Study On The Doctor-patient Relationship Status Quo And Countermeasure In Large Comprehensive Military Hospital

ObjectiveThe tense doctor-patient relationship not only has a considerably negative psychological effect to the patients and their families,but also seriously interfere with the normal work order of medical institutions,increasing the workload of medical management department and the psychological pressure of the medical staff,harming the reputation of the image in society of the medical institutions and medical personnel,and finally affecting the construction of a harmonious society.How to rebuilding a harmonious doctor-patient relationship and maintaining the normal order of medical service,both doctor-patient interests,have posed a serious issue needing mutual concern in the whole society.In this research subject,basing on the current doctor-patient relationship status quo and characteristics of military hospitals,we studied on the present basic situation of the doctor-patient relationship in large comprehensive military hospital,main characteristics and influence factors,exploring main measures to improve the doctor-patient relationship,aiming to further optimize the medical service quality,improve the medical personnel professional identity and the patient service-satisfaction-ratio.Methods1.The research object(1)Completely randomly,we selected 200 medical personnel,including military personnel in active service,civil servants,employed staff,training and interns,as well as 200 hospitalized patients and their families from a large comprehensive military hospital to carry on the doctor-patient relationship related cognitive situation questionnaire survey.(2)We Invited 15 frontline medical staff representatives and 15 patient(families)representatives to conduct an informal discussion,in order to understand the actual conditions of the doctor-patient relationship in this military hospital,analyze the main problems in the doctor-patient relationship of the hospital.(3)Through visiting the medical ethics and cultures(MEC)office and doctor-patient communication office,we collected related data on the hospital Medical Ethics and Patient-Doctor Dispute(PDD).2.The research method(1)Literature researchRelated literature refer to the doctor-patient relationship collected from the database of China National Knowledge Infrastructure(CNKI),Wanfang data,the third military medical university library digital resource and so on,relevant theoretical knowledge and concepts mastered through reading lots of books,the current research status of doctor-patient relationship at home and abroad was understood.(2)Questionnaire methodAccording to the actual characteristics of large-scale comprehensive military hospital,doctor-patient relationship questionnaire was self-designed,including medical personnel questionnaire and the patients questionnaire.Quantitative employed medical staff in direct contact with the patients and being willing to participate in the questionnaire survey,as well as quantitative patients,in and out,without mental disorders and being willing to cooperate with the investigation of questionnaire survey were randomly selected to conduct the questionnaire survey.Then questionnaires were retrieved valid for data organizing.(3)Representatives informal discussion method15 representatives were randomly selected respectively from the hospital medical staff and hospitalized patients and their relatives,to participate in the symposium.(4)Visiting survey methodThe data relating to the medical ethics and medical disputes in last four years were collected by visiting the medical ethics office and the doctor-patient communication office in the hospital.Results1.The cognition of the doctor-patient relationshipIn terms of the cognition of the trust degree in doctor-patient relationship,about 8.9% and 34.6% of doctors believed there was full trust and relative trust between the doctor-patient relationship,and 35.6% thought the distrust existed between doctor and patient.Meanwhile,29.4% and 39% of patients believed doctor-patient relationship based on full trust and relative trust,and only 11.3% thought there was distrust relationship between doctor and patient.The recognition evaluation of service quality in military hospital from both doctors and patients: 29.8% of the medical staff thought it was better,65.4% thingking no different,4.8% thinking poorer.Besides 76.5% of patients thought it was better,18.7% thingking no different,and 4.8% thingking poorer.2.The evaluation of the present situation of the doctor-patient relationship6.8% of the medical staff evaluated doctor-patient relationship very satisfying,29.3% thinking it relative satisfying,52.9% thinking not at all.On the other side,18.7% of patients evaluated doctor-patient relationship very satisfying,44.9% thinking relative satisfying,13.9% thinking not at all.On aspect of doctor-patient communication,there were 8.0% of indeed satisfied patients,17.6% of patients showing satisfied,on the other side 62.6% not satisfied,Patients communication time with doctors longer than 10 minutes only accounted for 3.2%,between 5 to 10 minutes accounting for 19.3%,and less than 5 minutes took up amazing 77.5%.There was significant differences in satisfaction with doctor-patient relationship between medical staff in different identity categories.The education,occupation,expense category of patients made huge impact to the satisfaction degree of doctor-patient relationship.3.The doctor-patient relationship factorsMedical staff regarded the limited medical resources as the primary reason,accounting for 74.9%,high hospitalization costs accounting for 67.0%,negative misleading by the news media and public opinion accounting for 69.0%.On the other side,patients thought the high medical costs were the primary reason accounting for 87.2%,negative misleading by the news media and public opinion accounting for 42.9%,the limited medical resources accounting for 62.0%.In the survey of influence factors from doctors with the doctor-patient relationship,medical staff insisted that heavy excessive workload was the crucial factor accounting for 88.5%,insufficient communication with the patient accounting for 81.2%.Patients relatively thought insufficient communication was the primary reason,accounting for 85.0%,poor professional ethics holding lower percentage(46.5%).In the survey of influence factors with the doctor-patient relationship from patients,the medical staff insisted mistrust on the medical staff was the primary reason,accounting for 91.6%,patients’ deeply high expectations taking up 70.7%.But,patients regarded lacks of medical professional knowledge was the primary factor,accounting for 86.6%,bias to the medical personnel taking up 56.1%.According to the survey of influence factors with the doctor-patient communication,the medical staff insisted overload work of medical staff and then lack of time was the primary reason accounting for 91.6%,asymmetry of medical professional knowledge taking up 78.0%,insufficient communication skills mastered by medical staff holding 69.1%.Relatively,patients regarded asymmetry of medical professional knowledge as the primary factor,accounting for 89.8%,inadequate attention paid by the medical staff holding 66.8%.4.Measures to improve the doctor-patient relationshipBoth doctors and patients agreed that strengthening the doctor-patient communication and increasing investment in medical field were the main measures: 97.4% of the medical staff chose to strengthen the doctor-patient communication,with 92.1% choosing the government increasing spending on health,70.7% choosing deeper reform of the medical system.Otherwise,96.8% of patients chose to strengthen the doctor-patient communication,90.4% choosing the increasing government spending on health,79.7% supporting hospitals to strengthen the construction of medical ethics.5.Doctor-patient representatives discussionThe positive side of this military hospital reflected in the discussion included that the medical ethics education carrying out well,a higher service quality overall,the military hospital brand trusted generally by patients,medical technology appreciated universally by patients.Relatively,negative aspects included that medical charge was unbearable for patients,hospital procedure and link needing to optimize,minority individual medical staff service quality being not high enough,medical insurance system being unreasonable,the medical staff work being excessive heavy but low benefits,etc.6.Visiting surveyThere was a obvious increasing number of complaints of medical ethics and medical disputes in the latest four years.Conclusion1.There was no doubt that the large comprehensive military hospital medical ethics construction effect is significant,with the brand image deeply rooted in the hearts of the people,and medical technology level and service quality appreciated by the majority of patients.2.both sides of doctor-patient realized the importance of doctor-patient relationship in medical activities,and wanted to establish collectively participative mode of the doctor-patient relationship.The doctors held a more pessimistic cognition on the current status of the current doctor-patient relationship compared with the patients.3.The diversity of personnel composition in large comprehensive military hospital had significant influence on the doctor-patient relationship(p<0.05).On the satisfaction survey analysis of doctor-patient relationship aiming to doctors in different identity categories as well as patients corresponding to different categories of management doctors in identity,the doctors in military category won the highest satisfaction,besides the education personnel won the lowest satisfaction.4.Patients got the higher degree,the lower satisfaction degree.Relative to the civil service,enterprises and institutions,as well as self-employed,farmers got more doctor-patient relationship satisfaction.Patient satisfaction at his own expense was low.5.patients were not satisfied with the doctor-patient communication and the doctor-patient communication time was not obviously.Doctors insisted that workloads was the main reason,on the other hand patients believed that the asymmetry of professional knowledge was the main factor.6.Both sides of doctor-patient agreed on the social factors was the first element of the doctor-patient relationship nervous,with medical staff believing the limited medical resources worked most,patients voted he high medical expenses is for t the primary reason.On the aspect of doctor-factor,doctors insisted excessive workloads the major reason,besides patients stuck to the insufficient communication between each other.Referring to the patient factors,medical personnel mentioned most the distrust from patient,and patients believed the short of medical professional knowledge was the vital factor.7.Strengthening the doctor-patient communication,increasing government investment in medical field,deepening the reform of medical system and hospital to strengthen the construction of medical ethics is considered to be the main way to improve the doctor-patient relationship.