会话分析研究 ：医生与年长病患相互推辞进行内窥镜的决定权 = Conversational analysis : deflecting responsibility between doctor and elderly patients in decision-making for flexible cystoscopy

• Main Author: 许宇慧 Koh, Gee Hui
• Other Authors: Lim Ni Eng
• Format: Final Year Project
• Language: Chinese
• Published: 2019
• Subjects: DRNTU::Humanities::Language::Chinese
• Online Access: http://hdl.handle.net/10356/76485
• Institution: Nanyang Technological University

新加坡医患关系正在朝向“以病患为中心” 的目标前进，即强调医患之间是共同合作关系，而并非从上至下地单一听令。因此认为病患应该拥有充分的自主权，更尊重病患的道义权。然而并非每一位病患都要负起做决定的责任。本文将通过会话分析机制，具体探讨在泌尿科医患之间协商决定是否进行内窥镜的过程，看一看当两者都不想要成为决定的一方时，他们如何处理问题和矛盾。从分析结果发现，当医生要求病患决定是否进行内窥镜时，病患表达自己缺乏医疗知识和权威而拒绝决定。再者，当病患对于内窥镜做出某种表态后，又直接把责任抛回给医生，表明医生应该做决定。因此本文显示“以病患为中心”的医患关系，鼓励病患共同参与抉择的过程在实际上含有矛盾和问题。 医疗体系所定下的目标在实际操作上仍然有待加强和思考，这并非如此之简单能够一笔一画地达成共识。The Singapore medical scene has since transited to delivering patient-centered care，emphasising that doctor-patient relationship is a collaborative effort and not solely on the doctor’s instruction. Hence, the importance of patient autonomy and deontic rights of the patient have been further elevated. However, not every patient wants to be the person responsible for decision making. This paper discusses the treatment recommendation process between doctor and patient in the Urology Department through Conversation Analysis. It will also examine closely at the negotiation of ownership when both parties does not want to be the decision maker. The results show that patient resists making a decision to decide if they want to undergo scope, by claiming that the decision should be contingent to that of the doctor’s epistemic authority. Patient even deflect the responsibility back to doctors, clearly stating that they do not want to be the decision maker after making some form of decision of undergoing the scope. This discussion shows how the idealness of patient-centered care, which promotes the sharing in decision making, may be conflicting with the stance of the patients.