肝癌病人求醫行為與醫病關係之初探

A Preliminary Study of Medical-care Seeking Behavior and the Patient-physician Relationship in Patients with Hepatocellular Carcinoma

目的：探討以肝癌病人觀點之求醫行為與理想醫病關係。方法：於2010年4月間，以中部某區域教學醫院放射腫瘤科之肝癌門診病人進行研究。受測者必需年滿18歲以上，具語言及表達能力、無嚴重精神疾患，並同意受訪者為限。總受訪人數共五人。於不受干擾的情境下，藉由錄音以半結構性訪談指引與深度訪談方式完成資料收集。結果：本研究中，求醫過程絕大多數病人仍依賴非專業轉介系統處理其疾病。當病人進入正式醫療體系後，求醫行為的最重要的行動邏輯是信任。代理委託之責任為病人心目中的關鍵信任面向。對於理想的醫病關係，病人除了期望醫師能充分告知病情外，最重要是關懷與親切的態度。結論：當代醫病的醫病關係已脫離父權模式，醫師與病人間的良好互動與溝通可減少醫療糾紛，進而創造醫病雙贏。

Purposes: To investigate medical-care seeking behavior and the ideal patient-physician relationship from the point of view of patients with hepatocellular carcinoma. Methods: The study recruited outpatients with hepatocellular carcinoma in the Departments of Radiation Oncology from a hospital in central Taiwan in April 2010. Patients who were over 18 years of age, able to communicate verbally, had no severe mental disorders, and were willing to give written informed consent were qualified to participate. A total of five participants were interviewed. Using a semi-structured interview guide, in-depth interviews were conducted to collect data and tape-recorded in an interruption-free environment. Results: During the process of medical-care seeking, the vast majority of patients relied upon a lay-referral system to cope with their illness. When patients entered the formal medical system, the most important factor in medical-care seeking behavior was trust. The patients highlight agency/fiduciary responsibility as the key dimension of trust. For an ideal patient-physician relationship, the patients expected their physician to not only be well-informed about the illness, but also to have a caring and cordial attitude. Conclusions: The contemporary patient-physician relationship has moved away from the paternalistic model. Good interaction and communication between physicians and patients could decrease medical disputes and create a 'win-win' situation.