医患信任关系的特征、现状与研究展望

我国医患间的“关系信任取向”明显,医生被赋予高角色期待,不同科室、不同等级医院及城乡医疗机构的医患信任水平差异显著。近年来我国医患信任水平持续下滑,具体表现为医患纠纷与暴力事件的发生频次上升、对医疗服务满意的患者比例减少、医患彼此的评价及信任度降低等方面。已有研究集中于患者人口统计特征、心理契约、医务工作者的人格特质等个体因素对医患信任的影响,注意到医患信任具有影响医患双方态度与行为以及临床疗效的功能,然而医患信任危机产生的社会心理机制、医患信任建立和维持的过程机制仍不明晰。同时,医患信任现状评估和测量指标构建还不够健全,医患信任关系的行为决策实验设计等方面还有待加强。
The doctor-patient trust in China is highly relationship-oriented and doctors are usually expected to play authoritative roles. There are big gaps in doctor-patient trust between different departments within the same hospital; between hospitals at different levels; and between rural and urban hospitals. In recent years, the trust between doctors and patients has been declining, as evidenced by among others the increase of doctor-patient disputes and the violence arising therefrom, the decrease in the number of patients who are satisfied with the medical services and the deterioration in the mutual assessment and trust between doctors and patients. Previous studies focused on the impacts of individual factors on doctor-patient trust, such as the demographic characteristics and psychological contracts of patients, the personality traits of medical workers, and also noted the effect of doctor-patient trust on their attitudes, behaviors and clinical efficacy. However, the social psychological mechanism of doctor-patient trust crisis, the procedural mechanism of building and maintaining doctor-patient trust are still not clear. Meanwhile, the situation assessment and the current index system of doctor-patient trust are not sound enough, and the experimental design of the behavioral decisions in the doctor-patient trust relationship studies still needs to be strengthened