Satisfaction with patient-doctor relationships in inflammatory bowel diseases:Examining patient-initiated change of specialist

AIM:To assess the reasons for,and factors associated with,patient-initiated changes in treating specialist in inflammatory bowel diseases(IBD).METHODS:Prospectively identified IBD patients(n = 256) with ≥ 1 encounter at a metropolitan hospital were surveyed,including whether they had changed treating specialist and why.Negative reasons included loss of confidence,disagreement,and/or personality clash with the specialist.RESULTS:Of 162 respondents,70(43%) had ever changed specialists;30/70(43%) for negative reasons,52/70(74%) in the preceding year.Patients with negative reasons for changing(n = 30) were younger(median,35.2 years vs 45.3 years),had higher IBD knowledge(median,5.0 years vs 4.0 years),yet had lower medication adherence and satisfaction scores(median,19.0 years vs 22.0 years,14.0 years vs 16.0 years respectively,Mann-Whitney tests,all P < 0.05),compared to all other responders(n = 132).Patients with a recent change(for any reason) were more likely to have Crohn's disease,currently active disease,previous bowel resection and recent hospitalization [OR 2.6,95% CI(1.3-5.4),2.2(1.0-4.7),5.56(1.92-16.67),2.0(1.3-3.0),eachP < 0.05].CONCLUSION:Changing specialist appears associated with patient-related(age,nonadherence) and contemporaneous disease-related factors(recent relapse) which,where modifiable,may enhance patient-doctor relationships and therefore quality of care.

Study on the Relationship between Psychological Stress and Doctor-Patient Relationship of Cancer Patients and Their Families

Objective: To research the relationship between psychological stress and doctor-patient relationship of cancer patients and their families. Methods: The patients were randomly divided into the intervention group and the control group, and PDRQ-15, pcl-c, SAS and SDS scales were selected as evaluation indexes, and the levels of norepinephrine and dopamine were compared between the patients diagnosed with PTSD cancer and those without PTSD. Results: 1) The total score of PCL-C, SAS, SDS, PDRQ-15 scale of the cancer patients and their families after the intervention of clinical psychological care was significantly lower than that of before intervention and the control group. 2) The correlation coefficients between PCL-C, SAS, SDS and PDRQ-15 of cancer patients and their relatives were 0.971, 0.952 and 0.939 respectively. The significant test P value was less than 0.05 and the difference was statistically significant. 3) The plasma levels of dopamine and norepinephrine in cancer patients under stress were significantly higher than those in cancer patients without stress (P Conclusion: After psychological Intervention of cancer patients and their families, post-traumatic stress disorder, anxiety, depression and doctor-patient relationship were all improved.

A Literature Review in Immuno-Oncology: Pathophysiological and Clinical Features of Colorectal Cancer and the Role of the Doctor-Patient Interaction

This review is intended to describe the features of colorectal cancer both in terms of pathophysiology and clinical features of the pathology. It also describes the anatomical and clinical features of different primary tumor locations in colorectal cancer. It is also to note how relevant it is to identify rectal cancer and colon cancer as different pathologies due to the clinical, pathophysiological and immuno-oncological features of rectal cancer compared to the ones of colon cancer while remarking the importance of medical doctors in the interaction with oncological patients. Background: Colorectal Cancer (CRC) is a major public health problem, representing the third most commonly diagnosed cancer in males and the second in females and it is fundamental to note and discuss doctor-patient interaction, fundamental for proper adherence and psychological status of the oncological patient, when discussing such important and impactful pathologies. Conclusions: This review highlights the possibility of an update in the terminology of Colorectal Cancer (CRC) into different clinically relevant pathologies within the umbrella term colorectal cancer (for instance rectal and colon cancer as different tumors). It also remarks on the importance of medical doctors in the interaction with oncological patients.

Reflection on the cognitive differences between doctors and patients

As we all know, the doctor-patient relationship in China is in a very tense state. There are many reasons for this situation, an important factor among them is the cognitive differences between doctors and patients.Here we analyze the reasons for the cognitive differences between doctors and patients from the perspective of both doctors and patients cognition of diseases, the motives of both parties and the expectations of curing diseases.We will also discuss a: "patient-centered" concept, strengthening effective communication between doctors and patients, as well as how they can respect each other's personality and rights.

人文关怀理念下急性前庭综合征患者的诊疗路径研究

当前在急性前庭综合征诊疗工作中存在着较多困境,比如病因复杂难鉴别,临床医生诊治水平参差不齐、人文关怀意识不强、沟通缺乏技巧性和缺乏内在亲和力等。各种原因使急性前庭综合征患者在诊疗过程中困难重重,不能得到及时有效的治疗,加剧了医患矛盾。为此,运用人文关怀理念探索急性前庭综合征诊疗工作的新路径,医患之间相互尊重,打造具有“人文关怀”价值取向的医务工作者队伍,推动“人文关怀”理论与实践有机统一,以期更好地促进急性前庭综合征诊疗工作的落实,帮助更多患者重建信心,提高生活质量,改善医患关系。

临床医生实践医患共同决策的思考

医患共同决策是继家长式决策模式和知情同意模式后,逐渐被大家认可的临床决策模式。在我国经历20多年的发展,逐渐被临床医生所认可并不断引入临床实践,但其发展并不如想象中那么乐观。虽然它可以改善医患关系、减少决策失误,但实际工作中仍存在缺乏政策指引、医患双方互不信任、医生没有实现共情等诸多实际问题,致使医患共同决策的推进并不顺畅。因此,医患共同决策模式作为理想的决策模式,在我国临床工作中仍需要不断探索与完善。

基于患者公共关系管理的医患矛盾解决方法初探

医患矛盾的影响因素是复杂、深远的,双方之间的矛盾亟须得到有效解决。文章基于患者公共关系管理有关理论方法,分析日益凸显的医患矛盾现状及其成因,并应用患者公共关系管理手段,不断加强医院患者公共关系管理。通过持续完善、改进患者公共关系管理标准作业,设立专业化管理部门,提升危机意识,拓展宣传服务与教育外延等一系列富有较强操作性的管理行动,能够有效地为医院日常运营创造以患者为代表的良好的外部公共关系环境,对缓和当下不断激化的医患矛盾起到了积极影响;同时也对探索建立与完善医患矛盾应对相关机制具有一定的参考意义。

Trust in Clinical Practice: A Systematic Review

Background: The aim of this study is to gain a better understanding of the true importance of trust in clinical practice by looking at how it is formed, how it affects clinical practice, and how to improve it. Methods: Using the PRISMA-ScR checklist, a review of the literature was performed to identify research evaluating the importance of trust in the doctor-patient relationship. After thorough screening and removal of duplicates, 21 articles were used in the literature review. Results: The classifying themes that emerged in the selected articles were What Makes Trust and Effects of Trust. The theme of What Makes Trust garnered two subthemes as well: Impact of Doctor-Patient Relationship on Trust and Impact of Shared Decision-Making on Trust. Further to that, the overarching themes found were slightly more specific. They were Traits of Trust, Mistrust and Barriers to Trust, Positive Effects of Trust and the Effects of a Lack of Trust. We found that the best way to improve trust was to improve communication between the patient and the doctor. Additionally, we found that the biggest barrier to a trusting doctor patient relationship was a stigmatised condition, followed by a perception of a financially-motivated doctor. Finally, we found that a lack of trust can prevent patients from seeking and receiving proper treatment. Conclusions: With a better understanding of how trust is built and the extent of the role it plays in clinical practice, we hope that this growing knowledge can improve the practice of many doctors in the future. It is certain that more research needs to be done in this area, especially focusing on vulnerable and stigmatised populations such as chronic pain patients.

结直肠癌诊治中的伦理问题研究

结直肠癌是常见的恶性肿瘤之一,中国结直肠癌的发病率和死亡率均保持上升趋势。作为一种高发性恶性肿瘤,在筛查、诊断以及治疗过程中,结直肠癌不仅具有与其他疾病类似的一般伦理问题,同时还存在自身疾病所特有的伦理问题,包括结直肠癌筛查与医保报销的可及性、问诊与查体中隐私暴露与医患关系物化、过度诊疗中的癌症细胞“杀”与“养”相平衡的问题,以及肠造口引发的患者生理与心理问题等内容。总结与分析了结直肠癌诊治中具有特殊性的伦理问题,并提出了相应的对策与建议。

多点远程执业模式对医师注意义务认定的挑战及其回应

多点远程执业模式以医师为主体,通过互联网技术为注册医师多点、线上执业提供了可能,但也对医师注意义务的认定带来挑战。在多点远程执业模式下,法律关系由简单变得复杂,诊疗场景由单一转向多变,主观医疗过错的判定由相对容易变得较为困难。在这种情况下,医患关系的成立节点、医师在不同情境下的具体诊疗义务以及各主体之间的责任分配规则等问题需要重新思考。医患关系是否存在之认定应以是否接受诊疗为关键判断因素,远程诊疗下应扩张解释医师的亲自诊查义务。各主体之间的责任分配以合同作为主要判断依据,如果不存在合同,则需要根据民法典中相关规定进行确定。

医患共同决策诊疗模式在胸部肿瘤患者中的应用进展

医患共同决策(shared decision making,SDM)作为新型的诊疗决策模式,能够有效解决胸部肿瘤诊疗过程中患者的依从性问题,平衡医患双方的地位,逐渐在胸外科临床实践中得到重视和应用。将SDM应用于胸部肿瘤诊疗过程中有利于提升医生的诊疗水平,缓解责任压力;减轻患者的心理压力,提高患者的依从性;提高医信力并减少医患冲突。由于患者自身的医学素养和自主性有限,医患比例失衡导致的诊疗时间紧张,同时由于已有的研究存在样本量有限等原因尚不能证明采用SDM模式对于胸部肿瘤的治疗有明确的增益,推行SDM模式仍面临阻力。未来通过开发辅助决策系统以及提升医生的人文关怀能力将更有利于推动SDM模式在胸外科的实际应用。

法律视角下构建和谐医患关系的路径研究——基于产科医疗损害案件判例的分析

分析了中国裁判文书网2020年1月—2022年6月期间20例产科医疗损害案件中医方存在的法律问题,希望在法律背景下探索医方为构建和谐医患关系可借鉴的路径。第一,医疗机构应建立危重症孕、产妇抢救评审制度和预警机制,确保孕产妇和新生儿生命健康安全,防范产科不良事件的发生。第二,加强产科医疗执业人员人文素质培养是和谐产科医患关系的基础。第三,加强《中华人民共和国民法典》《中华人民共和国医师法》等相关法律和法规的培训和学习。第四,尊重患者的知情权,用制度规范知情同意履行的环节和程序,更进一步探索知情同意履行形式。第五,探索医疗风险分担机制,建议产妇购买产科意外保险合理分担医疗风险。第六,引入医务社工,加强医患沟通,提升全社会产科风险意识。

患者视角下多重制度逻辑对医患关系的作用机制研究

目的探究多重制度逻辑对医患关系的作用机制。方法通过梳理多重制度逻辑理论,提出患者视角下多重制度逻辑对医患关系作用机制的概念模型,并对江苏省2家三级公立医院住院患者进行问卷调查,分析患者视角下多重制度逻辑对医患关系影响的作用路径,验证概念模型。结果构建了多重制度逻辑对医患关系作用机制的概念模型,验证了患者视角下多重制度逻辑对医患关系有明显影响,市场逻辑和社会逻辑的交互在一定程度上影响医患关系,患者关注焦点在多重制度逻辑对医患关系的影响作用中起到中介效应,多重制度逻辑和患者信息配置能力的交互对患者关注焦点影响明显。结论多重制度逻辑对医患关系的影响存在两条路径:一是多重制度逻辑对医患关系发挥作用的直接效应路径;二是患者关注焦点的中介效应路径,该路径受到患者个体信息配置能力的调节。

某三甲专科医院2016—2020年医疗纠纷赔付案例分析

目的 通过对安徽省某三甲肿瘤医院2016—2020年发生的医疗纠纷案件进行分析,提出预防和减少医疗纠纷发生的对策。方法 收集该院2016—2020年52例已赔付医疗纠纷案例,对其发生情况、科室分布、产生原因以及解决途径进行统计分析。结果 该医院医疗纠纷发生率总体呈下降趋势,纠纷科室集中在外科手术科室,主要通过协商调解或诉讼途径解决纠纷。结论 做好医务人员医疗纠纷防范培训和事后考核,加强医患沟通,建立医疗风险分担机制有利于预防和减少医疗纠纷。

医生医患环境感知与防御性医疗行为倾向关联研究

目的:了解医生防御性医疗行为倾向现状,探索医生的医患环境感知与防御性医疗行为倾向之间的关系。方法:对黑龙江省27家公立医院的医生进行问卷调查,采用因子分析法提取医生的防御性医疗行为倾向类型,运用Amos26.0构建医生医患环境感知与防御性医疗行为倾向关系的结构方程模型。结果:医生积极防御性医疗行为倾向平均得分为14.98±5.24,消极防御性医疗行为倾向得分为16.37±7.62。医生积极防御性医疗行为倾向与医患互动(β=0.435,P<0.001)、制度环境(β=0.146,P<0.001)和文化环境(β=0.132,P=0.012)存在正相关关系,与对患者行为态度评价无关(P>0.1)。消极防御性医疗行为倾向与医患互动(β=-0.279,P<0.001)、对患者行为态度评价(β=-0.210,P=0.012)和文化环境(β=-0.042,P<0.001)存在负相关关系,与制度环境(β=0.078,P=0.007)存在正相关关系。结论:提升医生对患者行为及态度的评价,加强医患互动以及改善外部的制度和文化环境将有利于医生正确认识防御性医疗行为,减少消极防御性医疗行为的发生。

硕士规培生临床共情对医患关系的影响机制:基于群际心理的视角

目的:从群际心理的视角考察硕士规培生临床共情对医患关系的影响及作用机制,并检验群际焦虑的中介效应及社会认同的调节作用。方法:采用社会认同问卷、杰弗逊医学生共情量表、群际焦虑量表、医患关系量表对481名临床医学专业型硕士规培生进行问卷调查。结果:1硕士规培生临床共情显著正向预测医患关系(β=0.35,95%CI=[0.27,0.42]);2群际焦虑在临床共情与医患关系中起中介作用,中介效应占37.5%;3该中介作用的后半段路径受到社会认同的调节作用(β=0.07,95%CI=[0.01,0.13])。具体表现为,高社会认同削弱了群际焦虑对医患关系的负向预测作用。结论:硕士规培生临床共情不仅能直接影响医患关系,而且会通过群际焦虑间接影响医患关系,且社会认同在中介模型的后半路径起调节作用。

“12345”热线诊疗投诉特征、产生原因及改进建议分析——以江苏省某口腔医院为例

正视口腔患者的合理诉求,及时、有效地处理患者的诊疗投诉,关系到口腔医疗服务质量提升与患者就医体验改善,具有重要意义。通过对江苏省某三甲口腔专科医院2019-2022年“12345”热线受理的1 778例诊疗投诉进行分析发现,诊疗投诉数和每万人次诊疗投诉数均逐年上升,单月诊疗投诉数受到疫情防控政策影响呈现波动趋势,患者投诉内容主要集中在工作流程、疫情防控、医疗质量、停诊问题等方面。导致上述问题的原因主要包括突发公共卫生事件的影响、医疗资源配置不合理、医务人员医疗技术不足与职业倦怠、医患双方的认知存在差异、投诉处理机制与医疗纠纷管理不适配。为此,建议提升突发公共卫生事件的处置能力;合理配置医疗资源,持续优化诊疗流程;提升医疗服务水平,积极缓解职业倦怠;消除医患认知差异,推动共同决策模式构建;优化投诉管理机制,避免医患矛盾加剧。

基于挫折攻击理论的急诊工作场所暴力成因分析及预防对策探讨

我国急诊科工作场所暴力发生率高、持续存在、防范难度大,对医务人员造成严重的伤害。为解决这一问题,基于挫折攻击理论,探究患者遭遇医源性挫折后发动攻击的心理动因,发现医源性挫折来源、受挫患方的特征、急诊硬环境刺激、社会情境是引发急诊科工作场所暴力的重要原因。因此,建议医疗机构从医疗风险沟通、医方人文关怀、暴力高风险人群管理、急诊环境的基础设施、维权渠道、媒体报道入手,利用多元化措施预防和治理急诊科工作场所暴力,从而缓解医患矛盾。

某三级医院2020年-2022年医疗投诉状况调查分析

目的通过调查分析某三级医院医疗投诉案例中其医疗投诉事件的起因及诉求,为改善医疗服务水平和减少医疗投诉的发生提供建议。方法采用回顾性分析法,对该医院2020年—2022年间受理的315件医疗投诉案例进行整理及分析。结果医疗投诉率呈逐年下降趋势,投诉的主要来源是12345便民热线和医务科投诉办的受理;服务态度、医疗质量、医患沟通、医疗流程是医疗投诉的主要内容;投诉对象中,投诉科室以临床科室居多,被投诉人员以医师为主。结论以投诉管理为抓手,改善服务态度,加强医患沟通,规范诊疗行为,增强医院综合服务能力,进而提升医疗质量,改善患者就医体验。