Slingsby B T
Department of Biomedical Ethics, Graduate School of Medicine, Kyoto University, Yoshida Konoe-cho Sakyo-ku, Kyoto 606-850119, Japan.
Soc Sci Med. 2004 Jul;59(1):83-91. doi: 10.1016/j.socscimed.2003.10.006.
This study deconstructs the current dynamics of the physician-patient relationship in the treatment of minor mood disorders including depression in Japan. An in-depth qualitative investigation was conducted on psychiatrists employed at mental health clinics, university hospitals, and psychiatric hospitals. Triangulation was conducted concurrently using key informant interviews and periodic non-structured interviews with additional physicians and patients. Results revealed two patterns of omakase (entrusting) (Omakase Model) and an emerging pattern of patient participation in decision making (Participatory Model). The pattern traditionally denoted by the Omakase Model encompasses an active and passive entrusting model. The phenomenon of an emerging Participatory Model was uncovered whereby an in-depth analysis led to an understanding behind the associative physician-patient relationship, communication patterns, and a patient's level of awareness. It was found that while active participation in medical decision making is capable of raising the level of treatment efficacy, it is not only active participation in medical decision making, but also active participation in medical treatment that is valued in the physician-patient relationship. Ultimately, a patient actively participates in his or her medical treatment under either the active Omakase Model or Participatory Model, be it entrusting or participatory. Consequently, the active Omakase Model will continue to remain functional alongside the Participatory Model while the passive Omakase Model is likely to fade away in time.
本研究剖析了日本在治疗包括抑郁症在内的轻度情绪障碍时医患关系的当前动态。对心理健康诊所、大学医院和精神病医院的精神科医生进行了深入的定性调查。同时采用关键 informant 访谈以及与其他医生和患者的定期非结构化访谈进行三角测量。结果揭示了两种 “委托”（omakase）模式（委托模式）和一种新出现的患者参与决策模式（参与模式）。传统上由委托模式表示的模式包括主动和被动委托模式。发现了一种新出现的参与模式现象，通过深入分析可以理解背后的医患关系、沟通模式以及患者的认知水平。研究发现，虽然积极参与医疗决策能够提高治疗效果，但在医患关系中，不仅积极参与医疗决策受到重视，积极参与医疗治疗也同样受到重视。最终，患者在主动委托模式或参与模式下，无论是委托还是参与，都会积极参与自身的医疗治疗。因此，主动委托模式将与参与模式一起继续发挥作用，而被动委托模式可能会逐渐消失。
