扭曲的赋权:中国城市公立医院的医患权力关系——以纠纷解决与处理为例

Doctor-patient relationship: a study of dispute solutions in the public hospitals of Chinese cities

基于1000多例案件档案,以及针对关键性个案的当事人的访谈、医患纠纷处理过程的田野观察,以中国城市公立医院的医患纠纷发生与处理为例,分析纠纷发生和解决过程中的医患权力关系,以及国家制度实践对双方权力策略的影响。一方面,在形成阶段,纠纷中的医患双方在医疗效果、医疗正当性、医疗风险认知及医疗治疗不良后果归因存在系统性的偏差。另一方面,在解决阶段,医方更倾向于使用技术化的赋权手段,患者更倾向于使用社会化的赋权手段。在不同类型的纠纷解决过程中,国家介入程度、医患双方自主性存在显著差异。与西方医患权力关系有所差异的是,中国医患权力关系具有高度情境性,且极易受到国家等外生变量的影响。

There are abundant studies on doctor-patient relationship while few of them discuss empirically the doctor-patient power relationship in China. Based on 1,000 archival files,interviews and field investigations,the author analyses the doctor-patient power relationship in medical disputes cases in the public hospitals of some Chinese cities and how the government can influence the relationship. In the formative stage,a perception gap between doctors and patients occurs in terms of clinical outcome,legitimacy,risks and causes of unsatisfying effect. In the resolution stage,hospitals favor technical means while patients prefer social means. Government intervention and disputants’autonomy vary sharply from case to case. Unlike the situation in the West,the doctor-patient power relationship is highly contingent and is subject to government influence in China.