Ghoshal Rakhi, Madhiwalla Neha, Jesani Amar, Samant Padmaja, Badhwar Vijaya, Surve Sweta
PhD Fellow and Senior Researcher, Centre for Studies in Ethics and Rights, Mumbai;
J Med Ethics Hist Med. 2013 Jan 23;6:2. Print 2013.
Understanding the complexities of a provider-patient relationship is considered to be of critical importance especially in medical ethics. It is important to understand this relation from the perspectives of all stakeholders. This article derives from a qualitative study conducted across six obstetric care providing institutions in the cities of Mumbai and Navi Mumbai, India, over a period of 10 months. Thirty obstetricians were interviewed in-depth to understand what they perceived as the most important aspect in developing a good provider-patient relationship. The study found that while most providers highlighted the point of communication as the most critical part of the provider-patient relationship, they admitted that they could not engage in communication with the patients for various reasons. Obstetric consultants and residents said that they were too overburdened to spend time communicating with patients; providers working in public hospitals added that the lack of education of their patients posed a hindrance in effective communication. However, providers practicing in private institutions explained that they faced a challenge in communicating with patients because their patients came from educated families who tended to trust the provider less and were generally more critical of the provider's clinical judgement. The article shows how provider-patient communication exists as an idea among medical providers but is absent in daily clinical practice. This gives rise to a discourse shaped around an absence. The authors conclude by decoding the term 'communication' - they read the word against the context of its use in the interviews, and argue that for the providers 'communication' was not intended to be a trope towards setting up a dialogue-based, egalitarian provider-patient relationship. Providers used the word in lieu of 'counselling', 'guiding', 'talking to'. It concludes that, despite the providers' insisting on the significance of communication and complaining about its absence, what they desired in reality was not the possibility of a dialogue with the patient or a chance to be able to share decision-making power with the patient, but to be able to provide better instructions and chart out what was best for them in a more detailed way.
理解医患关系的复杂性被认为至关重要，尤其是在医学伦理学领域。从所有利益相关者的角度理解这种关系很重要。本文源自一项在印度孟买和新孟买市的六家产科护理机构进行的为期10个月的定性研究。对30位产科医生进行了深入访谈，以了解他们认为在建立良好医患关系中最重要的方面。研究发现，虽然大多数医疗服务提供者强调沟通是医患关系中最关键的部分，但他们承认由于各种原因无法与患者进行沟通。产科顾问和住院医生表示，他们负担过重，没有时间与患者交流；在公立医院工作的医疗服务提供者补充说，患者缺乏教育对有效沟通构成了障碍。然而，在私立机构执业的医疗服务提供者解释说，他们在与患者沟通方面面临挑战，因为他们的患者来自受过教育的家庭，这些家庭往往对医疗服务提供者的信任度较低，并且通常对医疗服务提供者的临床判断更为挑剔。本文展示了医患沟通在医疗服务提供者中只是一种理念，但在日常临床实践中却不存在。这引发了围绕这种缺失形成的一种话语。作者通过对“沟通”一词进行解码来得出结论——他们结合访谈中该词的使用背景来解读这个词，并认为对于医疗服务提供者来说，“沟通”并非旨在建立基于对话的平等医患关系。医疗服务提供者用这个词来代替“咨询”“指导”“交谈”。研究得出结论，尽管医疗服务提供者坚持沟通的重要性并抱怨沟通的缺失，但他们实际想要的并非与患者对话的可能性或与患者分享决策权的机会，而是能够提供更好的指导并更详细地规划对患者最有利的方案。
