First, the change of the nature of contemporary doctor-patient relationship and the separation of doctor-patient interests.

Medicine, whether traditional Chinese medicine or western medicine, has always been aimed at serving life and objectively has the attribute of "goodness". From the perspective of genetics, medicine originated from the concept of "goodness" to save suffering. There is a view in the history of western medicine that "the instinctive impulse to relieve patients' pain is the reason for the origin of medical skills" [5] 144. As a medical symbol, "snake war" symbolizes the ambition to protect health. At the same time, the history of Chinese medicine also believes that due to the pain of human "death", "saints" created medicine with compassion, which promoted the emergence of medicine, and "saints are merciful and medicine prospers" (the criterion for treating typhoid fever). At the same time, the development of medicine is also driven by the power of "goodness". A history of human medicine is a history of constantly conquering diseases, maintaining health and saving suffering. Therefore, in the medical field, maintaining health and promoting life are the ultimate basis and standard of all values. It is precisely because of the value pursuit of serving life that medicine has enjoyed high honor since ancient times. However, in the process of medical development in China, with the deepening of the influence of science and technology and market mechanism, the values and purposes of medicine have changed, which has profoundly affected the essence of medicine and strongly impacted the relationship between doctors and patients.

Scientific and technological progress has promoted the great development of medical services in China. Objectively speaking, medicine is inseparable from science and technology, and it is important to put science and technology in a correct position. Driven by the power of science and technology, medicine itself has become overly dependent on technology, and the concepts of "omnipotence of science and technology" and "supremacy of science and technology" have emerged, so that the development of traditional Chinese medicine has a trend of "technical subjectivity" [6] 1-4. This trend is mainly manifested as "some technologies in contemporary medicine do not conform to the needs of medical purposes, but conform to what technology wants to do and can do, and what technology can achieve by virtue of its own potential, and technology develops because of its development" [6] 2, that is to say, in the process of medical development, technology leads medical purposes, stipulates medical processes and shapes medical attributes, thus making technology the whole of medicine. Among them, the most fundamental change is that technology has changed from a means to an end, changing the value direction of medicine that has always served life, and the attribute of "goodness" has become "technology". In this medical background, technology has become the standard to measure medical value, and medical personnel are naturally full of infinite pursuit of technology. In the process of diagnosis and treatment for patients, the lack of sufficient cautious awareness of the application of technology, or even blind application, not only leads to the increase of iatrogenic and drug-induced diseases, but also increases the rate of misdiagnosis and mistreatment. As some scholars have pointed out, "medicine sometimes seems to be led by elites who are mainly interested in developing their technical ability, and they seldom consider its social purpose and value, let alone the suffering of individual patients" [7]1-12. Traditional Chinese medicine culture holds that "medicine is benevolence" and emphasizes the role of medicine as a "life tool" in treating diseases and saving lives. Medicine should not develop technology for the sake of technology, but should always put technology in the position of "living tool" As for the relationship between medical skills and patients, Chinese medicine believes that it is "disease-oriented, work-oriented" (Huangdi Neijing), that is, the life of patients is the foundation, technology is the standard, technology serves life, and medical skills must be based on the life of patients and used for life. In contrast, modern medicine with technology as the main body has become "putting the cart before the horse" and "playing with things and getting tired of it". As a result, medicine and technology have formed the same body with the same process and goal, but life and health are separated from it. In fact, it is precisely based on the purpose that medicine serves life that there is an isomorphism of health interests between medicine and human life, and doctors and patients become an isomorphism of health interests. Therefore, when the interests of medicine and human life are separated, the health interests of doctors and patients have no internal basis, and it is inevitable to move towards separation.

The nature of the market is profit-seeking, while the nature of medicine is "goodness", which are essentially conflicting. If the technical subject makes medicine deviate from the "good" value direction, then the market mechanism enters medical activities, which makes the development of medicine deviate from the "good" value direction. In China, after being pushed to the market, hospitals, as medical carriers, attach great importance to "profit" in their management, and market logic dominates the survival and development concept of hospitals. As a result, the relationship between doctors and patients has changed in nature. Nowadays, patients are usually called buyers or customers of medical care, while doctors are called sellers or providers of medical care. In this way, the doctor-patient relationship is regarded as a commodity exchange relationship. " [8] 36 The medical staff involved pretend to be "sellers" and "providers". Therefore, the consciousness of "profit-seeking" in medical activities is prominent, and even the phenomenon of "money worship" appears. It can be seen that after the market mechanism enters medical activities, the doctor-patient relationship is simplified and distorted into an economic relationship. When the economic relationship dominates the doctor-patient relationship, the doctor-patient relationship will be strongly impacted, so that in the process of medical "consumption", patients spend more, doctors earn more, patients spend less and doctors earn less. If the main body of technology leads to the separation of health interests between doctors and patients, then the pursuit of profit by medical care makes them change from the same body of health interests to the opposite body of economic interests.

Second, the loss of humanistic spirit and the separation of emotional identity between doctors and patients in contemporary doctor-patient relationship.

The research object of medicine is "man", and "man" is humanistic, so humanistic spirit is inherent in medicine. The doctor-patient relationship is an interpersonal relationship formed in medical activities, and the medical concept guides the whole process of medical activities. The process of medical activities varies with different medical concepts, and the relationship between doctors and patients is also different. Medical concept determines the characteristics and types of doctor-patient relationship, and to some extent, what kind of medical concept will have what kind of doctor-patient relationship. When the medical concept has humanistic spirit, there will be emotional cohesion between doctors and patients. Under the guidance of traditional holistic medical model, doctors will pay attention to patients' psychology and emotions. For example, Hippocrates once said, "We must know what pain is, why there is pain, and what harm it does to people" [5] 13. Huangdi Neijing also said: "Any treatment must observe its potential conditions, suit its pulse, observe its will and its disease." In this medical concept, "human" is complete and its integrity is respected. Doctors "are both doctors of body and soul" [5] 18. At the same time, in medical activities, doctors and patients pay attention to emotional communication and contact, "doctors and patients should be close" [5] 17, and doctors should be "loyal to their feelings" (Yu Chang). In a word, the traditional medical concept maintains a strong humanistic spirit. In medical activities, patients' spirit needs to be paid attention to, and doctors and patients maintain a sense of closeness. Based on the common goal of healing and restoring health, both sides have a sense of unity, can cooperate sincerely, and are emotionally cohesive [4].

1977, an American scholar, Professor engelhardt, proposed that the medical model should be changed from "biomedical model" to "bio-psychological-social medical model". The medical field in China has also recognized the necessity and importance of this change in theory, but this change has not been realized in medical practice [9] 337-340. In other words, in fact, the biomedical model still dominates medical activities today. Under the guidance of biomedical model, the diagnosis and treatment process is carried out and completed in the field of "biological attributes", and doctors are limited to discussing diseases and their treatment on the biological level of patients. Insufficient attention is paid to the psychology, feelings and emotions of patients, so that diseases and patients are separated, diseases and people are separated, and the integrity of people is simplified as "biology". In medical activities, "people have disappeared for a long time, and they are still disappearing" [10] 4 19, and medical treatment has changed from "humanitarianism" to "morbidism", and gradually "serious illness does not emphasize people". At the same time, medicine is developing in the direction of pursuing positivism and objectification. In this process, the medical experience "disenchantment" played down the awe of life [1 1] 2. In order to better focus on their "scientific world" in the process of diagnosis and treatment, doctors are not only indifferent to patients' sufferings, but also keep the necessary emotional distance from patients. For example, according to the requirements of modern medicine, in the process of writing medical records, it is required to stop using any subjective words when describing the patient's situation. The more objective the better. Under the influence of such medical concept, medicine not only has no awe, but also weakens emotion. The dichotomy of subject and object in medical knowledge is manifested in the doctor-patient relationship, that is, the doctor as the cognitive subject and the patient as the cognitive object become the dichotomy of subject and object, and the patient becomes the objectified and externalized world of the doctor. In the process of doctor-patient communication, doctors are immersed in the "scientific world" and patients are in the "life world", so doctors and patients become people in two worlds. Moreover, the intervention of a large number of instruments and equipment in medical activities has greatly reduced the direct communication between doctors and patients. Face-to-face communication has become insignificant before the intervention of technical equipment, and the relationship between doctors and patients has been "materialized". When medicine is controlled by biological model, dominated by natural science and intervened by technical means, "our treatment is mechanical and impersonal, and our therapists are characterized by keeping a distance, being calm and detached, having formal relations and using abstract concepts." [12] It can be seen that during the development of medicine, which continuously strengthens its science and technology and weakens humanistic spirit, due to the lack of dichotomy between doctors and patients, emotional communication and humanistic care, the humanistic quality of medicine has declined, and the humanistic spirit of medicine has lost, which has alienated doctors and patients who should have close feelings, lacking unity, low cooperation, loss of internal cohesion and emotional separation.

Thirdly, the weakening of the virtue of contemporary doctor-patient relationship and the separation of the moral identity between doctors and patients.

Medicine has the attribute of "goodness", and its ultimate realization can not be separated from the "goodness" of medical staff's inner humanity. Although in the history of medical development in China, the promotion of science and technology is enormous, and medicine cannot be separated from science and technology, but science and technology is a double-edged sword. Without the guidance of "goodness" of human nature, its function may be "evil" Therefore, the cause of "goodness" can only be guaranteed by the power of "goodness". Therefore, virtue is the fundamental force of medicine, which is manifested in the doctor-patient relationship, that is, virtue is the main regulating force of doctor-patient communication. In fact, because medicine is a "good" cause, the essence of the doctor-patient relationship is moral. Its content is the relationship between the rescuer and the rescued. Only with virtue as the main regulating force can this morality be guaranteed, the moral relationship between doctors and patients be consistent with medicine itself, and medical activities can be carried out smoothly. Since ancient times, medicine has attached great importance to virtue and virtue. Since Hippocrates, western medicine has put forward very comprehensive requirements for doctors' virtue, emphasizing that "their character must be like a gentleman" [5] 17 Plato, a great western philosopher, also put forward that "they treat their bodies with thoughts, and if their thoughts are bad or degenerate, they can't treat diseases well" [5] 22. Traditional Chinese medicine (TCM) has a high demand for virtue and rich content, which is very prominent in the history of medical ethics in the world. Traditional Chinese medicine believes that "medicine is benevolence", and only by practicing medicine with "benevolence" can we realize the functions of medical skill to save people, that is, saving people with heart, living with heart and forbearing with heart. And pay special attention to the main virtues such as benevolence, wisdom, honesty and non-deception. Traditional medical activities are based on intrinsic virtue, which is used as a regulating force in the communication between doctors and patients. Doctors will turn patients' needs into their own moral requirements and take moral responsibility by "doing righteousness" instead of "doing righteousness". In this way, doctors agree with and actively practice the moral requirements of medical activities, patients trust the moral quality of doctors, and the two sides form a moral unity.

With the development of medicine, medicine has changed from individual medical practice mode to group medical practice mode, from paying attention to "good people" to paying attention to moral "good behavior", from paying attention to individual virtue to paying attention to group norms. In a sense, the emphasis on norms enhances the operability of morality and is conducive to the objectification and generalization of moral requirements. This focus is the promotion of medicine. However, this weakens the role of virtue and virtue, and holds that the focus of ethics in the medical field is "norm" [8] 3 1-37, which makes the internal and external forces of morality lose tension and inevitably affects the practice of moral requirements. In short, the exertion of moral function needs to maintain the necessary tension between internal virtue and external norms to form a joint force, and moral construction needs "internal and external integration". The function of moral norms is based on intrinsic virtue. If the protection of internal virtue is lost only by the adjustment of moral norms in the communication between doctors and patients, moral requirements will become a mere formality, and it will be difficult for patients to establish trust in doctors. In fact, in the form of regulating the relationship between doctors and patients, China's medical undertakings not only rely more and more on moral norms, but also increase legal and administrative means. Although these means should be increased, it is difficult to achieve substantive results without virtue as the basis. As far as legal means are concerned, doctors' commitment to moral responsibility will not only become more passive, but also focus on how to protect their legitimate rights and interests by legally binding both doctors and patients. Therefore, "the provision of inversion of burden of proof in 2002 requires doctors to prove their innocence in medical disputes. This is now widely regarded as the beginning of overtreatment. In order to avoid being unable to prove their innocence when they go to court one day, doctors prepare' evidence' in advance by' doing all the tests that can or can't be done'. " [1] It can be seen that without the support of internal virtue, legal means will not only fail to achieve the expected results, but even add new problems. The National Health and Family Planning Commission requires (from May 1, 20 14) that medical institutions above the second level in China must sign a doctor-patient agreement, and both parties promise not to accept or send "red envelopes" and valuables within 24 hours of the patient's hospitalization. Although the effect of this administrative means has yet to be confirmed, it is certain that if these external requirements are not transformed into internal self-requirements, whether it is moral requirements, legal requirements or administrative requirements, their practice is not inevitable. In the development of China's medical undertakings, from the emphasis on moral norms to the increase of legal and administrative means, the regulatory power tends to be externalized and compulsory, but the role of internal virtue is weakened. In the end, the external requirements and the internal requirements of doctors cannot be unified, and their implementation cannot be guaranteed. In this way, in the process of communication between doctors and patients, doctors lack recognition and subjective will for moral requirements, and their commitment to moral responsibility will be passive and even a mere formality. Therefore, patients can't form trust in doctors' moral quality, and doctors and patients' morality will be separated.

Fourth, amblyopia, the limitation of contemporary doctor-patient relationship, the separation of doctor-patient life.

From the perspective of life, patients are people whose lives need to be saved, and doctors are people who save lives. Harmonious doctor-patient relationship is inseparable from the * * * cognition of life between doctors and patients, which is what we call the * * * recognition of life. Although the pursuit of medicine in the direction of saving lives is infinite, "medical skills are born of nature" [5] 29, but in a specific period, the ability of medical skills is always limited. Furthermore, although medicine holds high the banner of "saving the wounded and rescuing the dying", the objective law of birth, illness and death determines that death is inevitable. Therefore, in reality, medicine is always presented as a "flawed art". As a patient, based on the limitations of medicine, it forms an objective understanding and evaluation of the incurable situation of patients, especially the death of patients, which has a profound impact on the communication between doctors and patients. However, the correct understanding of patients can not be separated from medical guidance. In the history of traditional medicine, doctors are very concerned about the limitations of medicine. According to Records of Historical Records, Bian Que was "famous all over the world" because of his superb medical skills. People rated him as "a man who can live and die with Bian Que" and thought he could come back to life. Hearing such praise, Bian Que said: "The more people who can't live and die, the more people who can make their ears stand up", and "being born" is the premise of doctors' efforts. Be objective and sober about the limitations of medicine. So Chinese medicine pays more attention to "death". For example, in Huangdi Neijing, it is said that "the five Zangs have been defeated, and their colors are exhausted" ("Su Wen's Three Steps and Nine Later Theories"). "Death certificate" represents the signal of life crisis. On the one hand, Dong Xiao can save it in the bud. On the other hand, if death is irreversible, it will have to be "Shun Tian". Therefore, in case of incurable situation, such as Hua Tuo, a famous doctor in the Three Kingdoms period, he will tell the truth. Similarly, in the history of western medicine, Hippocrates also clearly pointed out that "people with terminal diseases" and "medicine is powerless" [5] 15.

Driven by science and technology, medicine has changed many "can't" into "can" in the development process, and its medical ability has been continuously enhanced. This development trend even gives human beings the ability of "God" and acts as "the role of God". Under the background of rapid progress and great ability of medicine, people are accustomed to the "ability" of medicine, so that they always ignore the "incompetence" of medicine itself. In medical activities, medicine forgets modesty, and doctors are often arrogant. Due to the limitations of medicine on itself, it has become amblyopic and lacks correct guidance for patients. People's requirements and expectations for medical ability have risen to "modern people can't accept death" and "because he (she) feels that it is really wrong to die in such a state, how can advanced medical technology not cure their own diseases?" [13] 655 This understanding has brought deep hidden dangers to the communication between doctors and patients. In today's medical activities, the death of patients in hospitals often becomes the fuse of contradictions and disputes between doctors and patients. "No matter how well the patient is treated, he will die if he is not cured, so he is absolutely unwilling; Family members of patients always focus their anger on doctors and hospitals after the death of patients, and will never accept such consequences "[13] 655. This kind of understanding and attitude of patients is of course a manifestation of information asymmetry between doctors and patients, but from a medical point of view, it reflects the importance of strengthening the understanding of medical limitations. Objective evaluation of medical ability can promote people to correctly understand death. Under the background of medical limited amblyopia, due to the lack of guidance and education for patients to objectively evaluate their medical ability, patients can't correctly understand the situation of medical incompetence, and doctors and patients lack knowledge of death, which leads to where will you go.

To sum up, the problem of modern doctor-patient relationship in China is the separation of doctor-patient identities. Therefore, relieving the tense development trend of doctor-patient relationship and building a harmonious doctor-patient relationship is actually the reconstruction of doctor-patient identity. If the separation between doctors and patients is the result of medicine deviating from itself, then the reconstruction between doctors and patients is actually the process of medicine returning to itself. To complete this process, at least medicine needs to return to the attribute of "goodness" in order to rebuild the interests of doctors and patients. It is necessary for medicine to greatly enhance the humanistic spirit and let doctors and patients return to the same body of emotion. It is necessary for medicine to pay more attention to the power of virtue, so as to rebuild the moral unity between doctors and patients. It is necessary for medicine to objectively face its own limitations, guide people's concept of death, and realize the reconstruction of the life of doctors and patients. In addition, it should be noted that the identity between doctors and patients should be reconstructed on the basis of Husserl's intersubjectivity between doctors and patients, and the independence of doctors should not be abolished because of the unity and integrity of identity, especially in the current situation where the personal safety of doctors has been repeatedly endangered, more attention should be paid to the reasonable rights and interests of doctors. This should be a principle for doctors and patients to establish equal weight.

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