医疗暴力事件如何影响医患信任--基于认知与归因的视角

How Violence in Medical Treatment Affects the Trust Between Doctors and Patients:From the Perspective of Recognition and Attribution

暴力伤医是近年来频繁出现的社会问题。医疗暴力事件会对医患信任产生怎样的影响?鲜有实证研究给出答案。医患信任可以被进一步区分为患者信任与医生信任,个体对医疗暴力事件的认知与归因对医患信任的两个层面都会产生影响。根据公众情境理论,可以将医疗暴力事件认知划分为“问题认知”“涉入度认知”和“受限认知”三个维度;将医疗暴力事件归因划分为患方、医方、制度等因素。以深圳市为例进行的实证研究发现:在患者信任层面,只有“涉入度认知”具有负向作用,其他两个维度没有统计显著性;医方归因会降低患者信任,制度和患者经济归因反而促进了患者信任。可见医疗暴力事件并不必然降低患者信任,关键在于患者认为该事件是否和自己有关联以及如何归因。在医生信任层面,认知的三个维度都有显著的负面作用,患方和制度归因均不同程度地降低了医生信任。因此,医疗暴力事件的负面效应更多体现在医生群体。修复医患信任关系,需要更完善的法律和制度,也需要医患之间更充分、有效的沟通,媒体报道也应增强科学性和专业性,立足于“灭火”而不是急于作结论。

Violence in medical treatment is a social problem that occurs frequently in recent years.How does it affect trust between doctors and patients?Few empirical studies has given an answer.The trust between doctors and patients falls into two categories:patient’s trust and doctor’s trust.According to the situational theory of publics,the recognition of violence in medical treatment can be further divided into“involvement recognition”,“problem recognition”and“constraint recognition”.The violence in medical treatment can be attributed to factors such as patient,doctor and institution.Taking Shenzhen as an example,the empirical study finds that with regard to the patient’s trust,only“involvement recognition”has a negative effect,while the other two are not statistically significant;the attribution to doctors reduces patients’trust,whereas institution and patients’economic attribution promote patients’trust.As can be seen,violence in medical treatment does not necessarily reduce the trust of patients,and the problem lies in whether patients are involved and to what the violence is attributed.In terms of doctors’trust,the three dimensions of recognition have significant negative effects,and the attribution of patients and institutions reduces doctors’trust to some degree.Therefore,violence in medical treatment has more negative effects on doctors than on patients.To rebuild the trust between doctors and patients,laws and institutions need to be improved,and more sufficient and effective communication between doctors and patients is also needed.Media outlets should also be more scientific and professional.They should aim at solving problems rather than leaping to conclusions.