“我的健康我做主”:宏观叙事医学视域下医患交流患者争取权力言语行为研究  

“My health,my choice”:research on patients’power-calming speech acts in doctor-patient communication from the perspective of macro narrative medicine

作　　者：李芳[1] LI Fang(School of Health Humanities,Peking University,Beijing 100191,China)

机构地区：[1]北京大学医学人文学院,北京100191

出　　处：《中国医学伦理学》2024年第11期1316-1324,共9页Chinese Medical Ethics

基　　金：中华医学会医学教育分会和全国医学教育发展中心2023年医学教育研究立项课题“基于自然语料的叙事性医患互动数智化专题库建设”(2023A03);中国外语战略研究中心-外教社“世界语言与文化研究”项目资助“医患冲突协商模式的交际民族志研究”(WYZL2023BJ002);北京大学医学部教育教学研究课题“基于自然语料分析的医患会话坏消息告知评估与会话模式研究”(2020YB25)。

摘　　要：近年来,中国医患冲突问题引起世界范围内的关注,从本质上改进医患交流质量刻不容缓。从广义叙事医学视角出发,结合社会语言学领域对语言与权力关系的探究,聚焦患者的主体性,致力于探讨医院情境医患交流过程中患者是否以及如何通过话语来展开权力协商。采用交际民族志方法对辅助生殖医学领域内的医患交流进行实地考察,收集田野笔记医患会话录音材料。在扎根理论的指导下对数据进行了编码分析。研究发现:患者在交流中采纳了七类言语行为来“争取权力”:“寻求诊疗建议”“寻求医疗信息”“确认行动指导”“提供信息”“参与决策”“建立关系”以及“维护隐私权”。每一类言语行为都具有多样化的表现形式,在医院特定场景中呈现出不同的分布特征。关注医患交流中的患者视角,丰富对患者主体性的考察,是对“以患者为中心”的交流模式的具体化补充和发展。The frequent occurrences of medical violence in China have attracted world-wide attention.It is critically important to improve the quality of doctor-patient communication.Taking the perspective of macro narrative medicine,this study adopts a sociolinguistic approach to examine the interplay between language and power in doctor-patient communication.More specifically,an ethnographic study was conducted in the reproductive center of a public hospital in Beijing to investigate whether and how patients claim power in doctor-patient communication.Recordings of doctor/nurse patient conversations and field notes were collected.Grounded theory was used to analyze the data.Systematic coding was conducted through Atlas.ti.The analysis shows that patients do claim power and they do so through seven types of speech acts:request for suggestions,request for information,request for clarification,providing information,participating in decision-making,establishing ties,protecting privacy.Every speech act is realized through various forms and presents different distribution patterns across the four observational sites in the hospital.This study has innovated and enriched the investigation of patient’s agency in doctor-patient communication,which hopes to yield useful implications for the implementation of patient-centered care.

关 键 词：叙事医学 医患交流 以患者为中心 权力 言语行为 

分 类 号：R-052[医药卫生]