Characteristics of Illness Attribution and Doctor-patient Relationship of Patients with Multiple Somatic Symptoms in Outpatient Clinics of a General Hospital
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摘要:
目的 了解综合医院门诊多躯体症状患者的患病观念和医患关系特点。 方法 纳入2012年3月至10月北京协和医院消化内科、中医科和心理医学科门诊患者共150例, 根据躯体症状严重程度量表(somatic symptom scale of the patient health questionnaire, PHQ-15)总分≥ 10和 < 10分为多躯体症状组(SOM+组)和对照组(SOM-组), 每组各75例。患者就诊前完成疾病归因问卷, 就诊后医生和患者分别完成医患关系问卷、本次就诊的满意度及所用时间量表。 结果 SOM+组患者认可由心理因素(16.0±4.3比13.5±4.9, P < 0.01)、文化特定因素(6.5±1.8比5.6±1.8, P < 0.01)导致患病的得分高于SOM-组。SOM+组患者的医患关系问卷总分(37.7±6.7比39.6±6.4, P=0.011)及"医生对我有所帮助"、"医生有足够的时间给我"和"对医生给的治疗很满意"条目得分显著低于SOM-组(P=0.028, 0.038, 0.022)。而医生对SOM+组患者评分在"为模糊主诉困扰"和"照顾病人费时"两条目上显著高于SOM-组(P=0.047, 0.021), "面对病人心情舒适程度"评分显著低于SOM-组(P=0.014)。SOM+组患者和医生对于治疗的满意度均显著低于SOM-组(P=0.048, 0.044)。关于就诊时间, 患者评价SOM+组与SOM-组差异无统计学意义(P=0.814), 医生评价SOM+组显著长于SOM-组(P=0.030)。 结论 多躯体症状患者对疾病的归因既包括心理社会因素, 也包括生理因素; 此类患者的医患关系困难, 患者常感到得不到帮助和时间不够, 医生常感到困扰和费时。 Abstract:Objective To explore the illness attribution of patients with multiple somatic symptoms and their relationship with doctors. Methods This cross-sectional study was conducted from March to October, 2012, involving 150 participants who were recruited through convenience sampling from the outpatient clinics of Gastroenterology, Traditional Chinese Medicine, and Psychological Medicine of Peking Union Medical College Hospital. Based on somatic symptom scale of the patient health questionnaire (PHQ-15), the patients were divided into multiple somatic symptoms group (SOM+group, PHQ-15 score ≥ 10) and control group (SOM-group, PHQ-15 score < 10), with 75 patients in each group. The patients completed the illness attribution questionnaire while waiting to see the doctor. After visiting the doctor, each patient and doctor were invited to finish the patient-doctor relationship questionnaire (PDRQ) or difficult doctor-patient relationship questionnaire (DDPRQ) respectively, as well as to report the degree of satisfaction with the clinic visit and the estimated time of this doctor-visiting. Results The SOM+ group were more likely than the SOM-group to attribute their illnesses to psychological factors (16.0±4.3 vs. 13.5±4.9, P < 0.01) and culture-specific factors (6.5±1.8 vs. 5.6±1.8, P < 0.01). Moreover, the total score of PDRQ in the SOM+ group was significantly lower than that in the SOM- group (37.7±6.7 vs. 39.6±6.4, P=0.011), so did the scores for items "my doctor can help me", "my doctor has enough time for me", and "I am satisfied with the treatment" (P=0.028, 0.038, 0.022). On the other hand, the doctor-reported scores were also higher in the SOM+ group regarding "frustrated by the patient's vague complaints" and "caring for this patient is time-consuming" (P=0.047, 0.021), while lower for the item "I felt at ease when with this patient" (P=0.014). The degrees of satisfaction of both patients and doctors in the SOM+ group were significantly lower than those in the SOM- group (P=0.048, 0.044). The patients reported no significant difference in visit time between the SOM+ group and the SOM- group (P=0.814), but the doctors-reported visit time in the SOM+ group was longer than that in the SOM- group (P=0.030). Conclusions Patients with multiple somatic symptoms attribute their illness to both psycho-social factors and physical factors. Relationship between doctors and these patients is difficult. Patients are likely to feel not being helped or given enough time, while doctors are likely to feel frustrated and time-consuming. -
表 1 患者疾病归因问卷各条目回答“同意”“非常同意”者所占比例(%)
条目 SOM+组
(n=75)SOM-组
(n=75)P C1压力或烦恼 69.3 44.0 <0.001 C2遗传(家族性) 18.7 20.3 0.592 C3细菌或病毒感染 17.3 17.3 0.798 C4食物或进食习惯 48.0 37.4 0.041 C5纯属偶然或运气不好 12.2 13.3 0.490 C6过去不良的医疗 25.4 17.6 0.048 C7环境污染 21.3 35.1 0.583 C8我自己的行为 43.2 37.4 0.299 C9我的心态不好,如我对人生想法
太悲观38.7 25.4 0.104 C10家庭问题或烦恼 45.4 26.7 0.007 C11操劳过度 42.7 25.4 0.020 C12我的情绪状态,如我感觉情绪低
落、寂寞、焦虑或空虚56.0 32.0 0.001 C13衰老 28.0 19.0 0.110 C14饮酒 9.3 16.0 0.411 C15吸烟 9.3 14.7 0.888 C16意外事故或损伤 12.0 6.7 0.308 C17我的性格 50.7 42.6 0.385 C18我的免疫力下降 64.0 46.7 0.012 表 2 患者医患关系问卷各条目回答“相当符合”或“完全符合”者所占比例(%)
条目 SOM+组
(n=75)SOM-组
(n=75)P 1.我认为我的医生对我有所帮助 72.0 82.7 0.028 2.我的医生有足够的时间给我 72.0 82.7 0.038 3.我信任我的医生 85.1 92.0 0.333 4.我觉得我的医生能理解我 84.0 87.9 0.332 5.我的医生非常愿意帮助我 84.0 90.7 0.228 6.我和我的医生对于病因的看法一致 75.4 79.8 0.074 7.我可以和我的医生沟通 84.0 88.0 0.223 8.对于医生给我的治疗,我很满意 77.4 85.2 0.022 9.我感觉我的医生是平易近人的 89.4 92.0 0.387 表 3 医生困难医患关系问卷各条目回答为“同意”至“非常同意”者所占比例(%)
条目 SOM+组
(n=75)SOM-组
(n=75)P 1.在结束今天的治疗后,您在多大程
度上乐意病人再次就诊?*72.0 82.7 0.202 2.这位病人让您感到有多沮丧? 10.7 6.7 0.289 3.您认为该病人的控制欲有多强? 24.0 25.3 0.564 4.这位病人模糊的主诉在多大程度上
困扰了您?17.4 6.7 0.047 5.该病人有多强的自我毁灭性? 13.3 9.3 0.447 6.请问您私下觉得您在多大程度上不
希望该病人再次就诊?16.0 12.0 0.309 7.今天在面对这位病人时您心情有多
舒适?*70.7 80.0 0.014 8.您照顾该病人有多费时? 42.7 25.3 0.021 9.您在照顾这位病人时有多热情?* 86.7 84.0 0.816 10.您在与这位病人交流时有多困难? 17.3 10.6 0.469 *为反向计分条目 表 4 患者和医生分别对本次就诊感到满意者所占比例和认为诊疗所用时间(%)
条目 患者评价 医生评价 SOM+组
(n=75)SOM-组
(n=75)P SOM+组
(n=75)SOM-组
(n=75)P 对医生给的治疗/给患者的治疗满意 77.3 89.3 0.048 69.4 77.4 0.044 医生给您看病/您给患者诊疗用了多少时间(min) 0.814 0.030 <5 5.8 7.1 2.7 12.0 5~10 37.7 44.3 38.7 42.7 11~15 21.7 10.0 25.3 24.0 >15 34.8 38.6 33.3 21.3 -
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