Construct A New Thought On Diagnosis And Treatment: A Narrative Research On Doctor-patient Communication In Orthopedic Clinic

This paper investigates the doctor-patient communication in the orthopedic outpatient department of a tertiary hospital in Guangdong province by means of participant observation under the perspective of narrative medicine.First of all,this paper comprehensively reviews the research history and current situation of on narrative medicine and doctor-patient communication in orthopedic clinic,and proposes the approach to study doctor-patient communication in a narrative medicine perspective.Secondly,through the empirical study in the orthopedic outpatient department of a tertiary hospital in Guangdong province,this paper demonstrates various doctor-patient conflicts and analyzes the causes under the perspective of narrative medicine.From the patient aspect,the conclusion is that in addition to seeking to solve the pain and understand the cause of the disease,orthopedic outpatients also seek for the comfort and support from doctors,but there are also unreasonable purposes caused by commercial insurance and personal disputes.What’s more,some patients who come to the clinic tend to utter no words,mainly because they are not good at expressing their conditions and treatment intentions,and also lack for proper health literacy.From the doctor’s part,compared to ward,the diagnosis and treatment in outpatient service process offered by orthopedic surgeons is rather simplified due to the limit of time and space,which represents in the form of "treatment as the main purpose,examination as supplemental,assistance at times,comfort as rare".This way of treating patients fully embody existing patriarchal way of diagnosis and treatment in doctor-patient communication: the spotless of patient’s emotional needs,or use professional terms without explanation,or lacking the respect for the patients’ autonomic rights.Doctors in orthopedic clinic do not fully grasp the essence of patient empowerment,and it is also difficult to make patients to decide on their own.Thirdly,based on the narrative analysis of the typical cases,characteristics and existing problems of doctor-patient communication in orthopedic clinic are revealed.Therefore,this paper proposes a new mode of clinical thinking as "attaching importance tocommunication when diagnosing and treating,and paying attention to patients’ narratives during medical interview" to explore the way for narrative medicine to take root in clinical practice in China.From the theoretical level,this model provides not only advice to clinicians and medical students to be well-trained,but also encourages hospital and medical education providers to further theoretical research of narrative medicine in the long run.While from the practical level,it is necessary to change the inherent thinking pattern between doctors and patients due to a certain degree of mismatches between patients’ needs and the medical services provided by doctors.Therefore,the feasibility of improving patient’s health literacy is put forward with the intention to promote a more harmonious communication between doctors and patients,so that doctors can give full play to their professional knowledge and patients can better reach to an ideal and satisfactory clinical outcome.This paper includes eight parts.Chapter 1 mainly introduces the background information of the research problems,and proposes the theoretical and practical significance of the research on doctor-patient communication based on narrative medicine.After defining the concept of doctor-patient communication and narrative medicine,the research history and current situation of the two subjects at home and abroad are summarized.Also,methodology of the research,the basic structure of the paper,along with the innovation and difficulties of the research are all introduced.Chapter 2 explains the three elements of narrative medicine--attention,representation and attribution,and puts forward the theoretical analysis framework of narrative medicine,laying a theoretical foundation for the narrative analysis in the following chapters.Chapter 3 analyzes the purpose and characteristics of rural patients visiting orthopedic department through displaying three cases.Chapter 4 analyzes the purpose and characteristics of urban residents visiting orthopedic department through the demonstration of three cases.Chapter 5 compares the purposes and characteristics between urban and rural patients when visiting orthopedic clinic.Chapter 6 analyzes the characteristics of outpatient diagnosis and treatment of orthopedic clinicians through the demonstration of three cases,and thus concludes thecurrent outpatient diagnosis and treatment mode of orthopedic doctors that "treatment is the main,examination is the auxiliary,less help and less comfort".Chapter 7 puts forward a new thought on diagnosis and treatment,which is "attaching importance to communication when diagnosing and treating,and paying attention to patients’ narrations during medical interview",and systematically introduces it.It is pointed out that clinical medical students and clinicians should establish a thinking mode of diagnosis,treatment and communication in the analysis of illness and medical decision-making,systematically consider diagnosis and treatment,attach importance to communication,pay attention to the disease narrative of patients,and cultivate doctors with high integration of humanistic quality and medical professional and technical knowledge.Chapter 8 summarizes the thesis and gives feasible suggestions to improve the health literacy of patients.