| Summary: | 碩士 === 慈濟大學 === 人類發展學系碩士班 === 101 === Because of the advances in medical technology, physicians tend to get all the information about patients by the findings of laboratory or high-tech inspection rather than traditional interrogation. In fact, the condition will let doctors just focus on the “disease”, not the “patient”. The art of medicine will be simplified as a rational medical technology, resulting poor doctor-patient relationship and increasing numbers of medical disputes. In order to solve the above problems, "narrative medicine" provides different thinking processes with traditional biomedical model.
The so-called narrative medicine, are not only the understanding of healing and illness of patients, but also the description of the interaction between doctors and patients in emotional and interpersonal levels. The writing can help doctors to experience the suffering of patients and how they survived with their illness. And also, through the process of writing and understanding, doctors can reveal the transcendent truth of illness and treatment, and can embody themselves in the truth of human life. Using narrative medicine, we can explore the training and literacy of medical students in medical humanities. Appropriate curriculum to cultivate competence of medical humanities can be designed upon our study.
Medical students in 5th and 6th grades were included in the study. They were asked to finish an illness history of a patient they cared before. The software NVivo was used to perform qualitative analysis of different characterizations of medical humanities in the contents. There were 115 texts analyzed. There are eight domains conducted, including " patient’s characteristics", "explanatory models of patients", "impacts of diseases on patients and their families", "behaviors of seeking medical treatment"," culture and health "," society, resources and health "," doctor-patient relationship", and "self-reflection". Students most focus on the domain of "impacts of diseases on patients and their families", especially in the part of "physiological impacts". Corresponding to Arthur Kleinman’s eight questions of cross-cultural care, we found that: The first three questions of Arthur Kleinman are to investigate patients’ understanding about the causes of disease. Only about ten percent of students noticed the idea. The fourth and fifth questions of Arthur Kleinman discuss the cognition about disease and it’s prognosis of patients and their families. Nearly 30% of the students mentioned "patients’ awareness and feeling about their diseases "," the cognition about prognosis "and" the perceptions of families about diseases which patients had ". The sixth question discusses the treatment options and patients’ expectations of prognosis. There were about 50% of the students realized the ideas. The last two questions, talk about the impact and self-adjustment of patients and their families. The descriptions of students in this aspect are very abundant and diversely. It is very difficult to summarize the consistency between students’ content. Broadly speaking, the findings can correspond well on Arthur Kleinman’s eight questions of cross-cultural care. It can be summarized that in the text of illness history, medical students are not familiar with the aspects of cultural issues and the explanatory model of patients. In the parts of quantitative, all the p values of chi-square tests were greater than 0.05. We can assume that the literacy of medical students in medical humanities may not be related with genders, ways of entrance, and learning levels of basic and clinical phases.
As the results, medical students already have abilities of self-reflection and introspection. By the guiding and discussing with their role models, and the recognizing of patient-center care issues in caring true patients, the cognition of students in medical humanities can be empower.
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