| In the context of the national strategy of Healthy China,the public’s demand for health is increasing day by day,and a harmonious doctor-patient relationship has become the fundamental requirement.However,the current situation is that the doctor-patient connection is becoming more and more untight,and the doctors are difficult to obtain the trust of their patients.The doctor-patient relationship is increasingly tense,and doctor-patient conflicts occur frequently.These are wounds that medicine cannot afford.The more the medical technology advanced,the more the medical personnel depend on technology.As a consequence,the doctor-patient relationship is seriously materialized,where in the social attributes,personal characteristics and psychological demands of patients are largely ignored by doctors,which is one of the origins of the divergences between doctors and patients.Therefore,the primary task to realize the new medical purpose is to build a harmonious doctor-patient relationship to bridge the divergences between doctors and patients.Narrative medicine is a new subject,which is established to cope with the increasing coldness of medicine and to reconcile the tension of doctor-patient relationship.The essentials of narrative medicine are: by listening to the patients’ story of diseases and empathizing with them,the medical staffs can be promoted to have more introspection and then to improve doctor-patient communication,and further,to restore and respect the patient’s subjective status,to re-radiate humanistic temperature in medical decision-making and bridge the divergences between doctors and patients.Interdisciplinary research method,case analysis,and questionnaire were applied to carry out this research from four aspects.The first aspect was to clarify the concept and connotation of intersubjectivity,doctor-patient relationship and narrative medicine and to associate intersubjectivity with narrative medicine.The second aspect deconstructed the doctor-patient divergences from the perspective of intersubjectivity,analyzed the root of the doctor-patient divergences,and examined how narrative medicine bridged these divergences through case analysis,and then proposed that narrative medicine bridged the doctor-patient divergences based on the intersubjectivity between doctors and patients.The third aspect was to verify the function in clinical practice and the effect of narrative medicine in bridging the doctor-patient divergences through questionnaires,and to explore how to promote narrative medicine in clinical practice and improve the narrative ability of medical staffs.Finally,it discussed the practice pathway of narrative medicine bridging the doctor-patient divergences.The main body of the research includes the following 6 parts:Part 1: The theoretical basis of the research.Firstly,the connotations of subjectivity and intersubjectivity were discussed in detail,and then the concept of intersubjectivity was introduced into doctor-patient relationship.After that,the concept,contents,and models of doctor-patient relationship were outlined,the doctor-patient relationship/communication among different models were characterized,and then the intersubjectivity being formed or not were discussed.Finally,the concept of narrative medicine,research progress at home and abroad and its relationship with related disciplines were reviewed in detail.And it deeply analyzed how the three elements of narrative medicine(attention,representation and affiliation)benefit the formation of doctor-patient bond during the process of doctor-patient communication and enhance the understanding and trust between them,and further,how empathy and reflection resolve conflicts and reach consensus.Part 2: The origin and realistic manifestations of doctor-patient divergences from the perspective of intersubjectivity.Firstly,the impact of scientism,mechanical reductionism and mind-body dualism on medicine was discussed respectively,which leaded to the change of doctor-patient dual subject status and doctor-patient divergences.Then,it illustrated the realistic manifestations of the doctor-patient divergences,and interpreted from the perspective of intersubjectivity that when patients lose their subject status or were different from the objects that doctors pay attention to,there will be misunderstandings between doctor-patient subjects.Finally,three cases were analyzed to illustrate the manifestations.Part 3:Narrative medicine bridges the divergences between doctors and patients by intersubjectivity.Four narrative-medicine stories were analyzed to find the intersubjectivity embodied in the practice of narrative medicine and its role in bridging the divergences between doctors and patients.Theories of philosophy,ethics and psychology were used to analyze the different needs of different patients in the process of medical treatment,as well as the reshaping of patients’ subject status by narrative medicine and the bridging of divergences in medical cognition and decision-making motivation between doctors and patients.Next,it was expounded that the bridging of doctor-patient divergences in narrative medicine was based on the intersubjectivity between doctors and patients,and the realization of intersubjectivity was to practice narrative medicine.As the subject,the patient should also play the role of the subject and realize the two-way empathy between doctors and patients,which is the emotional cornerstone of bridging the doctor-patient divergences.Finally,some measures were put forward to improve the empathic ability of doctors and patients.Part 4:Medical staff’s understanding of narrative medicine in bridging doctor-patient divergences.A questionnaire was administered to 990 medical staffs who had been somewhat familiar with narrative medicine,to summarize the respondents’ understanding of the functions of narrative medicine,their real experiences in clinical practice of narrative medicine,and the suggestions put forward by medical staff to better promote narrative medicine in clinical practice.Discuss the results of the questionnaire,and verify that narrative medicine can effectively achieve subjectivity and promote the joint fight against diseases between doctors and patients.Finally,the results of questionnaire survey were discussed,and the role of narrative medicine in promoting doctor-patient joint fight against diseases was summarized.The results of questionnaire were discussed,then,the role of narrative medicine in promoting the potentials of fighting against diseases was summarized,and the responsibilities that medical staff and hospitals should undertake in the practice of narrative medicine were emphasized.Finally a new training method of narrative medicine was come up with to make it more convenient for medical staff to participate.Part 5:An discussion on the clinical pathway of narrative medicine to bridging the divergences between doctors and patients.After verifying the positive role of narrative medicine,this study further aimed to promote its better application in clinical practice.Since that,The Pre-consultation List of Narrative Medicine was designed,and then the purpose,the theories of ideas,the specific content of the list,and application method were introduced.It was expected that this list would became a helpful tool for the clinical practice of narrative medicine in bridging the divergences between doctors and patients.Part 6: Research Summary and Prospects: Firstly,this research is summarized,followed by the identification of two innovative aspects of this study.These include conducting literature mining,investigation,validation,and tool development to explore the role of narrative medicine in bridging the gap between doctors and patients,as well as focusing on in-depth research on inter-subjectivity,a topic that has not been thoroughly studied in previous narrative medicine research,in exploring the principles and applications of narrative medicine in bridging the divergences between doctors and patients.Finally,prospects for future research are presented. |
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