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【Objective:】 To explore the ethical dilemmas faced by the critical care physicians in the process of practicing the right to informed consent in a region of Beijing. 【Methods:】 14 doctors in the critical care unit from 5 medical institutions in a certain region of Beijing were interviewed in depth face-to-face by qualitative research method. The data obtained were analyzed through coding, classification, and extraction of subjects. 【Results:】 The lack of trust in doctor-patient communication leads to the instrumentalization of the right to know. When the decision of family members is inconsistent with the patient’s right to life and health, doctors are faced with the dilemma of choice and its impact. 【Conclusions:】 Faced with such ethical dilemmas, it is suggested to rebuild doctor-patient trust through multiple measures, and make appropriate restrictions on the agent-executing of the right of informed consent.
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Objective@#To evaluate the degree of trust of patients in community traditional Chinese medicine(TCM)physicians, based on the TCM service capability promotion program, and to analyze the impacts by TCM prevention and health care service.@*Methods@#1 391 patients at 22 primary health service centers in 3 cities from Zhejiang province were investigated using the Chinese version of Wake Forest Physician Trust Scale(WFPTS)in September, 2017. Quantitative and qualitative variables were described by mean±SD, and ratio respectively. Differences were compared by t test, ANOVA and Kruskal-Wallis test.@*Results@#Chinese version of WFPTS had good reliability and validity in measuring community TCM physicians. The average scoring of patients′ trust in community TCM physicians was 38.00±6.42, while their benevolence and competence were 19.14±3.41, 18.82±3.50 respectively.For patients with different demographic characteristics, their quantity and the way to acquire and utilize TCM prevention and health care service had different degrees of trust in community TCM physicians. Patients′ gender, age, awareness and utilization of TCM prevention and health care service, etc. affect the degree of trust in community TCM physicians.@*Conclusions@#Patients have higher degree of trust in community TCM physicians, and improving the rate of awareness and utilization of TCM prevention has positive impacts on the degree of trust in these physicians. It is proposed that health knowledge education be strengthened and skills of community TCM physicians′ capacity be enhanced through various ways.
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Objective To analyze the impacts of bureaucracy management at tertiary public hospitals in Beijing on exchange modes and trust between doctors and patients, using both the bureaucracy theory and trust theory. To study the role of such management as an organizational structure for hospital operation and service, in the transition of doctor-patient trust from traditional special trust to a universal trust based on bureaucracy structure and specialized job division. Methods The purpose sampling method was used to select 94 hospital administrators, medical staff, and patients from six tertiary hospitals for a field survey. Results Bureaucracy at public tertiary hospitals keeps improving, and its systematic and refined organizational structure is changing the exchanges between doctors and patients, earmarking universal trust of the fundamental type of doctor-patient trust, aided by special trust. Rules and regulations of bureaucracy normalize medical services, and specialization enables medical workers in their clinical work against difficult and severe diseases, winning both reputation and patient trust as well. However, the specialized, professional and dehumanized characteristic of bureaucracy tend to encourage doctors to attend to diseases than patients, and separate links in medical services to decrease doctor-patient trust in the meantime. Conclusions Bureaucracy is a necessary organizational form of urban public hospitals, but it should strengthen their humanity feature and improve their communication with patients with rules and regulations. At the same time, with the use of integrated medical mode in clinical practice, bureaucracy could be improved to benefit patients and enhance trust of patients.
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Taking 6 one class A tertiary public hospitals at the top of the national medical service system in Beijing as the research site, and from the perspective of bureaucracy and system construction of public hospitals, this paper conducted a qualitative study on the doctor-patient trust mode, and analyzed that the institutional trust mode formed by the factors of universalism communication type and reputation trust mechanism among doctors and patients based on the framework of bureaucracy organization was the dominant mode of public hospitals. However, the traditional interpersonal trust mode still existed in the doctor-patient relationship in a recessive way. Systematic, rigorous hospital bureaucracy organization and system made public hospitals not only had a harmonious, orderly and efficient operation of the diagnosis and treatment environment, but also had well-known experts and professional standards at home and abroad, enjoying irreplaceable reputation and trust. Meanwhile, the principle of bureaucratic matter-based principle made an ineffective corporation between different clinic departments and the lack of interpersonal communication and humanistic care between doctors and patients, affecting the trust between doctors and patients. On this basis, it is proposed to strengthen the construction of humanistic environment in public hospitals, incorporate humanistic care and good doctor-patient communication into the performance appraisal of departments and medical staff. At the same time, by integrating the application and practice of medical model in diagnosis and treatment, it is advocated to rebuild more patient-friendly medical management based on organ system, and constantly improve the system trust between doctors and patients.
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The expansion movement of the market and the reverse movement that it has encountered to control its expansion constituted the " double movement" written by the British scholar Karl Polan.In traditional China,because the market was strictly embedded in the social,political,economic and ethical structure,there was no so-called " double movement",and the trust between doctors and patients was naturally established and historical-ly continued.Since the reform and opening up,with the gradual introduction of market mechanism in the reform of medical system,the market was increasingly " un-embedded" and expanded rapidly.At the same time,the socie-ty represented by the patients and their families gradually began to wake up and took action against market expan-sion,forming a more typical trend of " double movement" and triggering a more obvious crisis of doctor-patient trust.From the perspective of "double movement",to rebuild doctor-patient trust in the new period must re-em-bed the market into the society and strictly regulate some spontaneous social reverse movements.
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Objective To learn the current doctor-patient trust in contracted service of family physicians in suburban Beijing, and analyze its influencing factors from residents′ perspectives to propose countermeasures. Methods A total of 197 contracted residents were sampled from 12 community health service centers in 4 out of 10 suburb districts of Beijing, for a questionnaire survey using stratified random sampling method. Items of the questionnaire cover residents′knowledge of the family physicians′ contracted service, their trust of family physicians′ competence, and their trust level of the ethics and the influencing factors. Measurement data were calculated form the mean value, while the count data were subject to proportion analysis, frequency description and rank ordering. Results 175(88.8% )and 156(79.2% )of the contracted residents trust the ethics and competence of their family physicians. Whether the ethics trust exists between doctors and patients was decided by if residents′respect, care, and interests considerations taken into account by the physicians; the factors influencing the competence trust of the residents were the age, education of the residents, and whether the physicians display respect, care. Conclusions Upgrading the medical competence and ethical conduct is conducive to the establishment of doctor-patient trust. In the establishment of the family physicians contracted service, it is necessary to improve acceptance of the contracted residents. At the same time, medical ethics issues such as respect for care, privacy protection, and maximum interests of the residents in the process of medical treatment deserve further attention.
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Objective:To analyze the causes and influencing factors of the strained relationship between doctors and patients and explore the corresponding countermeasures.Methods:Five public hospitals in Ningxia were selected to conduct a questionnaire survey.The influencing factors of doctor-patient relationship were analyzed using SPSS17.0,combined with the results of field case interviews.Results:The society was not satisfied with the medical staff,the rate of dissatisfaction was 87.9％.The causes of tense doctor-patient relationship were mainly focused on the following aspects:imperfect medical insurance system,unreasonable medical system,negative media reports,inflated expectations of patients,lack of necessary communication between doctors and patients,and lack of medical ethics.Conclusion:According to the influencing factors of doctor-patient relationship,this paper puts forward some countermeasures from the perspective of governments,the society and media.
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Objective:Through literature search,this paper aims to understand the current situation of social trust mechanism and the research progress of trust evaluation methods,and thus to provide theoretical reference for further researches.Methods:Using the literature search method,this paper sorted out,analyzed and concluded the domestic and foreign literatures and information about social trust mechanism and trust evaluation.Results:The domestic research on social trust mechanism could be mainly divided into two parts,while the foreign research path was different and mainly related to the field of electronic commerce,government departments,medical behavior,and so on.Evaluation methods in doctor-patient trust mainly included trust scale evaluation and trust model.Conclusion:There is a certain development of the domestic researches on social trust mechanism and evaluation,but still need further improvement.The limitation of doctor-patient trust evaluation is prominent and efforts should be made to research on the improvement measures of medical social trust mechanism.
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This paper analyzed the three basic principles of medical professionalism established in the Medical Professionalism in the New Millennium:Physician Declaration and influencing factors of a series of clear professional responsibilities from the medical technology , medical ethics , medical professional responsibility and medical equity four levels .The study found that the proportions of doctors and patients ' identification with the elements of medical professionalism were relatively high , of which the proportion of doctors was higher than patients .It indicated that the basic principles and professional responsibility advocated by medical professionalism had been recognized and accepted by medical staff and the public .
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This paper analyzed the three basic principles of medical professionalism established in the Medical Professionalism in the New Millennium:Physician Declaration and influencing factors of a series of clear professional responsibilities from the medical technology , medical ethics , medical professional responsibility and medical equity four levels .The study found that the proportions of doctors and patients ' identification with the elements of medical professionalism were relatively high , of which the proportion of doctors was higher than patients .It indicated that the basic principles and professional responsibility advocated by medical professionalism had been recognized and accepted by medical staff and the public .
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Objective To explore the relationship among aggression of patients,doctor-patient trust and perceived social support,and to provide a new prospective of improving doctor-patient relationship.Methods Data of Chinese buss-perry aggression scale,wake forest physician trust scale and perceived social support were collected from a sample of 338 patients in Guangzhou and analyzed with structural equation modeling.Results ①Median (interquartile range) of aggression,doctor-patient trust and perceived social support were 54(18),32(8) and 62(15) respectively.②Total score of aggression(Z=-2.37,P=0.02) and the dimension score of physical-aggression(Z=-4.07,P＜0.01) between different gender were statistically significant,and the scores of male were higher than female.③According to relevant result,aggression of patients was significantly negatively correlated with both doctor-patient trust (r=-0.13,P＜0.05)and perceived social support(r=-0.14,P＜0.01).Doctor-patient trust was significantly positively correlated with perceived social support(r=0.36,P＜0.01) ④Perceived social support fully mediate the relationship between aggression of patients and doctor-patient trust(GFI =0.989,NFI =0.989,IFI =0.998,CFI =0.998,RMSEA =0.026,x2/df=1.229).Conclusion Perceived social support is a protective factor of aggression of patients.Improving the perceived social support of patients can promote the doctor-patient trust.
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Doctor-patient trust is the core and foundation of harmonious doctor-patient relationship, because our country is at the stage of social transformation and deepening medical reform, various problems make the doctor-patient relationship unoptimistic, and there appeared crisis of confidence between doctors and patients. This arti-cle analyzes the current situation of doctor -patient trust in our country, based on the clarification of doctor -patient trust. It also comb the researches focused on doctor-patient trust evaluation on the basis of domestic and foreign literature. It is expected to provide a reference to the future evaluation of doctor-patient trust, to improve the level of trust between doctors and patients, and to build a harmonious doctor-patient relationship.
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Objective:To understand the status of outpatients′medical care and their impact on the doctor -pa-tient trust in Beijing .Methods:Three tertiary hospitals were selected due to most concentrated high -quality medi-cal resources , the largest number of patient visits , universalism and particularism trust could be compared , taking field observations , personal interviews and questionnaires methods .Results:The main factors affecting clinical doctor-patient trust are time, the doctor skills, medical ethics, medical and prescription drug division , etc.are appropriate and effective .Conclusion:Play the role of pyramidmedical system′s overall effectiveness , and es-tablish a patient-centered system for outpatient care as soon as possible a comprehensive grasp of the overall con -struction team doctor , continue to strengthen the standardized management of medication .
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Objective:To compare the similarities and differences of doctor -patient trust building mechanism between doctors in urban and rural areas from the perspective of rural residents by the empirical study .Methods:Based on the field research and secondary in -depth interviews to the related personnel in H County of Beijing .Re-sults:There had obvious difference of doctor -patient trust building mechanism between doctors in urban and rural areas from the perspective of rural residents .Trust building mechanism between village doctors were mainly the trust of the similar social background , between the doctors in township health centers and city hospital were the trust based on reputation , institution-based trust , and relationship-based trust .Conclusion:The difference of re-gional and cultural between urban and rural areas ,the nature of medical institutions the relationship with doctors , reputation of medical institution and medical and health care system in urban and rural areas ,maybe the reasons that The difference of doctor -patient trust building mechanism between doctors in urban and rural areas .
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Through field observation and in -depth interviews of H County , analyzed about the present multidi-mensional situation between patient and physician .This paper discussed villager autonomy environment barriers and village village system build trust between patient and physician′s interpersonal trust between patient and physician′s unique features , further improve the village of doctor -patient trust countermeasures and suggestions: strengthen the village doctor training;To strengthen the village doctor in performance appraisal of public welfare goal , consoli-date the village-level emotional trust between patient and physician; Establish differential income compensation mechanism , arouse the enthusiasm of the village doctor service , and improve the level of village -level doctor-pa-tient trust .
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Objective:To analyze the status of doctor -patient trust and its influencing factors based on the per-spective of the villagers .Methods:Using purposive sampling method , the selection of the H area as the research site in Beijing , for in the 14 township 80 administrative villages of trust information in the form of questionnaire sur-vey .Results:The 350 villagers were surveyed 301 villagers of village clinics held a positive attitude to the doctor -patient relationship , accounted for 86 .00%;There are 44 villagers of village clinics the middle ground the doctor-patient relationship , accounted for 12 .57%;Only five of the villagers of village clinics have held a denial atti-tude to the doctor-patient relationship , accounts for 3.43%of the proportion of the total .Based on blood kinship relationship between the villagers of village clinics and rural doctors more trust , but the technical level and service ability are the main factors affecting doctor -patient trust .Conclusion:Rural doctors and villagers in the same vil-lage , has a common living environment , interpersonal relationship , morality , interpersonal trust between each other is higher .In clinical activities , formed by the interpersonal relationship with the clinical common existing doctor -patient trust , is essentially interpersonal trust mask a lack of technology .Transformation in the society , how to im-prove the service ability of the village clinic , realize the village clinic real doctor -patient trust is the important connotation of health reform .
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From the perspective of both doctors and patients, the questionnaire survey was used in 1080 medi-cal workers and patients in 12 hospitals in Shandong province.They found that is extremely development trend to the doctor-patient relationship, doctor-patient trust evaluation is relevant, doctor-patient both pay attention to the influence factors of the government and society.Both doctors in the building of doctor-patient trust, is atta-ched importance to strengthen the construction of medical ethics of medical personnel, continue to deepen the re-form of the medical system and government regulatory functions into full play.
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This paper analyzed some policies of new health care reform from the perspective of doctor -patient trust.The implementation of the policy of income and expenses in two lines has changed the management mode of township hospitals , eliminated some factors harming the doctor -patient relationship .The policy of equalization of public healthand other policies have guided the hospitals to change the way of service , service and health man-agement into the village increased the degree of doctor -patient trust .But at the same time , to ensure the new health care reform run smoothly , township hospitals introduced various ways of prescribing restraints .In addition , the policy of zero profit for basic drugs also brought some restrictions and regulations , resulting in a decline of satis-faction of patients , who have a tendency to blame the hospitals and doctors for these inconveniences .This misun-derstanding has becomed the new difficulties for doctor -patient trust as policy running .
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Doctor-patient trust plays an important role in doctor-patient knowledge transfer.Investigating the basic features and trust performance of the patients, the authors classified by means of a cluster analysis, the patients into four groups with such criteria as the trust on hospital, trust on doctors, patient's awareness of the knowledge, and patient's compliance to the doctor's advice. The four groups are rational and suspicious, passive compliance, high self-confidence, and blind trust groups. In view of behavioral characteristics of the patients, different doctor-patient knowledge transfer strategies are suggested, in an effort to perform effective doctor-patient communication and to gain patient's trust.