以多元文化為觀點探究診間醫病關係之感知差距：以高雄市某地區教學醫院為例   免費試閱

Exploration of the Perception Gap of Doctor-patient Relationship from Perspective of Multiculturism: Exemplified by a Kaohsiung City Teaching Hospital

本研究旨在從社會學多元文化之觀點更深一層瞭解醫病關係，探究門診醫病關係之醫療社會學意涵，有別於過去從管理學理論出發的研究，另覓改善醫病關係之思維方向。研究者採用量性問卷調查與質性訪談研究兩個方法以增進研究效度，結構式問卷內容包含主體性、權力／知識、責任倫理、關懷倫理與多元文化素養之覺知及知識構面；質性訪談研究包括訪談11位門診病人與4位代表不同層級醫院之資深醫師。研究發現，除了「關懷」構面，量性與質性研究結果相似，即醫師與病人對醫師在醫病關係中表現認可程度有差距且醫師之認可程度較高，但質性研究顯示此結果醫師之陳述只於「應然面」非「實然面」，病人也多是「期待」而已。多元文化素養之角色，不論量與質性研究結果都顯示其有影響力。故此，研究者建議，建構診間良好的醫病關係，除了友善醫療環境的硬體架構外，專業知識之傳遞，是否能留意到多元文化的現實與潮流，進而思索發展多元文化取向之醫病關係的可能性與實踐之道，達到醫師「反思」與病人「充權」的目的，值得醫療者與教育者深思。

For a deeper understanding of the relationship between doctors and patients from perspective of multiculturism, the present study attempted to explore the medical sociology of outpatient doctor-patient relationship perception gap. This study, different from the past literature which was based on theory of management, explored the relationship between doctors and patients through the perspective of multiculturism to look for another direction in thinking of the doctor-patient relationship. Researchers used quantitative survey and qualitative interview to enhance the validity of the study. Constructive questionnaire formula contained five domains of subjectivity, power/knowledge, responsibility ethic, care ethic and multiculturism literacy. Qualitative interview study included interviews with 11 outpatients and four representatives of the different levels of senior hospital doctors. The study shows that except for “Care” facets, quantitative and qualitative studies gave similar results, namely, physicians and patients had a perception gap between the doctor-patient relationship and the physician showed a higher degree of perception. But the qualitative study shows that the statement of the physicians was mostly assumption instead of reality, and patients were mostly in expectation. Multiculturism literacy played a key role in both quantitative and qualitative research results. Therefore, the researcher suggests, additional to construction of the hardware architecture in a friendly medical environment, in order to establish a good doctor-patient relationship, the transfer of medical expertise should be enhanced by noticing the role of multicultural realities and trends, and then thinking of development of doctor-patient relationship in the perspective of multicultural orientation, to obtain physicians’ reflection and patient’s empowerment. This topic is worthy of medical educators’ thought.