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.

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.

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.

Humanity factors and more: A little heads up for medical students and future doctors

Exactly how can we become a successful doctor in the future? It has been widely accepted that chasing perfection in our field of expertise alone is not enough. Here in China, doctors have the liability to do more. Chinese doctors are relatively more prone to confronting difficult situations in a more complex manner. Therefore, the humanity factor in medical practice is discussed, and some essential communication skills are suggested for medical practitioners, with heartfelt anticipation for a better medical environment as well as a more pleasant Doctor-Patient relationship.

A Pragmatic Study on Non-aggressive Doctor-patient Conflict Talk-From the Ecolinguistic Perspective

Doctor-patient relationship is a very important relationship between doctor and patient and patient’s family member.In interpersonal communication,non-aggressive discourse often leads to conflicting response.It is the most common doctor–patient relationship between doctor and patient.There are limited studies on non-aggressive conflicting response.Language used is the most important basis in conflicting response to non-aggressive discourse.Language and culture are broad and diverse.Different speech methods and language content lead to different response.Based on this,this paper explains response to non-aggressive conflict talk between doctor and patient in the perspective of ecolinguistics,to provide reference.

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.

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。

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。

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。

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。

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。

改善患者就医体验提升满意度实践探索

在医疗市场竞争日益激烈的今天,患者就医感受直接决定着满意度,更决定着医院的社会形象。作者以改善患者体验提升满意度为抓手,聚焦上海某医院“医疗环境更友好、医疗服务显尊重、就诊流程更便捷、医患关系增互信、医院治理促合作”5个重点环节,就如何进一步强基础、补短板、促实效提升患者满意度做了有益的探索。

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。

叙事医学本土化的若干思考

叙事医学为人文社会学科介入医学范畴提供了建构性方案,使技术至上的医疗实践逐渐转向重视患者个体的生活价值、痛苦关怀的人文实践,对于医患主体间的鸿沟消弭、理解改善具有独到之处。然而,在中国式现代化的路径视角下,依然需要对西方语境中的叙事医学方法论进行审慎反思,尤其是要考虑国别体制下的文化差异与社会现实,避免造成简单化搬运与应用。在扎根中国本土情境的基础上,探索适应我国的医疗卫生实践、构建和谐医患环境的叙事医学模式。

我国三级公立医院住院患者对医生的信任现状及影响因素研究

目的调查我国三级公立医院住院患者对医生的信任现状并分析其影响因素,为提升患者信任度、改善医患关系提供参考。方法依托第3次全国改善医疗服务行动第三方评估项目,选取全国31个省(区、市)和新疆生产建设兵团共136家三级公立医院开展调查,共收回21092名住院患者的调查问卷。应用R4.3.2软件对所得数据进行统计分析。结果我国三级公立医院住院患者对其主治医生的信任度为98.37%。患者职业、家庭年收入、医院类型等非医疗因素是住院患者对医生信任度的影响因素。结论我国三级公立医院住院患者对医生的信任度总体较高,但不同地区存在差异。应重视病区环境和膳食质量等非医疗因素的改进,以增强患者对医疗服务提供方的信任,提升患者整体就医体验,进一步改善医患关系。

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。

医务人员视角下医患心理契约对医患关系影响研究

目的:基于医务人员视角,探究医患心理契约对医患关系的影响。方法:采用修订的医患心理契约量表和医患关系量表(DDPRQ-10)进行问卷调查,运用描述性统计分析、相关分析和多元线性回归分析等对有效样本量进行分析。结果:相关分析显示,医患心理契约和医患关系存在显著相关关系,医患心理契约各维度和医患关系也存在显著相关关系;回归结果显示,发展责任维度对医患关系的影响差异具有统计学意义(P<0.05)。结论:建议提升公众健康素养、提升诊疗质量和落地叙事医学实践,增强医患间的心理契约,从而改善医患关系。