients

廖士程(Shih-Cheng Liao) ； 李明濱(Ming-Been Lee) ； 李宇宙(Yue-Joe Lee) ； 謝博生(Bor-Shen Hsieh) ； 林信男(Hsin-Nan Lin) ； 陳映燁(Mei-Chih Tseng) ； 曾美智(Ying-Yeh Chen)

《Journal of Medical Education》 4卷1期 (2000/03) Pp. 38-48

https://doi.org/10.6145/jme.200003_4(1).0004

摘要

醫病溝通是當代醫學教育之重要課題，亦是全人照護理念落實之關鍵步驟，過去在台灣地區針對醫病溝通之實證研究極為缺乏。本研究主要以某綜合醫院之非精神科病房住院病患為對象，探討醫病溝通之相關議題。研究對象為262位照會精神科之住院病患，由精神科照會醫師評估病患對原科身體疾病診斷及處置之瞭解程度、醫病溝通關係之品質、以及就精神科醫師觀點評估醫病溝通的困難度等四向度；並以此四向度為依變項，就個案之人口學及住院日數等相關變數進行單變量及多變量分析。本研究之結果顯示：在所有照會個案中有五成左右在診断暸解(53.1％)、處置暸解(50.8％)、以及醫病溝通關係(49.6％)方面有中度至顯著之困難。262位個案中，有74位診斷為腦症候群，在其餘188位非器質性腦症後群病患中，年齡在診斷瞭解一項有顯著預測力，溝通有困難者，年齡顯著較高；教育程度則於診斷瞭解及處置瞭解兩項具有預測力，有溝通困難者教育程度顯著較低；本研究之結論為：就照會精神科之身體疾病住院病人而言，影響醫病溝通之重要因素如下：精神科診斷之有無、年齡、以及教育程度；其中仍以精神科診斷具有較全面之影響力。由此觀之，經由照會精神醫學服務，精神科醫師可與其他科醫師共同合作，增進醫病溝通；同時藉由經驗累積，將影響醫病溝通因素之辨認及處理，落實於醫學教育中。

關鍵字

醫學倫理 ； 醫病溝通 ； 照會精神醫學 ； 知情同意

並列摘要

Physician-patient communication is importantin contemporary medical ethics education,especially in the climate of medical litigation and third-partyinvolvement in medical decision-making.However,there have been few reports that focus on the prevalence and character of physician-patient communication of in-patients in a general hospital setting.This study was aimed at investigating physician-patient communication.Two hundred sixty two medically ill in-patients,who were referred for psychiatricmanagement during a three-month period,were included in this study.All the subjects were evaluatedby consultants using the four dimensions of physician-patient communication including:understanding of diagnosis,understanding of treatment,degree of quality in doctor-patient communication,anddegree of communication difficulty assessed by psychiatric consultants.Univariate and multivariatemethods were used to analyze the relationships between the above dimensional variables and gender,age,education level,marital status,length of hospital stay,and presence of psychiatric diagnosis ofeach patient.Around 50% of the subjects had moderate to severe degrees of problems pertaining todoctor-patient communication.The present studyalso revealed the psychiatric diagnosis,age and education level predicted the physician-patient communication comprehension independently and thepresence of psychiatric diagnosis was more influential than the others.In addition,no demographicvariables had the predictive power on the degree ofdifficulty of physician-patient communication initems of psychiatric consultants'point of view.Based on this empirical data,collaboration between psychiatric consultants and physicians for managing andimproving doctor-patient communication should bestrengthened in the future.A general survey of thestatus of physician-patient communication in a general hospital is also needed.Finally,addition of thecontents regarding the physician-patient communication of specific patient populations may play animportant role in the future of medical ethics education of physicians.(Full text in Chinese)

並列關鍵字

medical ethics ； physician-patient communication ； psychiatric consultation ； in formed consent