醫「用」關係的知識與權力

醫病關係長期以來深受詬病，近年來醫界也開始出現反省的聲音。本文提出以「醫用關係」的思考模式來重新思考這個醫療社會學中的核心議題。「醫用關係」中的醫療專業者不限於醫師，還包括護士與其他醫療專業者；而醫療使用者則包括所謂的病患與尋求醫訊的民眾。「醫用關係」的思考可以讓我們看到一個比我們熟知的「醫病關係」還更複雜的圖像：在診療情境具有相當的「不確定性」的情況下，加上醫療者和使用者都是「多重認同的主體」，他們之間的互動具有多樣知識的交流和微觀權力運作的關係。因此，筆者主張不再以病人的滿意度和醫病溝通中的遵從醫囑為研究對象，而以知識和權力為「醫用關係」的問題核心之一。筆者以婦產科門診的經驗研究來說明，醫用互動時，在知識的交流方面，包括了醫學知識、社會論述與個人隱微的知識。至於權力的運用，不是完全如我們預設的來自單方面醫療專業者，醫療使用者也會採取策略進行協商、挑戰甚至乾脆出走。本文的討論期望給予醫療專業者反省思考的空間，而使用者也可以認知到有充權的可能性。

The doctor-patient relationship has long been the target for critics, and some reflexive views on the topic recently emerging from the Taiwanese medical profession. In this paper. I propose using the 'professional-user relationship' as an alternative approach to analyzing this core medical sociology issue. Here the professionals include doctors, nurses and other paramedical staff, while the user population consists of patients and others using medical resources. I believe the 'professional-user relationship' approach allows us to address the complexities of the issue better than the 'doctor-patient relationship' as it is generally understood. Due to the uncertainty involved with medical diagnoses and treatment, and given the fact that both professionals and users are subjects of multiple identities, interactions between the two are filled with various kind of knowledge and took place at micro-power level. I therefore argue in favor of shifting the current research focus from patient satisfaction and compliance to professional-user's knowledge and power. The gynecological encounters between the professionals and users serve as examples illustrating the nature of knowledge and power involved in such interactions-- knowledge including biomedical knowledge, social discourses and tacit knowledge held by individuals, and power meaning held by professionals as we usually assumed as well as held by users adopting strategies to negotiate outcomes, challenge decisions or simply turn to other choices. The discussion aims to provide the professionals with ideas for reflection and to show users a possibility of empowerment.