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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

史丽丽 熊娜娜 朱丽明 张晓阳 赵晓晖 洪霞 李涛 蒋静 孙夏媛 魏镜

史丽丽, 熊娜娜, 朱丽明, 张晓阳, 赵晓晖, 洪霞, 李涛, 蒋静, 孙夏媛, 魏镜. 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[J]. 协和医学杂志, 2016, 7(1): 23-27. doi: 10.3969/j.issn.1674-9081.2016.01.005
引用本文: 史丽丽, 熊娜娜, 朱丽明, 张晓阳, 赵晓晖, 洪霞, 李涛, 蒋静, 孙夏媛, 魏镜. 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[J]. 协和医学杂志, 2016, 7(1): 23-27. doi: 10.3969/j.issn.1674-9081.2016.01.005
Li-li SHI, Na-na XIONG, Li-ming ZHU, Xiao-yang ZHANG, Xiao-hui ZHAO, Xia HONG, Tao LI, Jing JIANG, Xia-yuan SUN, Jing WEI. Characteristics of Illness Attribution and Doctor-patient Relationship of Patients with Multiple Somatic Symptoms in Outpatient Clinics of a General Hospital[J]. Medical Journal of Peking Union Medical College Hospital, 2016, 7(1): 23-27. doi: 10.3969/j.issn.1674-9081.2016.01.005
Citation: Li-li SHI, Na-na XIONG, Li-ming ZHU, Xiao-yang ZHANG, Xiao-hui ZHAO, Xia HONG, Tao LI, Jing JIANG, Xia-yuan SUN, Jing WEI. Characteristics of Illness Attribution and Doctor-patient Relationship of Patients with Multiple Somatic Symptoms in Outpatient Clinics of a General Hospital[J]. Medical Journal of Peking Union Medical College Hospital, 2016, 7(1): 23-27. doi: 10.3969/j.issn.1674-9081.2016.01.005

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

doi: 10.3969/j.issn.1674-9081.2016.01.005
基金项目: 

中德科学中心项目 GZ690

国家卫生和计划生育委员会精神卫生服务能力建设试点项目 IHECC2013MHCB

北京市外国专家局引进国外技术、管理人才项目 GDJ20151100007

北京协和医学院青年教师培养项目 2014zlgc0730

北京协和医学院重点课程项目 2014-001-001

详细信息
    通讯作者:

    魏镜 电话:010-69156061, E-mail:weijing@pumch.cn

  • 中图分类号: R442.8

Characteristics of Illness Attribution and Doctor-patient Relationship of Patients with Multiple Somatic Symptoms in Outpatient Clinics of a General Hospital

More Information
  • 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。
  • 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69.344.0<0.001
    C2遗传(家族性)18.720.30.592
    C3细菌或病毒感染17.317.30.798
    C4食物或进食习惯48.037.40.041
    C5纯属偶然或运气不好12.213.30.490
    C6过去不良的医疗25.417.60.048
    C7环境污染21.335.10.583
    C8我自己的行为43.237.40.299
    C9我的心态不好,如我对人生想法
    太悲观
    38.725.40.104
    C10家庭问题或烦恼45.426.70.007
    C11操劳过度42.725.40.020
    C12我的情绪状态,如我感觉情绪低
    落、寂寞、焦虑或空虚
    56.032.00.001
    C13衰老28.019.00.110
    C14饮酒9.316.00.411
    C15吸烟9.314.70.888
    C16意外事故或损伤12.06.70.308
    C17我的性格50.742.60.385
    C18我的免疫力下降64.046.70.012
    下载: 导出CSV

    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72.082.70.028
    2.我的医生有足够的时间给我72.082.70.038
    3.我信任我的医生85.192.00.333
    4.我觉得我的医生能理解我84.087.90.332
    5.我的医生非常愿意帮助我84.090.70.228
    6.我和我的医生对于病因的看法一致75.479.80.074
    7.我可以和我的医生沟通84.088.00.223
    8.对于医生给我的治疗,我很满意77.485.20.022
    9.我感觉我的医生是平易近人的89.492.00.387
    下载: 导出CSV

    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?*
    72.082.70.202
    2.这位病人让您感到有多沮丧?10.76.70.289
    3.您认为该病人的控制欲有多强?24.025.30.564
    4.这位病人模糊的主诉在多大程度上
    困扰了您?
    17.46.70.047
    5.该病人有多强的自我毁灭性?13.39.30.447
    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?
    16.012.00.309
    7.今天在面对这位病人时您心情有多
    舒适?*
    70.780.00.014
    8.您照顾该病人有多费时?42.725.30.021
    9.您在照顾这位病人时有多热情?*86.784.00.816
    10.您在与这位病人交流时有多困难?17.310.60.469
    *为反向计分条目
    下载: 导出CSV

    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77.389.30.048 69.477.40.044
    医生给您看病/您给患者诊疗用了多少时间(min)0.8140.030
           <55.87.1 2.712.0
           5~1037.744.3 38.742.7
           11~1521.710.0 25.324.0
           >1534.838.6 33.321.3
    下载: 导出CSV
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  • 收稿日期:  2014-09-24
  • 刊出日期:  2016-01-30

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