公立医院医患关系紧张的原因及对策探讨--基于医患双方视角的分析

Analysis of Factors Influencing the Doctor-patient Relationship: A Perspective Based on the Doctors and Patients in Public Hospitals

目的从医患不同视角分析医患关系紧张的影响因素。方法采用分层抽样的方法选取黑龙江省5个市的13家市级公立医院以及市辖的8家县级公立医院共1 779名医护人员和332名就诊患者为调查对象,运用问卷调查法对医患关系紧张的原因进行调查。结果医生将政府投入不足(39.1%)、工作量大(37.9%)、信任缺失(37.8%)视为导致医患紧张的最重要根源因素,而患者将政府投入不足(45.48%)、自付医疗费用过高(41.87%)、看病难(40.06%)视为最重要的驱动因素。结论政府对公立医院投入不足以及医保制度经济保障能力弱所致个人自付医疗费用过高是医患冲突最深刻的制度根源,多重因素介导的医患信任缺失是触发和加速医患紧张的重要驱动因素。通过立法和制度设计,明确政府对公立医院的投入责任、重塑医患信任、营造良好就医的舆论支持环境等一揽子方案的制定是破解医患关系困境的根本解决之道。

Objective To analyze the factors influencing the doctor-patient relationship and to provide reference.Method A total of 13 municipal public hospitals and 8 county public hospitals were investigated,including 1 779 medical staff and 332 patients. Result The survey showed the top 3 factors influencing the doctor-patient relationship were lack of government investmen（39.1%）,heavy workload（37.9%）,and chasm between doctors and patients（37.8%）based on the doctors perspective. The top three reasons were insufficient government investment（45.48%）, high medical expenses（41.87%）,and difficult to see a doctor（40.06%）based on the patients perspective. Conclusion The utmost factors to drive and accelerate the conflict between doctors and patients included the following： lack of government investment and economic guarantee ability of medical insurance system resulted in high medical expenditure out-of-pocket, and lack of trust between doctor and patients. In conclusion, increasing government investment, rebuilding the trust between doctors and patients, creating a good media environment and medical environment, and improving the doctor-patient communication are feasible choices to improve the doctor-patient relationship.