The Misconception And Reconstruction Of The Physician-patient Communication

We analyze the deep reason on misconception of physician-patient communication from the view of medical sociology, in order to discuss and explore the new countermeasures in the medical services and physician-patient communication, and to construct the harmonious physician-patient relationship finally. Our study object is the living world, which is also the study object of sociology, and we try to understand the true meaning of illness from the profile of "living-experience" of illness.Firstly, the physician's and patient's different understanding to the meaning of illness lead to the misconception to the physician-patient's communication.In the reality of everyday life, the patient and physician encounter the experience of illness from within the context of different worlds. Each renders the experience thematic accordingly. The physician is trained to see illness essentially as a collection of physical signs and symptoms which define a particular disease state, while the patient experiences it essentially in terms of its effects upon his everyday life. The patient's categories that he uses to define his illness are concerned with everyday life and functioning, while the physician's categories are according to the prevailing "habits of mind" of the medical profession that render the illness thematic in terms of "objective", quantifiable data.In attending to the experience of illness the physician does so in light of the scientific training and professional aim. At this level he focuses upon the disease process itself. Consequently, the clinical data are of highest relevance to him. However, the patient is less concerned with the clinical data. What is most relevant to him is the effect the illness will have upon his life. So, it is impossible that the physician and the physician share the same system of relevant. The physician focuses upon the clinical data as "knowledge", but not "experience", in order to decide the possible therapy method. Consequently, he neglects the personal anxiety and fear of the patient. In the end, most physicians tend to take action at an aim field less than that of the patients' concerning, furthermore, the target of the action may be not the keenly felt pain.The physician's and patient's disagreement on the meaning of illness is not only a matter of different levels of knowledge, but also a matter of difference of scientific conceptualization and experience of illness. The patient encounters his illness in its qualitative immediacy. The physician, on the other hand, may consider it as a scientific construct (that is a state of disease), and deviate the patient's experience of illness. Consequently, a critical disagreement between the physician and patient on the meaning of illness is formed.The communication between the physician and the patient is not able to interact at a basis of shared typification. Whereas the physician sees the patient's illness as a typicalexample of a particular disease state, the patient treats this irregularity as a particular individual event. The patient encounters illness in its immediacy in the context of the world of everyday life, and the major threaten is the fundamental loss of wholeness. The physician can only interpret the illness according to his routine knowledge storage, and does not realize that the patient will not imagine his illness as a kind of typification. The difficulty of interacting the physician-patient communication lies in the fact that illness is a kind of immediate experience and it is difficult to communicate his deep apprehension to others, resulting in that the physician disbelieve the honesty of the patient as a reliable history relater, and neglect the experiencing of the patient.Secondly, the root of misconception in the physician-patient communication lies in the incompatibility of the meaning of science and humanities in the medical practice.The essential meaning of illness should be the "discomfort experience " of the patient. Illness is primarily experienced as a fundamental loss of wholeness. Modern medicine interprets the meaning of illness superficially by over-emphasizing the importance of "pure scientification" and "technology", while de-emphasizing the patient as a person.. The demands of psychology and emotion are ignored either. The physician cares naught for the experience of the patient. What he cares most is the biologic medical therapy including operation and drug-administration. The physician-patient communication is rare because of the physician's de-emphasizing.The mode of understanding of illness will affect the selecting of the mode of medical treatment greatly. If illness is attended totally by the "objective" pathophysiology, the major aim of medical treatment should be diagnosis and cure. It focuses on the state of disease, and ignores the patient's experience simultaneously. However, if illness is attended as the experience of lived-through disorders of the body, the focus should be put on the discomfort of the patient, and the connotation of therapy contain to alleviate the pain and discomfort of the patient, and to cure the disease. The aim of therapy is to help the patient to restore the integrity as a person.The essence of medicine should be the science of human being, which attends the human being who is struggling with painful diseases, and needing help urgently. However, the attention of the physician is attracted from the patient to the searching for the nosogenesis, the analysis of the data that deviate the normal limit, and the finding of the changes of the cellular or molecular structure and function. In the eyes of the physician, the patient is not the animated person who has emotion and thought any more, but that of mechanized, non-humanized and objected. That in turn leads to the non-humanization of medicine.From the very beginning, both the character of technology and humanity of medicine are the indiscerptible internal dual property of medicine. World Health Organization give the comprehensive annotation of health as : "Health is not only a state free of disease and pain but also a state of peace with body, psychology and society." And the putting forward ofrelevant medical model of biology-psycology-society is the embodiment of the humanity property of medicine. These indicate that medicine is not only a pure technical question. Modern medicine shoud be regressed to the human-centered medicine.Along with the development of medicine, people are recognizing progressively that there exist integrality links between medical technology and science of humanity-society, and between the internal branches of medicine. It is more definite that the development of medical technology is indiscerptible with humanity solicitude. Medicine is a science that is directly relevant to the life of human being, medical technology is an art that can improve health and alleviate pain simultaneously, and healthcare is a career that relate to the happiness of human being. So medicine should be the best link-point for the combination of scientific technology and humanity solicitude. The infiltration of scientific technology with humanity solicitude spirit is the perfect target of modern medicine.Lastly, we promote the major countermeasures on how to construct the harmonies physician-patient relationship.The physician-patient relationship is a kind of specific "face-to-face" relationship, which should be constructed on the basis of experiencing of the patient's illness, with a specific aim to cure the disease of the patient. However, the action of therapy includes a lot of contents, not only to cure the disease. The physician's understanding of the patient's life-threatening troublesome is the precondition of therapeutic work. As a therapeutic worker, the physician is not only a scientist, but also a collaborator of physician-patient relationship. The physician must try to understand the patient's experience of illness-as lived, in order to set down an effective therapeutic plan on the basis of his scientific knowledge.A shared world of meaning between the physician and patient,is constructed on the basis of the shared world of living experience between them. The physician can make full use of the empathetic understanding of the patient's illness. Clinical narrative disclose the meaning of the illness to the patient, while the patient endue with meaning, interpretation and cause and effect explanation to this happening. If a physician wants to understand the lived experience of illness and try to comprehend what does disease mean to a patient, he must try to find out the personal situation of the patient, that is to say , to understand the patient's illness in his specific living circumstance, transcending the objective, quantitative clinical data.To construct harmonious physician-patient relationship and realize benign communication between physician and patient, the medical practice must be developed on the basis of "human vision'" but not only "medical vision", the patient's experiencing must be taken into accounts. The serving object of medical practice should be considered as a human integrity with the characteristic of psychology, society, culture and spirit, but not simply an organism. Therefore, much attention and strength should be payed to the communication between the physician and the patient in the clinical practice, and the hospital and its staff...