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.

Under the narrative medicine theory to establish the evidence-based medical record written by doctors and patients through integrated therapy of traditional Chinese and western on digestive system diseases

Objective:The aim of this article was to discuss the theory of doctor-patient co-operated evidence-based medical record and set up the preliminary frame of the doctor-patient co-operated evidence-based medical record following the concept of narrative evidence-based medicine.Methods:The information was searched from Pubmed,Embase,CBMdisc,CNKI.A preliminary agreement was reached by referring to the principles of narrative medicine and advises given by experts of digestive system and evidence-based medicine in both Traditional Chinese Medicine and Western Medicine.Result:This research is a useful attempt to discuss the establishment of doctor-patient co-operated evidence-based medical record guided by the direction of narrative evidence-based medicine.Reflection and outlook:Doctor-patient co-operated medical record can be a key factor of the curative effect evaluation methodology system of integrated therapy of Tradition Chinese Medicine and Western Medicine on spleen and stomach diseases.

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.

Gorgeous Transformation Analysis on Influence of Doctors＇ Clothes on Patients

Doctors＇ clothes have bidden farewell to the historical limitation of only being used as the working clothes, which have become an important part of hospital image. In the eyes of patients, the appearance image of doctors is the image which is most concerned by patients. Doctors＇ clothes beauty reflects the inner beauty of doctors in working, giving the patients the warmth and comfort, which is of great importance to both the physical and mental therapy.

Functional Health Literacy and Doctor-Patient Communication: Experiences of HIV/AIDS Patients in Homa Bay County, Kenya

Patient involvement in the health care process has been documented as a critical component of successful disease management. However, inadequate functional health literacy among patients is a well-known barrier to effective doctor-patient communication, which has an adverse effect on health outcomes. This study aimed at investigating the association of functional health literacy and doctor-patient communication among HIV/AIDS patients in Homa Bay County, Kenya. It was a cross-sectional hospital-based survey conducted among 362 HIV/AIDS patients receiving care at the eight sub-county hospitals of Homa Bay county. Data was collected using a self-administered structured questionnaire. Cronbach’s alpha and confirmatory factor analysis tests were used to ascertain the reliability and validity of study instruments, while Logistic regression logistic analysis was used to measure the association between functional health literacy and doctor-patient communication. 51% of the respondents were females, and the majority (30.9%) of respondents fell in the age group of 45 years and above. The respondents’ functional health literacy levels were inadequate at weighted means scores of 3.23 [SD 1.31]. The study further established that functional health literacy significantly influenced doctor-patient communication [Nagelkerke R square = 0.318]. There is, therefore, a need to document the determinants of functional health literacy to improve it and make doctor-patient interaction an enjoyable and meaningful experience.

Survey on Knowledge Toward Diabetic Periodontal Condition and Oral Health Among Medical Staff and Patients

The study was conducted to understand the cognitive status of medical staff and patients on the status of periodontal disease and oral health care in patients with diabetes,and to provide reference for the implementation and improvement of diabetes management and health education.Using the Diabetes Periodontal Status and Oral Health Knowledge Questionnaire,108 doctors,190 nurses,and 212 inpatients were investigated.This study demonstrated that,the total scores of doctors,nurses,and patients with diabetes periodontal status and oral health knowledge were(31.18±5.14),(28.58±4.09)and(18.67±3.45)points,respectively.The results of regression analysis showed that education level,department,and related training experience(p<0.05,p<0.01)were the influencing factors of the diabetic periodontal status and oral health knowledge level of the medical staff,meanwhile the monthly income,department,and relevant training experience(p<0.05,p<0.01)were the factors influencing the diabetic periodontal status and oral health care knowledge level of the patients.In summary,the cognitive level of diabetic periodontal status and oral health care knowledge of the medical staff and patients’needs to be improved.Medical staff should pay attention to the study of diabetic periodontal status and oral health care knowledge,further perform a good job in the relevant health education of patients,which is helpful to maintain good oral hygiene.

疾病认知对老年高血压患者饮食依从性的影响及调节机制分析

目的:探索疾病认知对老年高血压患者饮食依从性的影响,以及影响过程中学习意愿和医患信任的中介作用和自我效能感的调节作用。方法:采用自编郑州市老年高血压群体健康管理调查问卷对郑州市辖区内的1 290例老年高血压患者进行调查。采用Mplus程序对相关变量构建回归模型,并进行中介效应和调节效应检验。结果:疾病认知可以正向影响老年高血压群体的饮食依从性,而且学习意愿和医患信任在其间发挥中介作用[β医患信任(95%CI)=0.127(0.041~0.213),β学习意愿(95%CI)=0.112(0.036~0.190),P<0.05],中介效应值均为0.021。除此之外,自我效能感可以调节疾病认知对老年高血压患者饮食依从性的影响[β(95%CI)=0.076(0.006~0.146),P=0.012]。结论:疾病认知可通过学习意愿和医患信任两个中介变量影响老年高血压患者的饮食依从性,且自我效能感具有一定的调节作用。

情景模拟结合CBL对提升产科住院医师医患沟通能力的效果分析

目的探讨在产科住院医师规范化培训(简称住培)中进行情景模拟结合以案例为基础的教学对医患沟通技能培训的效果。方法选取50名在产科规范化培训的住院医师为研究对象。培训前进行学员调查和医患沟通能力SEGUE测评。基于产科住培大纲选择5个典型病例情景,由教师录制5个典型病例病情医患沟通的示范视频,并梳理相关背景知识,在产科住院医师中依次开展培训课程,即视频示范、小组讨论、病例背景知识梳理讲解、分角色演练、演练后反馈和评价以及临床实践。培训后再次进行学员调查和医患沟通能力SEGUE测评。使用配对样本的非参数检验方法评价培训效果。结果情景模拟结合以案例为基础的教学的医患沟通技能培训后,学员医患沟通能力SEGUE测评总分提高[13.00(11.00~16.00)vs.22.00(20.00~24.00)],差异具有统计学意义(Z=-6.159,P<0.001);医患沟通能力SEGUE测评总体合格率提高[36.0%(18/50)vs.98.0%(49/50)],差异具有统计学意义(χ^(2)=43.464,P<0.001)。结论情景模拟结合以案例为基础的教学的医患沟通技能培训可有效提高学员医患沟通能力,调动学员的学习主动性,激发学员内在学习动力,建议在产科住培中纳入此类课程。

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。

急诊医疗实践中的伦理冲突与探讨

医学伦理学在急诊临床实践中遇到的具体问题非常复杂,其中良好的医患关系、以患者为中心是医学伦理学的基石。医疗工作围绕最大程度地改善患者的疾病预后,最大可能地实现患者及其家庭的幸福,照顾患者及家庭的情感需求,不能威胁医生执业安全来开展。医疗本身复杂、专业,患者个案处在不同的场景下,因不同的人、不同的家庭、不同的理念,具体的诊疗行为必然有所不同,没有完全统一的标准。对四个典型案例进行伦理学探讨,以期为临床工作中遇到的复杂伦理学问题提供思考方法。

PBL教学法联合情景模拟在医患沟通教学中的应用

目的 研究以问题为基础的教学法(problem-based learning,PBL)联合情景模拟在培养住院医师医患沟通能力中的作用。方法 将2022年9—12月在中山大学孙逸仙纪念医院进行规范化培训的40名二年级住院医师随机分为试验组20名、对照组20名,试验组采取PBL教学法联合情景模拟教学,对照组采用PBL教学法,共4学时。教学过程中进行课堂教学效果评价。教学前和教学结束后,分别应用医患沟通技能评价量表(doctor-patient communication skills evaluation scale,SEGUE)对2组学员进行医患沟通能力评价,对2组得分进行统计学分析。2组均发放教学满意度调查问卷。结果 试验组课堂效果优于对照组,试验组住培学员在课堂气氛、师生互动、讨论活跃度、课堂注意力和学习积极性方面的评分高于对照组,差异有统计学意义(P <0.05)。试验组在教学完成后的SEGUE量表评分高于对照组,差异有统计学意义(P <0.001)。试验组满意度高于对照组,但差异无统计学意义(P> 0.05)。结论PBL教学法联合情景模拟能够活跃课堂气氛、增加住培学员的学习积极性,有效提高住院医师的医患沟通能力,优于单纯PBL教学法。

案例分析教学法联合教师标准化病人在卒中后神经源性膀胱临床沟通教学中的应用

目的探讨案例分析教学法(case-basedlearning,CBL)联合教师标准化病人(teacher-standardized patient,TSP)在卒中后神经源性膀胱医患沟通教学中的应用效果。方法纳入首都医科大学附属北京天坛医院接受规范化培训的60名住院医师,随机分为对照组和试验组。对照组采用传统以授课为导向的教学法,试验组采用CBL联合TSP的教学方法。教学内容为卒中后神经源性膀胱的医患沟通,共计12学时。教学结束后使用TSP和医患沟通技能评价量表(set the stage,elicit information,give information,understand the patient’s perspective,and end the encounter;SEGUE)评估住院医师的医患沟通能力。结果对照组和试验组在年龄、性别、入组前理论考试分数及操作考试分数方面差异无统计学意义。教学结束后,试验组在SEGUE的问诊准备[(4.6±0.6)分vs.(3.7±0.8)分,P<0.0001]、信息采集[(8.6±1.1)分vs.(7.3±0.9)分,P<0.0001]、信息提供[(3.7±0.5)分vs.(3.3±0.6)分,P=0.0099]、患者理解[(3.5±0.4)分vs.(2.4±0.7)分,P<0.0001]及总分[(22.1±1.5)分vs.(18.5±2.0)分,P<0.0001]方面均显著高于对照组,在问诊结束[(1.7±0.6)分vs.(1.7±0.5)分,P=0.6305]方面与对照组差异无统计学意义。结论采用CBL联合TSP的教学方法能够显著提高住院医师在卒中后神经源性膀胱医患沟通方面的能力。这一教学策略有望成为医学教育中提高医患沟通技能的有效手段,从而提高医疗服务质量。

实施医师驾照式管理对医患纠纷的影响

应用SPSSAU(在线SPSS分析软件)分析某三甲综合医院实施医师驾照式管理前后,责任人为医生的685例医患纠纷数据,为各医院纠纷管理提供参考。研究发现,实施医师驾照式管理后,医患纠纷发生率、责任人为医生的纠纷占比均显著下降;各类原因(患者因素除外)引发的纠纷占比均显著下降;与医师驾照式考核内容直接相关的纠纷成因占比均显著下降;上级转办和网络途径受理的纠纷占比、调解和诉讼方式解决的纠纷占比以及赔偿纠纷占比均显著下降。由此可知,实施医师驾照式管理可有效降低医患纠纷发生,同时可促使纠纷平稳、低成本、高效解决。

由医方言语导致的医疗纠纷类型分析及应对建议

医生语言表达水平会直接影响信息传递和沟通效果。近20年来,有大量研究以量表的形式对医护人员和患者进行“医患沟通”相关问卷调查,但关于医患沟通实际应用和医患纠纷实例分析的研究较少。以某三甲医院《投诉登记本》为研究素材,总结出因医方语言产生的医疗纠纷的五种原因,分别为医方语气生硬、肢体语言失当;治疗方案沟通不明确;无法回答患者的问题;不同医生说辞相悖;病情预判与病情发展差距大。通过分析此类纠纷的处理要点,以期运用在今后的医学生医患沟通课程或医生语言技巧培训中,优化医患沟通,推动医患关系向好发展。

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。

医学本科教育中医患沟通能力的培养策略探讨

随着现代医学模式的转变,对医学生医患沟通能力提出了更高的要求,医生与患者之间的沟通交流愈发重要。良好的医患沟通能力已成为现代医生必备的核心能力之一,是建立和谐医患关系、顺利开展医疗活动的关键。长期以来,我国医学教育对于本科医学生医患沟通能力的培养重视不足。近年来各院校已逐渐开展相关的教学探索,但尚未形成系统规范的培养体系。文章主要针对如下内容展开:医患沟通能力培养的重要性、我国医患沟通教育现状、医患沟通能力培养的策略探讨,如“转变观念,重视医患沟通能力的培养”“早期接触临床”“加强相关课程建设”“分层次培训,关注学生特点因材施教”“建立医患沟通能力的考核机制”“加强综合素质培养,提升岗位胜任力”。同时,对医学本科教育中医患沟通能力的培养策略进行探讨。

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。

聊城地区医护人员安宁疗护认知及态度调查分析

目的调查聊城地区医护人员对安宁疗护的认知及态度现状,并分析相关影响因素,为进一步开展安宁疗护服务提供参考。方法采取便利抽样方法,于2022年1—6月选取404名聊城地区各级医院的医护人员为研究对象,进行安宁疗护知识及态度问卷调查,利用统计学方法进行相关影响因素分析。结果聊城地区医护人员安宁疗护的知识得分为(13.02±4.10)分,平均得分率为65.10%,态度得分为(38.67±5.64)分,平均得分率为64.50%。年龄(41~50)岁、接受过教育培训、医治或护理过中晚期患者、了解伦理道德和文化习俗与知识得分成正相关(P<0.05)。年龄(>50岁)、职称(副高级职称)、岗位(医疗)、医治或护理过中晚期患者会对态度得分产生显著的正向影响关系(P<0.05)。结论聊城地区医护人员对安宁疗护的认知和态度处于中等水平,加强建设规范的安宁疗护体系有助于提高医护人员的安宁疗护认知及态度水平。

情景式CBL联合SSP教学法在住院医师医患沟通技能中的应用研究

目的探索情景式案例教学法(CBL)联合学生标准化病人(SSP)在中医住院医师医患沟通技能培训中的运用效果。方法选取2022年2月—2022年3月进行住院医师规范化培训的2021级住院医师120人作为研究对象,随机分为对照组和观察组,各60人,进行医患沟通技能培训。对照组采用传统授课方式,观察组采用情景式CBL联合SSP教学方式授课,教学时长4周,每周1次,每次2学时。培训结束后,应用医患沟通技能评价量表(SEGUE)对两组住院医师的医患沟通能力进行评分,同时发放调查问卷对教学方法进行评价。结果医患沟通培训后,对照组和观察组SEGUE量表的总评分分别为(20.85±3.43)分、(23.93±2.11)分,观察组总评分及各维度评分均高于对照组,差异有统计学意义(P<0.05)。在对教学方法的评价方面,观察组均优于对照组,差异具有统计学意义(P<0.05)。结论情景式CBL联合SSP教学法应用于住院医师医患沟通技能培训效果较好,值得在今后的实践教学中推广应用。

基于“四象限模型”的医患信任测量量表构建及初步研究

目的 通过构建适宜我国应用的“四象限模型”医患信任测量量表,评价分析其效度及信度,为改善医患关系提供一定的帮助。方法 本文以国外学者研究的“四象限模型”为理论框架,通过文献回顾、访谈法、德尔菲专家咨询法等多种方式构建“四象限模型”医患信任测量量表,将某院作为实际研究的案例,对“四象限模型”医患信任测量量表的信度、效度进行检验。结果 “四象限模型”医患信任测量量表的总Cronbach’s α信度系数为0.912;分半信度R为0.863和0.932;内容效度Pearson相关系数0.38~0.81,均具有统计学意义;结构效度RMR为0.065,RMSEA为0.073,χ~2/df为2.236,GFI为0.791。结论 经过某医院的实证检验,“四象限模型”医患信任测量量表具有较高的信度和较好的效度,可为我国医患信任方面研究提供一个科学的、合理的、有效的并且符合我国国情的医患信任测量量表,在重构医患信任、改善医患关系方面有着广阔的应用前景。