转型乡村社会中医患信任.pdf

乡村社会转型时期的医患信任 ——以中部地区两村为例的研究 房莉杰 梁小 金承刚 摘要：本文以我国中部地区的两个村为例，调查了村民与村医和乡镇卫生院医生之间的 医患信任情况。研究发现，村民对村医和乡镇卫生院医生采取的分别是“人际信任”和“制 度信任”的信任逻辑;而在农村社会从传统向现代转型、农民对医疗专业化预期提高、医疗 服务更加专业化和制度化的背景下，未来村民对于村医的信任逻辑将是人际信任与制度信任 的叠加。而医疗体制与社会环境共同形塑了医生的行为，使村医和乡镇卫生院医生的行为既 有共性又有区别。通过与西方医患变迁的对话，本文认为，我国乡村社会正处于兼具传统性、 现代性、甚至后现代性的复杂转型期，未来需要思考的是如何将传统性因素融合进未来的社 会制度中，使其发挥积极作用。 关键词：医患信任、人际信任、制度信任、乡村社会转型 Doctor-patient Trust in Transiting Rural Society --A case study in two villages in central China Abstract: Based on the research in two villages in central China, this article found out that there were two different trust logics in doctor-patient trust in rural society. Villagers’ trust to village doctors was personal trust, while their trust to doctors of township hospital was institutional trust. With the transition from traditional society to a modern one, as well as the rising of villagers’ expectation to health service, the logic of villagers’ trust to village doctors would be a combination of personal trust and institutional trust. At the same time, both medical scheme and social environment shaped doctors’ behavior. Through comparing the doctor-patients relation in western nations with the one in Chinese villages, the article argued that rural society of China lies in a complicated and rapid changing period, and all the traditional, modern, and post-modern characters made us to think about how to integrate the traditional factors into modern institutions. Key words: Doctor-patient trust, Personal trust, Institutional trust, Transitional rural society 一、问题的提出：嵌入乡村社会的农村医患 “在现代工业社会里，疾病即意味着接触医学，去咨询医生，按医生的处方治病，这已 经成了人们感到身体不舒服和不正常后会立即作出的反应，甚至成了道德上的要求。应该做 ‘听话的病人’。”（亚当，2005 ）医患关系因此产生，病人“听话”是医患有效互动的基础。 然而在今天的中国，毋庸置疑的是医患关系的日趋紧张和恶化，近些年来“医患”