乡村两级医德关系及道德环境的比较分析

A comparative analysis of physician-patient relationship and moral environment between township health centers and village clinics

目的了解乡村两级医务人员所处的独特的医德关系及道德环境现状,探寻其中存在的伦理问题,并结合乡土社会的具体情境提出适宜的伦理改善之策。方法选取北京市北部某远郊区县,分层抽取3个乡镇,进行实地观察研究,观察访谈村民及乡镇卫生院患者48人,同时对该区14个涉农乡镇进行分层随机问卷调查,调查村民及乡镇卫生院患者350人,基于需方视角分析乡村两级医务人员置身的医德关系及道德环境,分析其中存在的伦理问题。结果被调查的村民及乡镇卫生院患者,对于当前乡村两级医患关系性质的认知,均以"诊疗关系"为主。在村级,村民认为医患之间处于第二位的关系是庄亲关系,这一比例(11.79%)明显高于乡镇卫生院患者的选择结果(1.10%)。村民对乡镇卫生院和村卫生室的医疗机构信任度分别为78.69%和80.67%;对乡镇医务人员和村医的信任度分别为81.88%和85.55%。结论乡村两级医务人员所处的道德环境有所差异,村级医务人员的职业道德受家庭道德和公共道德的交互影响,乡镇医务人员更多地呈现出职业道德的原貌。被调查对象对于村级医务人员及村卫生室的信任程度略高于其对乡镇级的信任程度。乡村两级医务人员要想与患者之间建立起持久的信任关系,均须在强化自身诊疗服务技能的同时,完善自己的道德品行,使患者从对其能力信任的建立上升至为终身的德行信任。

Objective To investigate the typical physician-patient relationship and moral environment that medical personnel in township health centers and village clinics are facing,explore the ethical problems,and put forward the appropriate ethical improvement measures combined with the specific situation of the local community. Methods There townships in north suburbs in Beijing were sampled by stratified sampling method. The field observation study was carried out. 48 villagers or patients in township health centers were interviewed; a questionnaire survey was conducted among 350 villagers or patients in township health centers. The physician-patient relationship and moral environment that medical personnel in township health centers and village clinics have been facing were analyzed from a demand-side point of view. The ethical problems were discussed. Results The respondents believe that the current rural physician-patient relationship is based on diagnosis and treatment,and followed by the relationship between folks at the village level（ 11. 79%）,which was significantly higher than the results of the township（ 1. 10%）. The villagers＇ trust in township hospitals and village clinics were 78. 69% and 80. 67%,respectively,and the trust degree to township medical staff and village doctors was 81. 88%and 85. 55%,respectively. Conclusions The moral environment faced by medical staff in township health centers and village clinics is different. The professional ethics of the medical staff in the village is influenced by the family morality and public morality,while the township medical staff show more occupation moral appearance. The level of trust in the village clinics is slightly higher than the level of trust in the township level. Rural medical staff who want to establish a lasting trust relationship between patients should strengthen their own medical service skills and improve their moral character at the same time,to enable patients build trust from their ability to a lifetime of moral trust.