Your understanding of the past doctor-patient relationship?

I, the current situation of the doctor-patient relationship

The doctor-patient relationship is to medical personnel, hospitals for the medical side, patients, family members for the affected party, the natural form of

[1] into a voluntary combination of a social and interpersonal relationships. With the rapid development of medical science and the improvement of national

national quality, people's attention to the right to health and medical needs of the expectations of the people have also increased, the professional ethics of medical personnel, technical level, quality of service and so on also put forward higher requirements. [2] However, with the transformation of society and the deepening of the market economy in China,

[3] the medical market has been profit-oriented, with conflicts of interest between doctors and patients, and tensions in the doctor-patient relationship. In the past 10 years

In the past 10 years, the incidence of medical disputes in China has been on a steep upward trend. [4] In 2012, the China Medical Doctors Association's "Doctor-Patient Relationship Research Report" showed that: 74.29% of medical personnel believe that their legitimate rights and interests cannot be protected, 47.35% of medical personnel believe that the current practice environment is "worse",

13.28% of medical personnel believe that the current practice environment is "extremely poor. [3] According to 2013 statistics from the Chinese Society of Hospital Administration, since the implementation of the Regulations on the Handling of Medical Accidents in September 2002, the incidence of medical disputes in China has risen by an average of 22.9% per year. [5] According to a survey conducted by the Chinese Society of Hospital Management, 98% of hospitals have doctor-patient disputes. Another survey showed that 73% of hospitals had medical staff threatened, beaten, or verbally abused, and 59% of hospitals had experienced "medical disputes" (e.g., the director or medical staff were mobbed or threatened) due to patients' dissatisfaction with treatment.[6] The current rate of medical disputes has increased by 22.9% per year since the Chinese Hospital Management Association's (CHMA) regulations began. [6] The current situation of medical disputes can be summarized as "many disputes, a wide range of types, high claims, difficult to deal with. [7]

Second, the analysis of the real causes of medical disputes continue to intensify

Data show that the causes of tension between doctors and patients are mainly the government (33.55%), medical (24.1%), lack of communication between the two sides (19.22%), the patient (8.79%), the media (7.5%)

[8] and other (6.84%) factors. Factors. Overall, the tension between doctors and patients is an indisputable fact,

Frequent doctor-patient conflicts have attracted the attention of all parties, but to refine its appearance, to find the causes of tension between doctors and patients is not purely a matter of cost, the crux of the problem comes from a professional perception, technological development, communication and coordination of many dimensions, so it is necessary to carry out a multi-dimensional coordination and system improvement in order to increase the trust between doctors and patients, thus easing the relationship between doctors and patients. Therefore, multidimensional coordination and system improvement are necessary to improve the trust between doctors and patients, thus easing the doctor-patient relationship. [9] In general, the factors that complicate the doctor-patient relationship*** are as follows.

(I) medical cost factors

Pharmaceutical costs have risen too fast, the proportion of medical costs borne by the individual is too high, to the majority of people, especially the poor people, bring enormous medical pressure, the small disease do not go to see, the big disease can not afford to see the majority of patients are currently facing serious problems. [3] A survey shows that 35% of patients believe that medical costs are too high and unreasonable. [2] Inflated prices of medicines and equipment, irrational basic drug catalog, unified procurement of medicines and separation of medicines are the main factors leading to the current high medical costs. [10]

Excessive medical costs undoubtedly add to the already physically and mentally traumatized patients. Patients in this situation are easily agitated, and any move by the doctor that is unsatisfactory to the patient may lead to conflict between the doctor and the patient. The patient's out-of-pocket expenses increase, part of the medical disputes can be said to be the transfer of the financial burden of the patient. [4]

(2) Doctor's factor

The vast majority of respondents believe that medical ethics and medical skills play an important role in influencing the image of the doctor, accounting for 72.37% and 17.83%, respectively, but with medical ethics as the most important. This indicates that, while medical technology is advancing, people are putting forward higher requirements for medical ethics. [11] Certain hospital leaders are busy grasping the economy, ignoring the scientific management and medical ethics education, [7] leading to individual medical personnel business ability defects and errors, lack of service consciousness, lack of service quality, responsibility is not strong, medical ethics deviation, resulting in the loss of patients' rights and interests as well as the first visit system of responsibility for the implementation of the system and other medical core system is not in place, violation of the rules and regulations of hospitals, clinical diagnosis and treatment norms and practice guidelines. [12] Misdiagnosis and mistreatment, delayed resuscitation, operational errors and other errors in diagnosis and treatment have occurred, leading to disputes in the hospital. [4] Some medical personnel are not patient enough in their work, do not pay enough attention to the patients, and also have the phenomenon of "cold, hard and push", which harms the patients' feelings. [12] In addition, different doctors have different diagnostic and therapeutic ideas, and sometimes have different diagnostic and therapeutic ideas for the same case, which makes the patients' trust in doctors decrease. In addition, studies have shown that if a doctor believes that his or her income level is low, he or she will seek to compensate in other ways, such as accepting red packets, kickbacks, and writing large prescriptions. This kind of distrust caused by individual doctors is gradually evolving into "collective distrust", which has tarnished the image of the entire medical profession. Part of the medical staff, weak legal awareness, lack of self-protection awareness. Medical behavior is not standardized in the details to give people a handle, so that they are in a passive position, to the occurrence of disputes bring hidden dangers. [11]

More and more research evidence suggests that there is a close relationship between the mental health of health care workers and the doctor-patient relationship. Poor mental health will affect the ability, skills and ways of handling, coping and coordinating doctor-patient relationship, doctor-patient communication will be problematic, which will lead to a sharp increase in psychological pressure, and may intensify the doctor-patient conflict, some of the occurrence of malignant medical errors may be related to the poor mental health of health care workers.[6]

This article is based on the findings of a study conducted by the National Institute of Health and Human Services (NIHHS). [6]

(3) Patient factors

In the context of the market-oriented operation of public hospitals, the patient's interests are gradually generalized and complicated, and they are no longer purely in pursuit of restoring their health and prolonging their life, but they also want to choose the best physicians, enjoy the best services, take the best medicines, spend less or no money, participate in the diagnostic and therapeutic decision-making, and receive respect and care as well as improve the quality of life. respect and care, and improved quality of life, among other interests.

In the medical field, the patient's role as a patient to a certain extent leads to a sense of psychological powerlessness and weakness of the patient, which in turn creates a certain dependence on the doctor, and at the same time, under the influence of anxiety, it is easy to idealize the process of treatment, ignoring the process of diagnosis and treatment and the patient's responsibility in the patient-physician relationship, and some of the patients only look at the results of the diagnosis and treatment, do not look at the process of the patient's life, and when the results of treatment are not satisfactory, the patient is prone to negative emotions. Patients are prone to negative emotions, completely ignoring the labor of medical staff in the treatment process and their own physical problems, shifting the blame to the doctor's poor technology, low level of treatment or other medical staff's poor care and medical ethics, resulting in disharmony in the doctor-patient relationship, and even resistance to the doctor, attacking the psychology. [13, 14] The moral quality of patients directly affects their behavior, and a few patients will make self-interested behaviors in the pursuit of maximizing their own benefits in the medical process. Patients generally lack medical knowledge and are easily misled by the media's non-objective evaluations, forming a negative impression of the medical profession, leading to a decline in patient compliance compared to the past, and deepening the doctor-patient conflict

Shield. [11, 14]

(4) Doctor-patient communication factors

Doctor-patient communication is the exchange of information between doctors and patients around the patient's health problems and diagnosis and treatment, the information exchanged includes the content of the disease diagnosis and treatment, but also with the diagnosis and treatment of the disease related to the psychological, social and other relevant factors,[15] is the medical personnel in the diagnosis and treatment activities with patients and their families in the information, emotional exchange, is a two-way communication between doctors and patients, is a two-way communication between doctors and patients, is a two-way communication between doctors and patients. It is a two-way communication bridge between doctors and patients, and is an indispensable communication between doctors and patients. [16] Data show that most doctor-patient disputes are not caused by poor medical technology or low quality of care. [14] Currently, more than 90% of doctor-patient conflicts and disputes originate from improper or ineffective communication. [15] Many hospital employees overly focus on the hospital and their own interests, and do not put the patient's health in the first place in the specific medical process, [17] insufficient understanding of the importance and necessity of doctor-patient communication; lack of awareness of humanistic care for patients; lack of communication skills; lack of staffing, resulting in limited time for communication between doctors and patients; lack of trust between doctors and patients, asymmetry in medical knowledge, and inability to think differently, there are communication barriers, and many patients also have problems with communication, and many of them have problems with communication. communication barriers, while many patients also have prejudice against hospitals and hospital workers, can not really understand the doctor's efforts and the complexity of the modern medical process, poor communication leads to increased mistrust of the situation. [15] This lack of communication between doctors and patients leads to a lack of trust and understanding between doctors and patients, so that patients can not correctly understand and face the accident in the treatment process, [1] and ultimately contribute to the deterioration of the doctor-patient relationship, and even cause medical disputes. [18]

(E) Specialized cognitive factors

The concept of asymmetric information (asymmetric information) comes from the economics of information, which refers to the uneven and asymmetric distribution of information among economic individuals corresponding to each other, i.e., some people have more information about certain things than others. [19] Medicine is

a rigorous science, at the same time, its professional nature is more prominent, medical personnel through professional learning and practice of professional medical knowledge obtained by the patients can not be reached, which from the beginning of the choice of health care careers have been from the professional perspective to start learning about the relevant knowledge, [9] and some patients lack a certain degree of medical knowledge, the acquisition of health care knowledge most of them are heard or the network, and unprofessional

The medical profession is the most important part of the medical knowledge, which is the most important part of the medical knowledge. And unprofessional

[9, 14] information, do not understand the specificity of medicine. Disease treatment takes time with uncertainty,

In addition to the doctor's technology and drug factors, healthcare service recipients there is a significant individual variability, the same drug or therapy for different patients have different effects. According to the data, domestic and foreign unanimously recognized that the rate of medical diagnosis is only 70%, and the success rate of all kinds of emergency resuscitation is only between 70

[14, 20] - 80%. Along with the continuous improvement of living standards, people's health awareness is constantly

increasing, more attention is paid to the early diagnosis of diseases, and patients generally have higher expectations of the process of diagnosis and treatment and its effects when they seek medical treatment. Once the diagnosis and treatment fails to achieve the expected results, under the pressure of high medical costs, they will put forward the right to claim, leading to tensions between doctors and patients. [13] In addition, doctors and patients from the disease and death of the view of the greater existence of contradictions, the occurrence of the disease is irreversible, its occurrence, development, treatment, etc. are established on the basis of objective and scientific, health care personnel to treat the disease and death of a more calm and objective, while the patient is the existence of the fear and helplessness of the psychological, and so the subjective will produce a negative emotion, and once the treatment is repeated is that the treatment of medical personnel have problems, so it is easy to lead to the medical staff to treat the patient. Treatment problems, so it is easy to lead to doctor-patient disputes. [9]

(F) media factors

Today, the media as a medium for the dissemination of information, greatly accelerating the speed of dissemination of information, enhance the transparency of the news, however, some of the media in order to seek public opinion effect, for medical safety incidents for the exaggerated, inaccurate reports, so that public opinion is skewed, the doctor-patient tensions intensified, the entire

the image of medical personnel were damaged, trust declined, conflicts, and the medical profession has been the most important factor. The image of the entire medical staff is damaged, the degree of trust decreases, and the conflict is sharpened and enlarged, leading to the impact of medical safety incidents from individual to a wide range. The lack of objective, impartial cornerstone of public opinion goal-oriented, excessive aggravation of medical behavior, will greatly undermine the credibility of the entire medical community

[7, 13]. Injuries to doctors online public opinion can generate a tsunami in a short period of time, and even appear online and offline linkage, triggering public **** security incidents, seriously affecting social harmony. Due to the lack of experience of medical institutions in responding to online public opinion, the lack of necessary and correct response to online public opinion, the inappropriate level of response of medical institutions, the inconsistent caliber of external information release, or even self-contradictory, as well as non-transparent information, and the lack of skills and ability to guide the direction of public opinion and to resolve contradictions, the credibility of hospitals is seriously damaged. [21] For this reason, as early as 2010, The Lancet, an internationally renowned medical journal, published an article arguing that China's media had exacerbated the tension between doctors and patients. Famous host Bai Yansong also reflected y on the problems of the media in the "News 1+1" program after the tragic case of killing doctors at Harbin Medical University.[22] Surveys have shown that 13% of patients in the media have been killed by doctors. [22] According to the survey, 13.2% of the medical staff believe that "public opinion" has contributed to the occurrence of violent injuries to doctors, and 7.8% of hospitals and 5.5% of patients hold this view. [23]

Because of the lack of corresponding laws to regulate the behavior of the media, some media do not understand the medical care but seek the "eyeball effect", [11] intentionally or unintentionally choose to "strong doctors and weak patients" reporting framework; constitute a deviation from the real The "mimetic environment" is not objective and fair; excessive pandering to patients and one-sided pursuit of click-through rates; the report is superficial and lacks in-depth analysis, which leads to the formation of "prejudice" and "stereotypes" of the audience towards the medical side, and to a certain extent, the image of the medical profession has been vilified, and the image of the medical profession has been aggravated. The image of the medical industry, intensifying the contradiction between doctors and patients. [24] This kind of report without vitality not only does not help to solve the problem, but will mislead public opinion, deteriorate the contradiction between doctors and patients, and even inspire the patients to use extreme means to harm the doctors and disrupt the order of work in hospitals. [22]

(VII) institutional factors of hospital management

Medical complaints are the concentrated manifestation of the dissatisfaction of patients and their families with the medical services, but also a breakthrough for hospitals to improve the doctor-patient relationship. According to the overall complaint situation in the hospital, the current hospital in the complaint management work to be further improved. The results of the survey also show that, with the improvement of the hospital's attention to the management of complaints, the hospital receives complaints from patients in the case of a clear downward trend. [2] The hospital organization's own low service, poor management is concentrated in [25] ① hospitals provide comprehensive services are not humane, such as the hospital environment is not set up reasonably, outpatient clinics or the relevant departments do not have clear signs to prolong the time of the patient's visit. ② part of the hospital excessive pursuit of economic interests, unreasonable charges, also easy to cause dissatisfaction with the patient. The survey shows that in recent years the disputes caused by charges accounted for 37.95% of all disputes. ③ hospital dispute handling mechanism is not sound, hospitals do not deal with medical disputes in a timely manner, do not pay attention to the hospital's shirking and acquiescence so that medical disputes lose the best time to deal with and control the doctor-patient disputes, leading to further escalation of conflicts between doctors and patients, and part of the hospital's legal awareness is weak, in order to seek stability is often the way of economic compensation to quell the medical disputes, invariably

[20] fueled by the patient's troublesome The first time I saw the movie, it was a very good one, but it's not a good one. In addition, in the face of sudden public **** relations crisis, hospitals

and related medical institutions did not form a good social communication mechanism, in dealing with related events, tired to deal with the effect is very little, which led to the hospital credibility damaged, the doctor-patient contradiction sharpened. [13]

(H) government factors

China's economic development has entered a stage of transition, more mature market model was introduced into the medical industry, at this point in time, some of the business model of the system of medical care has changed the social perception of the public welfare of

[9] medical institutions. The main income of modern hospitals is derived from three parts, which are

financial subsidies from the government, differential income from medicines, and income from medical services. [25] Relevant information shows that, while China's financial subsidies account for only 4% of GDP, for hospitals, such a situation

is simply not enough to maintain the normal operation of the hospital, had to seek the other two ways. The lack of government financial

[9,25] funding has led to a dilution of public welfare and a lowering of the standard of care in public medical institutions.

At the same time, China's current health care system is characterized by a narrow coverage of medical insurance, poor equity, a huge gap between urban and rural residents in the possession of health resources, and a significant difference in the degree of possession of health resources between different groups in urban areas

[1] and many other problems. In addition, the government's insufficient investment in public **** health care, including infectious disease

control, health education, maternal and child health care, environmental sanitation, occupational health, etc., as well as the low coverage of the medical insurance system, lack of fairness; the irrational distribution of health care resources, the government's poor supervision, etc., indirectly increase the number of unnecessary visits to the hospital, and the number of disputes between doctors and patients also increased naturally. [11,25,26]

Currently, China's legal system for handling and resolving medical disputes is not yet sound China is still in the primary stage of socialism, the legislation for the handling of medical disputes is still very imperfect, and the existing legal system is still very flawed, and the unsound legal system is difficult to correctly deal with and solve the medical

[1] disputes. Doctor-patient conflicts on the surface seems to be a social phenomenon, but when digging deeper to explore from one case to another can be found, doctor-patient conflicts are still the final destination of China's increasingly ossified health care system. As a symptom of the doctor-patient conflict to a large extent has affected the stability of Chinese society, harmony and the future direction, while the deeper level of the health care system of the existing shortcomings of the harm is to determine the general direction and development of China's medical and health care. [25]

(IX) Other factors

Influenced by subjective and objective factors, the reality is that the motives of doctors and patients are not pure. [27] Patients want to see the doctor is not difficult to see the doctor is not expensive, at the same time demand the quality of medical services, respect for their own personality, the right to information, the right to privacy protection, enjoy the treatment as a served - hospitals and doctors excellent service. Hospital operation and the normal work of medical staff not only in the treatment of patients to save people's lives

ideas and professional ethics under the guidance, but also to take into account the impact of personal interests, the doctor has to be in the treatment of patients to maximize their own interests as far as possible, including raising income, improve their business capacity and even social status, and there are some social factors in the hospitals by the impact of improper behavior and overmedication. malpractice and overmedication. [26, 27] In addition, hospitals lack the necessary humanistic care, not only for the physical care of patients, but also for their psychological care and the ultimate care of life. [28] On the one hand, health care workers are unable to give more emotional support to the patients due to burnout and professional emotional frustration, and on the other hand, patients are physically and mentally impaired due to their illnesses, and they need more comfort, understanding, and respect, which are not easy to be satisfied. This is the difference and contradiction between the emotional characteristics of doctors and patients. [26]