醫、病之間-以不孕婦女為例之探索研究
Between Doctor and Patient:An Exploratory Study of Infertile Women
中文摘要
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
英文摘要
The purpose of the study is to find infertile women’s experience and their view of doctor-patient relationship during the period when they are accepting reproductive therapy.
To understand the doctor-patient interaction, the researcher participated in two outpatient departments 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. When 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 doctors.
5.The concept of “the trust of doctor-patient relationship” can explain why patients continue to keep in touch with their doctors.
6.The concept of “emotional saturation” can explain the key point of interruption of doctor-patient relationship.
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 shopping.
