Objective To explore the factors which affect shared decision-making and develop strategies to get patients actively involved in clinical decision-making. Methods We conducted a survey on 566 patients of a Class A Hospital in Sichuan with group random sampling method. The data were collected by the use of anonymous selfadministered questionnaires. We used SPSS 10.0 to analyse the data. Results A total of 600 questionnaires were distributed at random, of which 565 were completed. There were 68% patients who had some knowledge of the disease, and 93% who were willing to participate in clinical decision-making. The patients’ biggest concerns were: treatment effect, cost and doctors’ skills. The biggest difficulties that patients worried about were: long-time waiting in out-patient departments and limited time to communicate with doctors. Conclusion As more and more patients would like to involve in shared decision-making, doctors need to provide patients with more choices and help them make a right decision in their treatment.
The relationship between doctors and patients becomes a public hot topic recently, which becomes more prominent during the reforming and transition of the health care system. The emergence of evidence-based medicine corresponds to the requirement of the clinical practice brought by the transition of the health care system. It will play an important role in improving the relationship between doctors and patients. The promotion of evidence-based practice will be helpful to alleviate the conflict between doctors and patients and to increase the quality of health care.
In recent two decades, the incidence and severity of medical disputes have been dramatically increasing in China which has a negative influence for patients, doctors and hospitals. It must be seriously regarded that 80% of the medical disputes are caused by the bad attitude of health care professionals, ethical problems, and poor communication skill with patients. Chinese health care professionals should be aware of how to establish a good doctor-patient relationship. The development of evidence-based medicine (EBM) will help us bridge a gap between medical science and clinical practice, revise our opinions, update our knowledge and improve our service. Cooperation with the Chinese Evidence-Based Medicine Center (CEBMC), and the Chinese Medical Doctor Association (CMDA) will help doctors practice legally and in an evidence-based manner so as to protect both rights of patients and doctors.
Objective To seek the best evidence on communication between physicians and patients so as to improve the physician-patient relationship in China. Methods We used the key words ‘physician-patient relationship’ and ‘communication’ to identify related systematic reviews and meta-analyses, and then evaluated them with the Overview Quality Assessment Questionnaire (OQAQ) checklist. Results Seventeen studies were included for final evaluation. According to the OQAQ checklist, the score range of the study quality was 3 to 9. 41.29% (7/17) of the included studies scored 7 to 9, 23.5% (4/17) scored 6, and 35.3% (6/17) scored 3 to 5. Factors influencing physician-patient communication primarily included communication targets, time, contents, and approaches. Conclusion There are not enough studies on physician-patient communication in China. We need to identify the problems affecting communication behavior, encourage patients to express their preferences, choose appropriate training strategies, and make timely evaluation so as to better satisfy the needs of patients and physicians.
目的 探讨诊断学床旁见习教学中学患关系现状，为提高诊断学床旁教学质量提供应对策略。 方法 采用自行设计问卷，于2010年5月-2011年6月对80名临床医学专业三年级本科生以及同期在内科住院的100例患者分别进行不署名学患关系问卷调查（有效问卷率分别为91.3%和67%），同时对8名带教教师和7名临床主管医生进行个别访谈。 结果 学生问卷调查显示，79.5%的学生曾在床旁教学中遭遇患者不同程度的拒绝或不配合，大多数学生认为有被拒的心理准备和承受力。患者调查显示，82.1%的患者不愿意接受学生问诊查体，58.2%的患者表示即便给予一定经济补偿，也不愿配合教学。而对带教教师及临床主管医师访谈结果显示，当前床旁带教难度大大增加，学患关系紧张。 结论 现阶段学患关系紧张，根据其涉及原因，提出提升医务人员及医学生人文观念，推进医疗、教育体制改革，建立媒体监督机制，开展公众教育等多层面的应对策略，同时提出课程设置、教学模式、师资培养等具体教学应对举措。Objective To explore the present status of the relationship between students and patients in diagnostic bedside teaching, in order to promote the teaching quality. Methods From May 2010 to June 2011, self-made questionnaires were adopted to carry out an anonymous survey among 80 medical students in grade three or above and 100 inpatients to investigate the relationship between the students and the patients(with an effective questionnaire rate of 91.3% and 67% respectively). Eight tutors and 7 physicians concerned were taken in the individual interview. Results The survey showed that 79.5% of the students encountered refusal from patients in bedside teaching, and most of them believed that they had psychological preparation and endurance for the refusal. A total of 82.1% of the patients expressed their unwillingness to accept examination by clinical students, and 58.2% of the patients were unwilling to cooperate in the teaching even with an amount of economic compensation. The tutors and physicians concerned stated that the student-patient relationship was undesirable at present. Conclusions The relationship between students and patients in bedside teaching is strained at present. Based on the complicated reasons, we propose such coping strategies as promoting humanism among medical workers and students, pushing forward the medical and educational reform, building media supervision, developing public education, perfecting course design, teaching style, and cultivation of teachers, and so on.
Objective To investigate the status of communication skills among medical students in order to provide targeted and operational interventions. Methods We designed the questionnaire ‘Questionnaire investigating the status of medical students’ communication skills’ to investigate the status of communication skills of medical students of the West China Clinical College. The sample was extracted by the way of stratified sampling. Results We put out 570 questionnaires and received 548 completed questionnaires. There was a statistical difference between students who came from the city and countryside in terms of communication skills. There was also a statistical difference between students with different backgrounds in communication skills. Conclusion ① Medical students have lots of advantages in interpersonal communication, but there are also lots of defects in their skill set. ② Medical students have been aware of the necessity of learning the basic theories of interpersonal communication to improve the physician-patient relationship in the future. ③ It has become a trend to carry out interpersonal education in medical universities. ④ Medical colleges need to integrate internal and external resources, professional education, moral education, and the construction of campus culture to foster medical students with good interpersonal skills.
Objective To explore the factors which influence the doctor-patient relationship and to provide evidence to help decision makers improve hospital management and construct a harmonious doctor-patient relationship. Methods Discharged patients of West China Hospital from 2003-2006 were randomly selected and asked to complete a specially designed questionnaire. Results In total, 8 000 questionnaires were distributed and 2 526 were returned. The retrieval rate was 31.57%. The responses showed that non-medical factors have became the main factors affecting the doctor-patient relationship (91.8%). Other important factors included medical cost (21.5%) and doctor-patient communication (11.51%). Conclusion We should boost hospital management level, train non-medical staff, save costs and improve doctor-patient communication.
To analyze the current doctor-patient relationship and explore its underlying reasons. Evidence-based medicine may provide scientific evidence for the deepening of healthcare reforms as well as the improvement of social security system; provide abundant information for both sides of the doctor-patient relationship; improve medical quality and reduce medical costs, so as to establish a harmonious patient-oriented doctor-patient relationship .
目的 调查医疗文书填写现状并探讨其对患者满意度之间的影响。 方法 2012年10月－12月以呼吸内科住院的患者为调查对象，调查其医疗文书完成情况，统计医疗文书缺项数目。同时参考国内外患者满意度研究，自制满意度调查表，调查患者对医务人员满意度；分析医疗文书缺项数目对患者满意度的影响。 结果 研究共纳入151例患者，共有126份医疗文书存在不同程度填写缺陷，占83.44%，平均缺项（11.58 ± 11.63）条。总体患者就医满意度为6.85分，与医疗文书缺项数目呈现负相关性（R=?0.602，P=0.001）。患者性别、年龄、文化程度、付费方式和住院天数与患者满意度无相关性。 结论 医疗文书缺项数目较多、完成质量不高。需要加强医务人员对于医疗文书完成质量的重视程度。