中医医患互动中所建构的医患关系 = Constructing doctor-patient relations in TCM interaction

• Main Author: 罗加皓 Loh, Jia Haw
• Other Authors: Lim Ni Eng
• Format: Final Year Project
• Language: Chinese
• Published: Nanyang Technological University 2023
• Subjects: Humanities::Language::Chinese
• Online Access: https://hdl.handle.net/10356/165062
• Institution: Nanyang Technological University

如今，医疗保健的专注点逐渐从以疾病为中心的治疗模式转向以病患为中心的治疗模式。在以病患为中心的治疗模式下，医生在医治病患病症的同时，也必须兼顾病患的个人需求与喜好，从而在尊重病患的前提下进行问诊与治疗。由此，医患关系在这一治疗模式当中扮演了非常重要的角色，因而日益受到医学界的重视。 中医作为在世界医学领域中有别于西医的医学体系，两者医学理念的不同体现在了问诊形式和治疗方式上。西医普遍上被赋予了较中医更为专业的地位，但在医患关系上，中医却能与病患建立起较西医医患之间更为亲近的关系。因此，本文旨在探究中医师与病患如何在互动的过程中建立比起西医医患之间更为亲近的医患关系。 通过在新加坡一家中医诊所收集的长达五小时的医患问诊会话，本文将以三段中医师与病患在“中医食疗”医理框架下的互动会话转写片段为例，展示中医问诊中饮食调整的对话内容由于涉及了病患的认知域，医师与病患因而得以在共享认知域里互动，使到医患会话的性质过渡和转变成为了非例行对话，以此拉近了医患之间的关系。本研究认为，中医医理是允许共享认知域的出现与会话性质的过渡和转变的原因之一，同时也是中医得以建立较西医更为亲近的医患关系的原因之一。 关键词：医患关系、中医医理、共享认知域、会话分析 Nowadays, the focus of healthcare is gradually shifting from disease-centered care to patient-centered care. Within patient-centered care, the doctors have to take the individual needs and preferences of patients into account while treating the symptoms, and thus conduct consultation and treatment on the premise of respecting the patients while treating the diseases that the patients encounter. As a result, the doctor-patient relationship plays a vital role in establishing patient-centered care, and hence increasingly valued by medical professions around the globe. Traditional Chinese Medicine (TCM) differs from Western Medicine (WM) in which their medical philosophies are reflected in the form of consultation and treatment. Western Medicine is generally given a more professional status than Traditional Chinese Medicine, but in terms of the doctor-patient relationship, TCM physicians are able to establish a closer doctor-patient relationship than WM practitioners. Therefore, this paper aims to explore how TCM physicians and patients establish a closer doctor-patient relationship than WM practitioners during the medical consultation. Based on five-hour recordings of TCM consultations collected from a TCM clinic in Singapore, three transcribed excerpts will be used in this paper to demonstrate TCM medical ethos is one of the reasons that TCM physicians are able to establish a closer doctor-patient relationship than WM practitioners as it allows the emergence of common epistemic domain and the transition and change of the nature of interaction. In particular, diet adjustment as one of the contents within consultation has involved the epistemic domain of the patients, and the doctor-patient interaction within the common epistemic domain has transited and changed the nature of doctor-patient interaction from transactional to non-transactional, thus constructing a closer doctor-patient relations. Keywords: Doctor-Patient Relationship; TCM Medical Ethos; Common Epistemic Domain; Conversation Analysis