|
心理学视角下的医患关系:解释水平的作用
|
Abstract:
物质生活的不断改善和提高使得大众对医疗质量和水平提出越来越高的要求,但目前医疗服务尚不能充分满足群众需求,医患关系和矛盾日趋紧张与激化。已有研究多从医患双方行为层面(如合作行为)提出改善医患关系和解决医患矛盾的策略与方法,鲜有研究探讨和分析医患双方心理认知表征方式的差异或不一致在造成不良医患关系中的重要作用。解释水平理论是新近发展的社会认知表征理论,该理论被广泛的应用于解释个体的行为差异。本文从解释水平理论以及与其密切相关的心理距离角度出发,分析解释水平和心理距离对医护人员和患者认知、情绪与行为的不同影响,及其在医患沟通与医疗决策等医疗实践领域的研究应用,进而从提高医疗信息的共享水平、改变医生和患者对不对等权利的认知、调整医生和患者对医患关系的归因方式三个方面,提出解决医患矛盾、促进医患关系改善的建议。
The continuous improvement of material life has led to higher requirements for medical quality and standards, but present medical services cannot fully meet the needs of the public. Doc-tor-patient relationship is becoming increasingly tense. Previous researches focused on behavioral strategies (such as cooperative behavior) to improve the doctor-patient relationship. However, little research has paid attention to the inconsistence of the cognitive representation between doctors and patients in causing bad doctor-patient relationship. Construal level theory, a newly developed social cognitive representation theory, has been widely applied to explain individual’s behavioral differences. From the perspective of construal level theory and psychological distance, the current paper described the different effects of construal level and psychological distance on the cognition, emotion and behavior of medical staff and patients, as well as the applications of construal level and psychological distance in the field of medical practice, such as communication among doctors and patients and medical decision-making, and then proposed suggestions from three aspects to promote the improvement of the relationship between doctors and patients: improving the sharing strategies of medical information, changing the cognition of unequal rights between doctors and patients, and adjusting the attribution to doctor-patient problems of medical staff and patients.
[1] | 杜淑英, 李有权(2008). 归因理论在减少医疗纠纷中的应用. 医学与哲学: 人文社会医学版, 29(6), 24-26. |
[2] | 弓思佳, 黎鹏程(2019). 医患关系紧张的原因及其改善策略. 中国中医药现代远程教育, 17(17), 156-158. |
[3] | 黄俊, 李晔, 张宏伟(2015). 解释水平理论的应用及发展. 心理科学进展, 23(1), 110-119. |
[4] | 金福年(2007). 加强医患沟通的有效途径. 中国医院, 11(8), 63-65. |
[5] | 李明晖, 饶俪琳(2017). 解释水平视角下的道德判断. 心理科学进展, 25(8), 1423-1430. |
[6] | 李雁晨, 周庭锐, 周琇(2009). 解释水平理论: 从时间距离到心理距离. 心理科学进展, 17(4), 667-677. |
[7] | 梁裕健(2016). 大学生归因方式研究综述. 文教资料, (15), 125-126. |
[8] | 林蜜(2009). 医患关系失谐及缓解对策研究. 硕士论文, 长沙: 湖南大学. |
[9] | 凌杰(2012). 注重医患沟通构建和谐社会. 医学信息, 25(12), 410-411. |
[10] | 莫秀婷, 徐凌忠, 罗惠文, 盖若琰(2015). 医务人员感知医患关系、工作满意度与离职意向的关系研究. 中国临床心理学杂志, 23(1), 141-146. |
[11] | 潘庆霞, 梁立波, 吴群红, 郝洁靓, 陶四海, 黄照权, 等(2016). 公立医院医患关系紧张的原因及对策探讨——基于医患双方视角的分析. 中国医院管理, 36(5), 68-70. |
[12] | 瞿雯, 高隽, 官锐园(2016). 大众偏见对医疗纠纷中归因和责任推断的影响. 中国临床心理学杂志, 24(2), 213-217. |
[13] | 孙鹤宇, 姜欢, 尹梅(2016). 解释水平理论视域下审看医患差异. 医学与法学, 8(6), 1-6. |
[14] | 孙鹤宇, 尹梅(2016). 对不同社会距离视域下坏消息告知伦理问题的探讨. 中国医学伦理学, 29(3), 421-423. |
[15] | 谭先健, 丁琴, 黄礼群, 夏婷婷, 康婉星, 姚国庆(2019). 我国医患沟通主要模式及思考. 华南国防医学杂志, 33(12), 851-854. |
[16] | 杨鸽(2017). 未来结果考虑和解释水平对健康/美味食物消费决策的影响. 硕士论文, 杭州: 浙江大学. |
[17] | 张丽(2018). 共享信息时代的医患沟通. 世界最新医学信息文摘, 18(75), 192. |
[18] | 张玥, 窦东徽, 辛自强(2018). 解释水平对自我控制的影响. 心理科学进展, 26(10), 1878-1889. |
[19] | 郑新(2012). 医务人员压力状况及对策. 中国公共卫生, 28(1), 45-46. |
[20] | Ashton-James, C., Van Baaren, R. B., Chartrand, T. L., Decety, J., & Karremans, J. (2007). Mimicry and Me: The Impact of Mimicry on Self-Construal. Social Cognition, 25, 518-535. https://doi.org/10.1521/soco.2007.25.4.518 |
[21] | Ayduk, ?., & Kross, E. (2010). From a Distance: Implications of Spontaneous Self-Distancing for Adaptive Self-Reflection. Journal of Personality and Social Psychology, 98, 809-829. https://doi.org/10.1037/a0019205 |
[22] | Baggs, J. G., Schmitt, M. H., Mushlin, A. I., Mitchell, P. H., Eldredge, D. H., Oakes, D., & Hutson, A. D. (1999). Association between Nurse-Physician Collaboration and Patient Outcomes in Three Intensive Care Units. Critical Care Medicine, 27, 1991-1998. https://doi.org/10.1097/00003246-199909000-00045 |
[23] | Balint, E. (1969). The Possibilities of Patient-Centered Medicine. The Journal of the Royal College of General Practitioners, 17, 269-276. |
[24] | Borkovec, T. D., & Inz, J. (1990). The Nature of Worry in Generalized Anxiety Disorder: A Predominance of Thought Activity. Behaviour Research and Therapy, 28, 153-158. https://doi.org/10.1016/0005-7967(90)90027-G |
[25] | Breitbart, W., Rosenfeld, B., Pessin, H., Applebaum, A., Kulikowski, J., & Lichtenthal, W. G. (2015). Meaning-Centered Group Psychotherapy: An Effective In-tervention for Improving Psychological Well-Being in Patients with Advanced Cancer. Journal of Clinical Oncology, 33, 749-754. https://doi.org/10.1200/JCO.2014.57.2198 |
[26] | Coombs, M., & Ersser, S. J. (2004). Medical Hegemony in Decision-Making—A Barrier to Interdisciplinary Working in Intensive Care? Journal of Advanced Nursing, 46, 245-252. https://doi.org/10.1111/j.1365-2648.2004.02984.x |
[27] | De Dreu, C. K. W., Giacomantonio, M., Shalvi, S., & Sligte, D. (2009). Getting Stuck or Stepping Back: Effects of Obstacles and Construal Level in the Negotiation of Creative Solu-tions. Journal of Experimental Social Psychology, 45, 542-548.
https://doi.org/10.1016/j.jesp.2009.01.001 |
[28] | Dhar, R., & Kim, E. Y. (2007). Seeing the Forest or the Trees: Im-plications of Construal Level Theory for Consumer Choice. Journal of Consumer Psychology, 17, 96-100. https://doi.org/10.1016/S1057-7408(07)70014-1 |
[29] | Eyal, T., Liberman, N., & Trope, Y. (2008). Judging Near and Distant Virtue and Vice. Journal of Experimental Social Psychology, 44, 1204-1209. https://doi.org/10.1016/j.jesp.2008.03.012 |
[30] | Fujita, K. (2011). On Conceptualizing Self-Control as More than the Effortful Inhibition of Impulses. Personality and Social Psychology Review, 15, 352-366. https://doi.org/10.1177/1088868311411165 |
[31] | Fujita, K., & Carnevale, J. J. (2012). Transcending Temptation through Abstraction the Role of Construal Level in Self-Control. Current Directions in Psychological Science, 21, 248-252. https://doi.org/10.1177/0963721412449169 |
[32] | Fujita, K., Eyal, T., Chaiken, S., Trope, Y., & Liberman, N. (2008). Influencing Attitudes toward Near and Distant Objects. Journal of Experimental Social Psychology, 227, 9044-9062. https://doi.org/10.1016/j.jesp.2007.10.005 |
[33] | Genschow, O., Hansen, J., W?nke, M., & Trope, Y. (2019). Psychological Distance Modulates Goal-Based versus Movement-Based Imitation. Journal of Experimental Psychology: Human Perception and Performance, 45, 1031-1048.
https://doi.org/10.1037/xhp0000654 |
[34] | Giacomantonio, M., De Dreu, C. K. W., & Mannetti, L. (2010). Now You See It, Now You Don’t: Interests, Issues, and Psychological Distance in Integrative Negotiation. Journal of Personality & Social Psychology, 98, 761-774.
https://doi.org/10.1037/a0017879 |
[35] | Halamish, V., & Liberman, N. (2017). How Much Information to Sample be-fore Making a Decision? It Is a Matter of Psychological Distance. Journal of Experimental Social Psychology, 71, 111-116. https://doi.org/10.1016/j.jesp.2017.03.004 |
[36] | Halamish, V., Nussinson, R., & Ben-Ari, L. (2013). In a Year, Memory Will Benefit from Learning, Tomorrow It Won’t: Distance and Construal Level Effects on the Basis of Metamemory Judgments. Journal of Experimental Psychology: Learning, Memory, and Cognition, 39, 1621-1627. https://doi.org/10.1037/a0032381 |
[37] | Henderson, M. D. (2011). Mere Physical Distance and Integrative Agree-ments: When More Space Improves Negotiation Outcomes. Journal of Experimental Social Psychology, 47, 7-15. https://doi.org/10.1016/j.jesp.2010.07.011 |
[38] | Ho, B., & Liu, E. (2011). Does Sorry Work? The Impact of Apology Laws on Medical Malpractice. Journal of Risk and Uncertainty, 43, 141-167. https://doi.org/10.1007/s11166-011-9126-0 |
[39] | Hojat, M., Nasca, T. J., Cohen, M. J., Fields, S. K., Rattner, S. L., Griffiths, M., Ibarra D., de Gonzalez, A. A.-G., Torres-Ruiz, A., Ibarra G., & Garcia, A. (2001). Attitudes toward Physi-cian-Nurse Collaboration: A Cross-Cultural Study of Male and Female Physicians and Nurses in the United States and Mexico. Nursing Research, 50, 123-128.
https://doi.org/10.1097/00006199-200103000-00008 |
[40] | Jiga-Boy, G. M., Clark, A. E., & Semin, G. R. (2013). Si-tuating Construal Level: The Function of Abstractness and Concreteness in Social Contexts. Social Cognition, 31, 201-221. https://doi.org/10.1521/soco.2013.31.2.201 |
[41] | Kaba, R., & Sooriakumaran, P. (2007). The Evolution of the Doc-tor-Patient Relationship. International Journal of Surgery, 5, 57-65. https://doi.org/10.1016/j.ijsu.2006.01.005 |
[42] | Kross, E., & Ayduk, O. (2008). Facilitating Adaptive Emotional Analysis: Distinguishing Distanced-Analysis of Depressive Experiences from Immersed-Analysis and Distraction. Perso-nality and Social Psychology Bulletin, 34, 924-938.
https://doi.org/10.1177/0146167208315938 |
[43] | Kross, E., Ayduk, O., & Mischel, W. (2005). When Asking “Why” Does Not Hurt Distinguishing Rumination from Reflective Processing of Negative Emotions. Psychological Science, 16, 709-715.
https://doi.org/10.1111/j.1467-9280.2005.01600.x |
[44] | Lammers, J., Galinsky, A. D., Gordijn, E. H., & Otten, S. (2012). Power Increases Social Distance. Social Psychological & Personality Science, 3, 282-290. https://doi.org/10.1177/1948550611418679 |
[45] | Lee, H., Deng, X., Unnava, H. R., & Fujita, K. (2014). Monoch-rome Forests and Colorful Trees: The Effect of Black-and-White versus Color Imagery on Construal Level. Journal of Consumer Research, 41, 1015-1032.
https://doi.org/10.1086/678392 |
[46] | Lee, H., Fujita, K., Deng, X., & Unnava, H. R. (2017). The Role of Temporal Distance on the Color of Future-Directed Imagery: A Construal-Level Perspective. Journal of Consumer Research, 43, 707-725. https://doi.org/10.1093/jcr/ucw051 |
[47] | Liberman, N., & F?rster, J. (2009). Distancing from Experienced Self: How Global-versus-Local Perception Affects Estimation of Psychological Distance. Journal of Personality and Social Psychology, 97, 203-216.
https://doi.org/10.1037/a0015671 |
[48] | Lu, J., Xie, X., & Xu, J. (2013). Desirability or Feasibility: Self-Other Deci-sion-Making Differences. Personality and Social Psychology Bulletin, 39, 144-155. https://doi.org/10.1177/0146167212470146 |
[49] | Magee, J. C., Milliken, F. J., & Lurie, A. R. (2010). Power Differ-ences in the Construal of a Crisis: The Immediate Aftermath of September 11, 2001. Personality & Social Psychology Bulletin, 36, 354-370.
https://doi.org/10.1177/0146167209360418 |
[50] | Manias, E., & Street, A. (2001). The Interplay of Knowledge and Decision Making between Nurses and Doctors in Critical Care. International Journal of Nursing Studies, 38, 129-140. https://doi.org/10.1016/S0020-7489(00)00055-9 |
[51] | Marguc, J., F?rster, J., & Van Kleef, G. A. (2011). Stepping Back to See the Big Picture: When Obstacles Elicit Global Processing. Journal of Personality and Social Psychology, 101, 883-901. https://doi.org/10.1037/a0025013 |
[52] | Namkoong, J. E., & Henderson, M. D. (2014). It’s Simple and I Know It! Abstract Construals Reduce Causal Uncertainty. Social Psychological and Personality Science, 5, 352-359. https://doi.org/10.1177/1948550613499240 |
[53] | Park, C. L. (2015). Integrating Positive Psychology into Health-Related Quality of Life Research. Quality of Life Research, 24, 1645-1651. https://doi.org/10.1007/s11136-014-0889-z |
[54] | Peng, J., He, F., Zhang, Y., Liu, Q., Miao, D., & Xiao, W. (2013). Differences in Simulated Doctor and Patient Medical Decision Making: A Construal Level Perspective. PLoS ONE, 8, e79181. https://doi.org/10.1371/journal.pone.0079181 |
[55] | Pierre, P., Céline, B., & Céline, D. (2006). Specifying Emotional Information: Regulation of Emotional Intensity via Executive Processes. Emotion, 6, 560-571. https://doi.org/10.1037/1528-3542.6.4.560 |
[56] | Richter, J., Eisemann, M. R., Bauer, B., Kreibeck, H., & ?str?m, S. (2002). Decision-Making in the Treatment of Elderly People: A Cross-Cultural Comparison between Swedish and German Physicians and Nurses. Scandinavian Journal of Caring Sciences, 16, 149-156. https://doi.org/10.1046/j.1471-6712.2002.00072.x |
[57] | Ridgeway, C. L. (2001). Gender, Status, and Leadership. Journal of Social Issues, 57, 637-655.
https://doi.org/10.1111/0022-4537.00233 |
[58] | Rim, S. Y., Min, K. E., Liu, P. J., Chartrand, T. L., & Trope, Y. (2019). The Gift of Psychological Closeness: How Feasible versus Desirable Gifts Reduce Psychological Distance to the Giver. Personality and Social Psychology Bulletin, 45, 360-371. https://doi.org/10.1177/0146167218784899 |
[59] | Rim, S., Hansen, J., & Trope, Y. (2013). What Happens Why? Psychological Distance and Focusing on Causes versus Consequences of Events. Journal of Personality and Social Psychology, 104, 457-472. https://doi.org/10.1037/a0031024 |
[60] | Ross, L. T., Lutz, C. J., & Lakey, B. (1999). Perceived Social Support and Attributions for Failed Support. Personality and Social Psychology Bulletin, 25, 896-908. https://doi.org/10.1177/0146167299025007011 |
[61] | Schaefer, A., Collette, F., Philippot, P., Van der Linden, M., Laureys, S., Delfiore, G., Salmon, E. et al. (2003). Neural Correlates of “Hot” and “Cold” Emotional Processing: A Mul-tilevel Approach to the Functional Anatomy of Emotion. NeuroImage, 18, 938-949. https://doi.org/10.1016/S1053-8119(03)00009-0 |
[62] | Sexton, J. B., Thomas, E. J., & Helmreich, R. L. (2000). Error, Stress, and Teamwork in Medicine and Aviation: Cross Sectional Surveys. BMJ, 320, 745-749. https://doi.org/10.1136/bmj.320.7237.745 |
[63] | Soderberg, C. K., Callahan, S. P., Kochersberger, A. O., Amit, E., & Ledgerwood, A. (2015). The Effects of Psychological Distance on Abstraction: Two Meta-Analyses. Psychological Bulle-tin, 141, 525-548. https://doi.org/10.1037/bul0000005 |
[64] | Spitzberg, B. H., & Manusov, V. (2015). Attribution Theory: Finding Good Cause in the Search for Theory. In L. A. Baxter, & D. O. Braithwaite (Eds.), Engaging Theories in Interpersonal Communication: Multiple Perspectives (pp. 37-49). Thousand Oaks, CA: Sage. |
[65] | St?ber, J., & Borkovec, T. D. (2002). Reduced Concreteness of Worry in Generalized Anxiety Disorder: Findings from a Therapy Study. Cogni-tive Therapy and Research, 26, 89-96. https://doi.org/10.1023/A:1013845821848 |
[66] | Sun, W., Fu, J., Chang, Y., & Wang, L. (2012). Epidemiological Study on Risk Factors for Anxiety Disorder among Chinese Doctors. Journal of Occu-pational Health, 54, 1-8. https://doi.org/10.1539/joh.11-0169-OA |
[67] | Szasz, T., & Hollender, M. H. (1956). A Contribution to the Philosophy of Medicine. Archives of Internal Medicine, 97, 585-592. https://doi.org/10.1001/archinte.1956.00250230079008 |
[68] | Thomas, E. J., Sexton, J. B., & Helmreich, R. L. (2003). Discrepant Attitudes about Teamwork among Critical Care Nurses and Physicians. Critical Care Medicine, 31, 956-959. https://doi.org/10.1097/01.CCM.0000056183.89175.76 |
[69] | Thomas, M., & Tsai, C. I. (2012). Psychological Dis-tance and Subjective Experience: How Distancing Reduces the Feeling of Difficulty. Journal of Consumer Research, 39, 324-340. https://doi.org/10.1086/663772 |
[70] | Torrez, B., Wakslak, C., & Amit, E. (2019). Dynamic Distance: Use of Visual and Verbal Means of Communication as Social Signals. Journal of Experimental Social Psychology, 85, 103849-103856. https://doi.org/10.1016/j.jesp.2019.103849 |
[71] | Trope, Y., & Liberman, N. (2003). Temporal Con-strual. Psychological Review, 110, 403-421.
https://doi.org/10.1037/0033-295X.110.3.403 |
[72] | Trope, Y., & Liberman, N. (2010). Construal-Level Theory of Psychological Distance. Psychological Review, 117, 440-463.
https://doi.org/10.1037/a0018963 |
[73] | Trope, Y., Liberman, N., & Wakslak, C. (2007). Construal Levels and Psy-chological Distance: Effects on Representation, Prediction, Evaluation, and Behavior. Journal of Consumer Psychology, 17, 83-95.
https://doi.org/10.1016/S1057-7408(07)70013-X |
[74] | Vallacher, R. R., & Wegner, D. M. (1989). Levels of Personal Agency: Individual Variation in Action Identification. Journal of Personality and Social Psychology, 57, 660-671. https://doi.org/10.1037/0022-3514.57.4.660 |
[75] | van der Spek, N., van Uden-Kraan, C. F., Vos, J. et al. (2014). Meaning-Centered Group Psychotherapy in Cancer Survivors: A Feasibility Study. Psycho-Oncology, 23, 827-831. https://doi.org/10.1002/pon.3497 |
[76] | Voyer, B. G., & Reader, T. (2013). The Self-Construal of Nurses and Doctors: Beliefs on Interdependence and Independence in the Care of Older People. Journal of Advanced Nursing, 69, 2696-2706. https://doi.org/10.1111/jan.12157 |
[77] | Vytal, K. E., Arkin, N. E., Overstreet, C., Lieberman, L., & Grillon, C. (2016). Induced-Anxiety Differentially Disrupts Working Memory in Generalized Anxiety Disorder. BMC Psychiatry, 16, 62-70.
https://doi.org/10.1186/s12888-016-0748-2 |
[78] | Vytal, K., Cornwell, B., Arkin, N., & Grillon, C. (2012). Describing the Interplay between Anxiety and Cognition: From Impaired Performance under Low Cognitive Load to Reduced Anxiety under High Load. Psychophysiology, 49, 842-852.
https://doi.org/10.1111/j.1469-8986.2012.01358.x |
[79] | Wang, Y., Gan, Y., Miao, M., Ke, Q., Li, W., Zhang, Z., & Cheng, G. (2016). High-Level Construal Benefits, Meaning Making, and Posttraumatic Growth in Cancer Patients. Pallia-tive & Supportive Care, 14, 510-518.
https://doi.org/10.1017/S1478951515001224 |
[80] | Watkins, E. R. (2008). Constructive and Unconstructive Repeti-tive Thought. Psychological Bulletin, 134, 163-206.
https://doi.org/10.1037/0033-2909.134.2.163 |
[81] | Winger, J. G., Adams, R. N., & Mosher, C. E. (2016). Relations of Meaning in Life and Sense of Coherence to Distress in Cancer Patients: A Meta-Analysis. Psycho-Oncology, 25, 2-10. https://doi.org/10.1002/pon.3798 |