[Keywords:] humanities; The medical spirit of human history; Doctor-patient communication; Physician's professionalism
1 humanistic medical spirit
The secret of medical enzymes is related to human raw birds. The essence of medicine is a "human" science, which focuses on people who are struggling with diseases and need care and help. Because medicine is considered as the most learned subject, doctors should be the most humane profession. As Lunen, the winner of the Nobel Prize in Medicine, pointed out: Divination has a stupid duality in essence. It is not only a science, but also an entrance, which needs the nourishment of humanistic spirit.
1. 1 About Humanities
Humanism usually refers to various cultural phenomena of human beings, especially the essence and simplicity of human beings. Humanism is the subject and human being, that is, people-oriented, caring, loving and respecting people, acknowledging people's value and respecting people's personal interests. English is the meaning of human beings, as well as humanity, enlightenment, kindness, charity and so on. If meat science mainly studies the objective material world and answers "what is it" and "seeking truth", then social mysticism mainly studies the social relations and laws between man and nature and answers "how to do it"; Then, humanities students should study people's spiritual world, guide people to develop human nature, improve their personality, sublimate their lives, and answer "how to do", "seek goodness" and "seek beauty".
Humanistic spirit is the core of human nature, refers to the excellent cultural accumulation and cohesion formed in human development, and is the inherent spiritual character of human beings. It can be divided into three connotations: first, people, personality embedding and human development; The second is literature, which solves the problem of what kind of cultural literacy and cultural character the society should cultivate; The third is spirit, which is to answer what kind of values a society should have. First of all, the humanistic spirit is embodied in the full affirmation of human value, human and life value, the affirmation of human independence and the pursuit of perfection, and the relative scientific spirit, which is characterized by the pursuit of goodness and beauty; Secondly, humanistic spirit is based on people's mental retardation, including foolish thinking and long-term literary quality; Finally, the spirit of entering the text includes non-intellectual factors such as values, morality and ideological realm. Examining and criticizing is Wan He's pursuit and concern for the meaning of life, which is the connotation of the series of humanistic flag pants. It includes the humanistic thought with the theme of reverence and respect for life and the deprivation of people's basic rights, the humanistic accomplishment embodied in rumors, thoughts, emotions, manners, will and cultural skills, rich rational understanding of the rise and fall of national culture, and rich understanding of the country, society, others and others.
1.2 medicine and humanities
Medical humanistic connotation is an important part of medicine. Especially with the development of modern medicine and the proposal of humanistic medicine, humanism, as the soul of medicine, has become the spiritual pillar of medical and professional doctors. It can be said that humanistic medicine, basic medicine, technical medicine and applied medicine together constitute modern medicine. "Western Internal Medicine" wrote: Medicine is a humanitarian profession that needs erudition. In the European revolutionary era of the19th century, some people who tried to reform medical insurance, such as Newman, wrote in 1847: "Medicine is a social science in terms of its inherent nature. As long as it is not recognized in practice, we can't fully enjoy its benefits and it will be an empty shell. "
Humanistic medicine is the generalization and abstraction of humanistic connotation in medicine, and it is an interdisciplinary group combining humanistic science, social science and medicine. Including medical ethics, medical psychology, medical philosophy, medical methodology, medical anthropology, medical aesthetics, medical sociology, medical logic and so on. As a new discipline group, humanistic medicine is a sign that medicine is maturing.
Why should we attach importance to humanistic spirit?
Roy porter lamented in his "Cambridge History of Medicine": If we don't adhere to the correct medical purpose and "value technology over people", then "the success of medicine may be leading to a monster created by ourselves, but we can't control it". Thirty years ago, Engel, an American psychiatrist, put forward a bio-psychological-social medical model, and made a critical reflection on the biomedical model dominated by reductionism. Twenty years ago, the World Federation of Medical Education pointed out in the Fukuoka Declaration: "All doctors must learn communication and interpersonal skills. Lack of * * * (compassion) should be as incompetent as lack of technology. " But up to now, the survey of Chinese Medical Doctor Association shows that more than 90% of medical disputes are caused by improper or insufficient communication between doctors and patients. The lack of humanistic spirit makes the medical profession in a passive position, so it is urgent to improve the humanistic quality of doctors.
2. 1 medical model and humanities
2 1 century, the outline of medical trend has appeared: from "disease medicine" to "health medicine", from emphasizing treatment to prevention, from antagonistic pathogen treatment to holistic treatment, from improving focus to improving ecological environment, from group treatment to individual treatment, from biological treatment to comprehensive physical and mental treatment, from emphasizing the role of doctors to emphasizing the self-care function of patients. All these changes show that the new medical model calls for doctors to change from "knowing only diseases, not knowing". For example, in 2006, MAYO CUNIC, the second-ranked hospital in the United States, put forward the medical model of PLEASECARE, which is a combination of art and science, and its core value is to shift medical attention from "disease" to "people"-"patient needs first".
2.2 Medical Purpose and Humanities
The purpose of modern medicine is not only to cure diseases, but also to include the following contents: ① to prevent diseases and injuries, and to promote and maintain health; ② Relieve the pain and suffering caused by the disease; (3) Caring for and curing patients and caring for those who cannot be cured; ④ Pay attention to the quality of life, avoid premature aging and death, and pursue peaceful death. Medicine involves the birth and death of people, has a wide range of sociality and needs the nourishment of humanistic spirit.
2.3 Medical Legal System and Humanities
At present, there are many laws, regulations, rules and regulations directly or indirectly related to the profession of doctors, and the study and implementation of these documents require medical personnel to have a high humanistic quality. Take the medical accidents and medical disputes that perplex medical institutions and medical personnel at present, the relevant laws and regulations involved include the Physician Law, the Criminal Law, the General Principles of the Civil Law, the Consumer Protection Law, and the Regulations on Handling Medical Accidents. Compared with the original Measures for Handling Medical Accidents, the Regulations on Handling Medical Accidents are different as follows: ① The connotation of the person responsible for medical accidents (including medical personnel and medical institutions, etc.). ) is unfolded; ② Items and standards of medical association appraisal and civil compensation have been added; (3) increasing the responsibilities of medical institutions and medical personnel; (4) Give patients more power (such as copying cases, etc. ); ⑤ The definition of medical errors is cancelled, and all medical errors are recognized as medical accidents. In addition, the provision of "inversion of burden of proof" increases the risk of medical liability.
2.4 Medical Education and Humanities
For some time, due to the neglect of humanistic medicine, the purpose of medicine has gone out of shape, which has aroused widespread concern and criticism in society: 1930, the Spanish philosopher Ortega gasset said: "Many medical schools are trying to teach physiology and chemistry to several grades, but perhaps no medical school in the world will seriously offer a course or discuss what a good doctor really means or what our ideal doctor should be like today?" Some scholars criticized: "The worship and commercialization of scientism and technology dried up the body of medical science like a sandstorm, making it lose its fullness and elasticity." "Before medicine in the 20th century, one foot had just walked out of the jungle of half-witch and half-doctor, and the other foot had fallen into the misunderstanding of scientism and technicalism."
Since the 1960s, western humanities education has entered a new stage of development, which has generally increased the proportion of humanities in the total curriculum of medical colleges, with 20% in the United States, 26% in France and 13% in Britain. In our country, "the way of university lies in virtue, in being close to the people and in perfection." It seems to be the spiritual fulcrum and logical starting point of our future. Professor Qiu Fazu often said, "Those who don't approach Buddha can't be doctors, and those who don't approach immortals can't be doctors." The goal of medical education is to cultivate talents with excellent medical skills and noble medical ethics, and to train medical students into "caring" good doctors, not just technical or professional leaders.
2.5 Medical Practice and Humanities
It is estimated that a doctor will treat120,000 to160,000 patients in his career. In other words, doctors spend most of their time in contact with patients. About 60% to 80% of disease diagnosis and treatment programs are based on the results of talking with patients. "No medical skills can cure patients, and no humanities can cure patients." The patient is not a disease, but a person. Therefore, a doctor's humanistic quality directly affects the level of diagnosis and treatment of patients. Foreign scholars point out that doctors should know five things about patients, namely, chief complaint, discomfort, distress, inconvenience in life and social problems. For medical practitioners, medicine is not only a profession, but also a career.
2.6 Medical market and humanities
For a period of time, the tendency of medical marketization has played down the humanistic spirit of medicine and weakened the cultivation of humanistic quality. Due to the system and mechanism, the salary in the operation of public hospitals in China is seriously insufficient. In order to survive and develop, some medical units rely on their own advantages, excessively pursue profits, excessively use diagnosis and treatment techniques and means, lower the requirements for humanities and dilute doctors' humanistic thoughts. In recent years, many medical reform reports and scholars' research show that medical services cannot be marketized, but they must adapt to the market.
2.7 High-tech and Humanities
The extensive application of advanced diagnosis and treatment technology has deepened the ideological tendency of attaching importance to people and technology over morality. As Roy porter 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." In the past, doctors usually used physical examination methods such as listening to medical history, asking and looking carefully, touching, knocking and listening (called looking, listening and asking in Chinese medicine) to diagnose and treat patients. Instead, it relies too much on various instruments and inspections, which leads people to answer "The better they do, the worse they feel". We can cure diseases, but we can't win the trust of patients.
2.8 doctor-patient relationship and humanities
Investigation of Chinese Medical Doctor Association 1 14 Hospital. From 2000 to 2003, on average, there were 66 medical disputes in each hospital, with 5 cases of smashing hospitals and injuring doctors and 5.42 cases, and the average compensation for each medical dispute was 108 10000 yuan. From June to 10, 2006, 350 hospitals in Beijing, Hunan and other provinces and cities were investigated. On average, medical disputes occurred in each hospital 15.3 1, which injured 332 people and caused economic losses14.48 million yuan. A survey conducted by the Democratic Party of Agriculture, Workers and Peasants on the medical practice environment in a big city shows that there are as many as 6,000-7,000 disputes every year, and 86.5% of hospitals have been besieged by crowds. The survey of Chinese Medical Doctor Association also shows that more than 90% of medical disputes are caused by improper or insufficient communication between doctors and patients.
The doctor-patient relationship is a special system. They are comrades in arms in the trenches. The relationship between them can not be simply handled by economic or legal means, but should be adjusted and improved by humanistic spirit. It is necessary to establish a people-oriented and humanized doctor-patient relationship.
2.9 Medical risks and humanities
With the development of medical science, new theories, new technologies, new instruments, new equipment and new therapies are increasing year by year. On the one hand, these high-tech technologies improve the quality of medical care, on the other hand, they also increase the medical risks, especially the safety of patients.
At present, patient safety in China faces six major challenges: ① The overall quality and technical level of medical staff need to be improved, continuing education and training are relatively lagging behind, individual medical staff are not responsible enough, and patient safety is neglected, resulting in medical accidents from time to time; ② In the process of medical service, some medical institutions are not standardized in practice, over-serving, and unilaterally pursuing economic benefits; ③ The extensive application of high technology, lack of standardized management, and the risks of medical technology itself cause harm to patients; ④ Patients' rights of informed consent, choice, privacy and participation are not fully respected and guaranteed; ⑤ Lack of effective medical quality and patient safety information, testing and evaluation system; ⑥ There are hidden dangers in irrational drug use, especially the abuse of antibiotics, injection safety and blood safety. These six challenges require doctors to have good humanistic thought and humanistic quality.
3 How to improve humanistic quality
The important idea of "humanistic medicine" should be fully embodied in medical teaching, professional skills training and practice of doctors.
3. 1 Strengthen the awareness of medical humanities education
As Academician Han Qide said: "Modern medicine has developed to the point where we must pay full attention to medical humanities. The present situation of doctor-patient relationship determines that we must strengthen medical humanities education. The reform of China's medical and health undertakings and the construction of a harmonious society determine that we must strengthen the construction of medical humanities. " Comrade Hua Yiwei always put the interests of the party and the people first, regardless of fame and fortune, self-sacrifice, selfless dedication and loyal service, and won the respect and love of the broad masses with noble medical ethics and superb medical skills. He inherited the traditional virtues of saving lives in the medical field of our country, carried forward Bethune spirit, embodied the spirit of the times of serving people's health wholeheartedly, and also embodied the spirit of medical humanism. We should carry forward the power of example, call on the conscience of the society, improve the sense of mission of medical staff to heal the wounded and rescue the dying and perform their sacred duties, motivate themselves to devote themselves wholeheartedly to the sacred cause of maintaining and promoting people's health, make new contributions to China's medical and health reform, and make more contributions to building a harmonious society.
Further improve medical education and increase the proportion of humanistic medicine in medical education. Increase the content of humanities education: offer medical ethics, medical sociology, medical psychology, medical linguistics, clinical communication skills, aesthetics, art appreciation and other courses.
3.2 Establish a new concept of medical ethics
At present, China's health reform and development plan is about to be introduced, the task of health reform is very heavy, the relationship between doctors and patients is still tense, some members of the public do not know enough about medical workers, there are some prejudices, and very few doctors also have professional ethics problems. These problems are not conducive to improving the relationship between doctors and patients and building a harmonious society. Doctors should establish a new concept of medical ethics: change the doctor-patient relationship into a benefactor and beneficiary, and establish an equal and honest doctor-patient relationship; Change the tower structure with doctors as the apex and build a ring service structure with patients as the center.
3.3 Strengthen the cultivation of humanistic quality
As a qualified doctor and nurse, in addition to medical professional knowledge and skills, you need to have professional skills such as a sense of professional mission, a good service attitude, the ability to communicate with patients, teamwork and management.
Doctor-patient communication is a part of interpersonal communication, including interpersonal attraction, verbal communication, nonverbal communication, dynamic silence, static silence, paralanguage and so on. Doctor-patient communication is a basic principle of diagnosis and treatment, which can be achieved through technical communication and non-technical communication. Correctly understanding and paying attention to the communication and exchange between doctors and patients is directly related to ensuring medical quality, improving service level, strengthening the construction of medical ethics, preventing and reducing disputes between doctors and patients, and building and maintaining a harmonious society. Medical workers should actively study and seriously study the problems existing in doctor-patient communication, learn the skills and skills of doctor-patient communication, enhance the ability of doctor-patient communication, strive to create a harmonious doctor-patient relationship, and constantly improve the level of medical services. Through different levels and various forms of humanistic medical training, doctors all over the country can improve their practical skills in scientific values, professional service attitude, communication ability, medical work management and psychological adaptability, and medical team spirit in the shortest time.
3.4 years of hospital management
The "Hospital Quality Management Year" organized by the Ministry of Health and state administration of traditional chinese medicine highlighted the theme of "patient-centered, improving the quality of medical services", deepened the service concept of "patient-centered" and improved the level of medical services. Adhere to Scientific Outlook on Development, regard strengthening hospital connotation construction as the top priority of hospital management, and increase the management responsibility of hospital directors.
Hospital directors should reduce clinical professional and technical services, focus on strengthening and improving hospital management, and safeguard the public welfare nature. Adhere to the interests of patients in the first place and vigorously strengthen the management of medical services.
3.5 Hospital culture
In 2007, the "Year of Hospital Management" specially proposed to strengthen the construction of hospital culture, emphasizing the spirit of loyal service and humanistic service culture. Hamel, a British management scientist, put forward that modern management is nothing more than the pursuit of two things-making management more scientific; Make management more humane. On the one hand, people-oriented management emphasizes respect for people, their feelings, personality and self-development needs; On the other hand, it emphasizes the educational function of culture, attaches importance to the construction of environment and atmosphere, advocates noble value pursuit, and creates good interpersonal relationships, which has a subtle influence on people managed by high-grade culture.
To build hospital culture, medical staff should establish a lofty sense of professional mission. People's humanistic knowledge is constantly accumulating, humanistic feelings are increasingly enriched, and humanistic quality is gradually formed. One is to emphasize respect for people. People-oriented, pay attention to people's needs, respect people's life dignity and life value. Patients and their families need care, so do hospital employees; The second is to emphasize humanization. China traditional culture has always attached importance to cultural edification. As a hospital administrator, we should constantly improve our ability to guide and influence culture, pay attention to advocating noble cultural concepts, and create a good humanistic atmosphere, which will edify and edify hospital staff and exert a subtle influence on patients and their families who come to the hospital for treatment.
3.6 doctor's statement
Vigorously publicize and carry forward the doctor's professional spirit in the new century-doctor's manifesto. The majority of medical staff should strengthen the construction of professional ethics, take the professional spirit of doctors as the code of conduct, and better serve the harmonious development of society and people's health. The Doctor's Manifesto has three basic principles and ten professional responsibilities-principles: the principle of patients' interests first, the principle of patients' autonomy, and the principle of social fairness; Responsibilities: Improve professional ability, be honest with patients, keep confidentiality for patients, maintain proper relationship with patients, improve medical quality, promote accessibility of medical services, distribute limited resources fairly, promote the complete and rational application of scientific knowledge, resolve conflicts of interest, safeguard patients' trust, and safeguard doctors' professional responsibilities.
The medical profession must clearly understand the principles and responsibilities of the doctor's spirit. At present, some individuals in the medical team have deviated from their value orientation, bred unhealthy ideas such as money worship, hedonism and individualism, weakened medical ethics, and unilaterally pursued material benefits in medical activities. In this case. It is particularly important to reaffirm the professionalism of doctors.
People who are interested in practicing medicine should have enough enterprising spirit. Doctors often work overtime for the benefit of patients, disrupting personal arrangements and family life, and money and reputation cannot be the purpose of chasing. Doctors should ask themselves whether they can keep their dedication forever, otherwise they will be full of contradictions, troubles and unhappiness. The medical port is closely related to people's lives. The essence of medicine is a "human" science, which focuses on people who are struggling with diseases and need care and help. Therefore, medicine is the most humanistic discipline, and doctors should be the most humanistic profession.