综合医院门诊多躯体症状患者的患病观念和医患关系特点

Characteristics of Illness Attribution and Doctor-patient Relationship of Patients with Multiple Somatic Symptoms in Outpatient Clinics of a General Hospital

目的了解综合医院门诊多躯体症状患者的患病观念和医患关系特点。方法纳入2012年3月至10月北京协和医院消化内科、中医科和心理医学科门诊患者共150例,根据躯体症状严重程度量表(somatic symptom scale of the patient health questionnaire,PHQ-15)总分≥10和<10分为多躯体症状组(SOM+组)和对照组(SOM-组),每组各75例。患者就诊前完成疾病归因问卷,就诊后医生和患者分别完成医患关系问卷、本次就诊的满意度及所用时间量表。结果 SOM+组患者认可由心理因素(16.0±4.3比13.5±4.9,P<0.01)、文化特定因素(6.5±1.8比5.6±1.8,P<0.01)导致患病的得分高于SOM-组。SOM+组患者的医患关系问卷总分(37.7±6.7比39.6±6.4,P=0.011)及"医生对我有所帮助"、"医生有足够的时间给我"和"对医生给的治疗很满意"条目得分显著低于SOM-组(P=0.028,0.038,0.022)。而医生对SOM+组患者评分在"为模糊主诉困扰"和"照顾病人费时"两条目上显著高于SOM-组(P=0.047,0.021),"面对病人心情舒适程度"评分显著低于SOM-组(P=0.014)。SOM+组患者和医生对于治疗的满意度均显著低于SOM-组(P=0.048,0.044)。关于就诊时间,患者评价SOM+组与SOM-组差异无统计学意义(P=0.814),医生评价SOM+组显著长于SOM-组(P=0.030)。结论多躯体症状患者对疾病的归因既包括心理社会因素,也包括生理因素;此类患者的医患关系困难,患者常感到得不到帮助和时间不够,医生常感到困扰和费时。

Objective To explore the illness attribution of patients with multiple somatic symptoms and their relationship with doctors. Methods This cross-sectional study was conducted from March to October, 2012, involving 150 participants who were recruited through convenience sampling from the outpatient clinics of Gastroenterology, Traditional Chinese Medicine, and Psychological Medicine of Peking Union Medical College Hospital. Based on somatic symptom scale of the patient health questionnaire （ PHQ- 15 ）, the patients were divided into multiple somatic symptoms group （ SOM ＋ group, PHQ- 15 score t〉 10） and control group （ SOM - group, PHQ-15 score 〈 10）, with 75 patients in each group. The patients completed the illness attribution questionnaire while waiting to see the doctor. After visiting the doctor, each patient and doctor were invited to finish the patient-doctor relationship questionnaire （PDRQ） or difficult doctor-patient relationship questionnaire （DDPRQ） respectively, as well as to report the degree of satisfaction with the clinic visit and the estimated time of this doctor-visiting. Results The SOM ＋ group were more likely than the SOM - group to attribute their ill- nesses to psychological factors （ 16.0 ±4. 3 vs. 13.5 ±4. 9, P 〈0. 01 ） and culture-specific factors （6.5 ± 1.8 vs. 5.6 ± 1.8, P 〈0. 01 ）. Moreover, the total score of PDRQ in the SOM ＋ group was significantly lower than that in the SOM - group （37.7 ±6.7 vs. 39.6± 6.4, P = 0. 011 ）, so did the scores for items ＂my doctor can help me＂, ＂my doctor has enough time for me＂, and ＂I am satisfied with the treatment＂ （P = 0. 028, 0. 038, 0. 022）. On the other hand, the doctor-reported scores were also higher in the SOM ＋ group regarding ＂frustrated by the patient＇s vague complaints＂ and ＂caring for this patient is time-consuming＂ （ P = 0. 047, 0. 021 ）, while lower for the item ＂I felt at ease when with this patient＂ （P = 0. 014）. The degrees of satisfaction of both patients and doctors in the SOM ＋ group were significantly lower than those in the SOM - group （P = 0. 048, 0. 044）. The patients reported no significant difference in visit time between the SOM ＋ group and the SOM - group （P =0. 814）, but the doctors-reported visit time in the SOM ＋ group was longer than that in the SOM - group （ P = 0. 030）. Conclusions Patients with multiple somatic symptoms attribute their illness to both psychosocial factors and physical factors. Relationship between doctors and these patients is difficult. Patients are likely to feel not being helped or given enough time, while doctors are likely to feel frustrated and time-consuming.