許多研究指出生殖科技治療中,影響病人治療意願、治療過程及治療結果最重要的因素是醫病關係 (Hertz 1982 , Cabau 等 1997a , Dowell 、 Snadden &Dunbar 1996) 。生殖科技治療的醫病關係是 一項特殊的議題 : 整個療程需要例行的監測以及和醫護人員的密切接觸,通常持續三至五年,需要 患者高度的參與配合,以成功懷孕為醫病雙方的最終目的 ( 李從業等 1997) 。因此,本研究關心不 孕婦女在接受醫療診治過程中的醫病關係及互動。針對不孕婦女與醫師互動的個人主觀經驗,以及 研究者臨床參與觀察來獲得資料,以了解不孕治療過程的醫病關係。本研究之目的有 :
一、發現不孕婦女接受生殖科技治療的個人主觀經驗,及對其醫病關係的感受及看法。
二、瞭解不孕診療過程中的醫病互動。
三、剖析不孕治療中,『性別』因素對醫病關係的影響。
本研究以某區域醫院之婦產科不孕門診患者為研究對象,以立意取樣的方式,採用質性研究方法中 的深度訪談法、參與觀察法收集資料 ; 以內容分析法分析資料。研究結果發現個案收集求醫相關的 訊息來自『女性資訊網』,個案對醫病關係的主觀感受是一『動態的』『累積過程』。個案自求醫 地點的選擇所發展出的『推力與拉力拉扯的概念』及個案求醫過程中『醫病關係中的信任感概念』
形成了醫病關係中『情感飽和概念』。『情感飽和概念』指影響個案求醫意願的關鍵在於醫病關係 中『不滿意情結』的『情感飽和』。這個概念能說明個案會離開醫病關係的時機。本研究亦提出醫 學人文在醫學的重要性,及以下三點建議 :
一、醫師養成教育必須重視醫病關係中的醫病溝通 二、增進醫療從業人員的性別意識
三、醫院應加強維護病人的隱私權 以供未來研究之參考。
關鍵字 : 不孕婦女、生殖科技、醫病關係、逛醫師
醫、病之間 - 以不孕婦女為例之探索研究
The purpose of the study is to find infertile women’s experience and their view of doctor-patient rel ationship during the period when they are accepting reproductive therapy.
To understand the doctor-patient interaction, the researcher participated in two outpatient departme nts practiced by doctors of different genders; in addition, thirteen infertile women were interviewed.
The major findings are:
1.Infertile women always get medical information from “women’s information net” to choose their doctors.
2.Infertile women’s view of the doctor-patient relationship is a dynamic accumulated process. Whe n they feel dissatisfied, they will find other doctors for better treatment.
3.The “doctor shopping” behavior only shows in modern medicine.
4.The concept of the “push-pull struggle” can explain how infertile women decide to select their do ctors.
5.The concept of “the trust of doctor-patient relationship” can explain why patients continue to kee p in touch with their doctors.
6.The concept of “emotional saturation” can explain the key point of interruption of doctor-patient r elationship.
According to these findings, our suggestions are:
1.Medical education should lay emphasis on doctor’s communication skills.
2.Improve medical members’ gender awareness.
3.Build a trusting environment for the patients in the hospital.
Key words: Infertile women; Reproductive technology; Doctor-patient relationship; Doctor shoppin g.
Between Doctor and Patient:An Exploratory Study of Infertile Women