【作者】 张莉；

【导师】 于静； 兰玲；

【作者基本信息】 郑州大学 ， 内科学（消化内科）（专业学位）， 2018， 硕士

【摘要】 目的医学技术发展日新月异,随之而来的是社会对疾病疗效的要求的提高,且在医患关系越发严峻的背景下,医生不但肩负着繁忙的诊疗工作、教学任务、科学研究以及业务学习,还要处理与患者及家属间的复杂人际关系,给心身带来极大压力。医务人员已成为健康高危人群,焦虑、抑郁发生率高。躯体化症状是包括胃肠道症状在内的一系列躯体不适症状的外在表现,由心理应激反应诱发,同焦虑/抑郁状态共存率极高。同时,由于诸多因素导致医疗纠纷急剧增加,医患关系的紧张态势日益严重,更有伤医、残医和杀医案件的频频发生。工作超负荷和医患关系紧张最易引起医务人员产生职业倦怠,即情感耗竭、去人格化和个人成就感降低。不和谐的医患关系加重了医务人员的心身压力,增加了焦虑/抑郁、躯体化症状和职业倦怠的发生风险;医务人员的焦虑/抑郁、躯体化症状和职业倦怠的困扰,也给其与患者及家属间的沟通带来障碍,加重医患关系的紧张度。我们认为,医务人员的焦虑/抑郁状态、躯体化症状及职业倦怠情况可能与医患关系的紧张度具有相关性。本研究对医生群体进行了焦虑/抑郁状态、躯体化症状、职业倦怠程度和医患关系紧张度的量化评价,对其相关性进行分析,并提出有针对性的干预措施,以期恢复医生对医患关系紧张度的正确认识,改善医生层面的紧张医患关系。方法纳入临床内科、外科、妇产科、儿科、眼科、耳鼻喉科、急诊科和重症监护室等共22个科室300名医生,收集医生群体基线资料,采用问卷调查法对医生群体焦虑/抑郁状态、躯体化症状、职业倦怠程度和医患关系紧张度进行量化评价,对其相关性进行分析。应用SPSS 24.0软件进行统计分析,统计学检验水准为α=0.05。结果1.医生对医患关系普遍持消极态度,总体对医患关系紧张度认知不良。85.0%的医生对医患关系紧张度的评分≥17分,认为医患关系不良,其中7.0%评分≥33分,认为医患关系紧张,且未受年龄、性别、学历和职称的影响(P>0.05)。2.医生群体焦虑、抑郁阳性率均为49.2%,其中中度以上焦虑水平为16.4%,中度以上抑郁水平为18.8%,且未受年龄、性别、学历和职称的影响;各科抑郁发生率与医患关系紧张度呈显著正相关(r=0.617,P=0.002)。3.医生群体躯体化症状阳性率61.6%,且未受性别、学历和职称的影响(P>0.05)。各科室医生群体躯体化症状阳性率与医患关系紧张度呈显著正相关(r=0.446,P=0.037)。4.医生群体的职业倦怠程度较高,情感耗竭、去人格化和个人成就感3个维度达到中度以上倦怠水平的比例分别为49.8%、53.2%和48.7%。不同年龄和职称的医生职业倦怠程度有统计学差异(P<0.05)。医生群体的情感耗竭、去人格化程度与对医患关系的不良认知呈正相关(P<0.001),个人成就感与对医患关系的不良认知呈负相关(P<0.001)。结论1.医生群体对医患关系普遍持消极态度,总体对医患关系紧张度认知不良。2.医生群体焦虑/抑郁状态、躯体化症状和职业倦怠等的发生率均较高。3.医生群体的抑郁发生率、躯体化症状阳性率、情感耗竭和去人格化程度与医生对医患关系的不良认知呈明显正相关,个人成就感与医生对医患关系的不良认知呈负相关。4.建议从改善医生群体的焦虑/抑郁状态、躯体化症状和职业倦怠程度等方面入手,进而改善医患关系紧张现状,从医方层面为良好医患关系的形成和维持提供新途径。更多还原

【Abstract】 ObjectiveWith the rapid development of medicine,the social demands for the curative effect of disease are becoming higher and higher,and in the situation that the doctor-patient relationship is generally tense,doctors not only undertake busy diagnosis and treatment,teaching tasks,scientific research and business learning,but also deal with the complex interpersonal relationship between patients and their families,which brings great pressure to the mind and body.Medical staff has become a high-risk group with high incidence of anxiety and depression.Somatization is an external manifestation of a series of physical symptoms including gastrointestinal symptoms.It is induced by psychological stress reaction and has high coexistence with anxiety/depression.At the same time,due to the rapid increase of medical disputes caused by a number of factors,the tension of doctor-patient relationship is becoming more and more serious,and the cases of malignant injury to medical staff occur frequently.Discordant doctor-patient relationship aggravate the psychosomatic pressure of the medical staff and increase the risk of anxiety/depression,somatic symptoms,and job burnout,which in turn brings obstacles to the communication between patients and their families,and aggravates the tension of the doctor-patient relationship.We believe that the anxiety/depression,somatic symptoms and job burnout of medical staff may be associated with the tension of the doctor-patient relationship.This study evaluates the anxiety/depression status,somatization symptoms,job burnout and doctor-patient relationship stress among doctors,analyzes their correlation,and then put forward targeted interventions to restore the doctor’s correct understanding of the tension of the doctor-patient relationship and improve the stressful doctor-patient relationship at the doctor level.MethodsThis study recruits 300 doctors from 22 clinical departments,such as department of medicine,surgery,obstetrics and gynecology,pediatrics,ophthalmology,department of ENT,emergency department and intensive care unit,etc.The general information of doctors were collected,and the anxiety/depression status,physical symptoms,job burnout and doctor-patient relationship tensity of doctors were quantified by questionnaire,and their correlation was analyzed.The statistical analysis was carried out with SPSS 24.0 software.The statistical level was α=0.05.Results1.Doctors generally took a negative attitude towards the relationship between doctors and patients,and the overall awareness of the doctor-patient relationship was poor.85.0% of the doctors had a score more than 17 on the doctor-patient relationship,who believed the doctor-patient relationship was bad,and 7.0% of the doctors had a score more than 33 on the doctor-patient relationship,who believed the doctor-patient relationship was tight;it was not affected by age,gender,education and job title(P>0.05).2.The prevalence of anxiety and depression among doctors was 49.2%,of which the level of moderate or above anxiety and depression was 16.4% and 18.8%,and it was not affected by age,gender,education and job title.There was a significant positive correlation between the incidence of depression and the tension of doctor-patient relationship(r = 0.617,P=0.002).3.The prevalence of somatization symptoms among doctors was 61.6%,and it was not affected by age,gender,education and job title.There was a significant positive correlation between the incidence of somatization symptoms and the tension of doctor-patient relationship(r = 0.446,P=0.037).4.The degree of job burnout among doctors was high.The proportion of emotional exhaustion,depersonalization and personal accomplishment reached 49.8%,53.2% and 48.7%,respectively.There was a statistical difference in the degree of job burnout of doctors of different ages and titles(P<0.05).The degree of emotional exhaustion and depersonalization among doctors was positively related to the bad cognition of doctor-patient relationship(P<0.001).The personal accomplishment was negatively related to the bad cognition of the doctor-patient relationship(P<0.001).Conclusions1.Doctors generally take a negative attitude towards the relationship between doctors and patients,and the overall awareness of the doctor-patient relationship is poor.2.The incidence of anxiety/depression,somatization and job burnout of the doctors was higher.3.The incidence of depression,the positive rate of somatization,the degree of emotional exhaustion and depersonalization were positively correlated with the doctor’s bad cognition on the doctor-patient relationship,and the personal accomplishment was negatively related to the bad cognition of the doctor-patient relationship.4.It is suggested that we should improve the anxiety/depression state,somatization symptoms and burnout degree of doctors.This will further improve the tense situation of doctor-patient relationship and provide a new way for the formation and maintenance of good doctor-patient relationship from the perspective of doctors.更多还原