의사-환자 관계에서 감정이입의 의미 연구 : 말기 유방암 환자 사례를 중심으로

이은영(Lee, Eun Young) 가톨릭생명윤리연구소 2020 인격주의 생명윤리 Vol.10 No.2

이 글은 현대의학의 위기를 의사와 환자의 관계성이라는 측면에서 접근하고, 양자의 관계 개선을 위한 전제조건으로 상호 인격적 관계성이 설정되어야 한다는 사실을 강조하는 데 목표가 있다. 그렇다면 의사-환자의 관계에서 양자의 차이를 극복하고 상호 소통과 신뢰관계의 구축이 어떻게 가능한가. 스그레챠가 주장하듯이, 의사-환자 상호 간의 관계가 4가지 모델 유형으로 고정되어 있기 보다는 현실적으로 환자의 상황에 따라 적절하게 양자 유형이 유동적으로 변할 수 있다는 견해에 필자는 좀 더 의미를 두고 있다. 필자가 제시했던 말기 유방암 환자 사례에서도 드러났듯이 의사-환자 관계에서 가장 중요한 것은 양자의 관계를 어떤 모델 유형으로 규정하고, 확정시키기보다는 의료인-환자 관계에서 양자 간 얼마만큼 신뢰를 바탕으로 인격적 관계성이 구축되고 있는가에 방점이 있다고 본다. 감정이입이 일정 부분 그 역할을 수행할 수 있다고 생각된다. 그렇다면 공감과 감정이입은 어떻게 구별되는가? 의사는 공감을 통해 환자에게 직접적인 위안을 줄 수 있으나, 환자의 표정이나 심경 즉 내면적 세계를 이해하는 데 한계가 있다. 공감에서는 상대방을 ‘위로’할 수 있으나 감정이입에서는 상대방의 외로움과 고통을 ‘이해’하고 상호 ‘교감’할 수 있는 가능성이 타진된다. 따라서 의사-환자 관계에서 의사의 환자에 대한 공감은 측은함을 유발시키지만, 감정이입은 의사가 환자의 상황을 이해하고, 환자 안으로 들어감으로써 양자 간 소통이 가능해질 수 있다. 또한 감정이입을 통한 환자-의사 관계에서는 환자를 인격적 주체로 이해할 뿐 아니라, 의사도 자기 자신을 객관적으로 이해할 수 있다는 점에서 우리는 감정이입의 유의미성을 언급할 수 있다. 슈타인도 언급했듯이 감정이입을 통해 의사는 환자의 고통과 슬픔, 불안감과 같은 내면적 세계를 이해하는 것이 일차적 목적이라면, 환자를 이해하는 의사 자신이 환자에게로 감정이입하면서 감정이입이 된 자기 자신을 객관적으로 되돌아 볼 수 있다는 측면에 또 하나의 목표를 둔다. 그런 한에서 의사는 감정이입을 통해 상호 인격적 체험을 하며 자기 인식, 자기 성찰과 관계성을 촉진함으로써 상호간의 간극이 해소될 가능성을 타진함으로써 의사-환자의 인격적 관계는 가능해지리라 판단된다. This study aims to emphasize the fact that the crisis of modern medicine should be approached in terms of doctor-patient relationship, and that mutual personal relationship should be established as a prerequisite for improving the relationship between the two. Then, how are the differences between the two persons in doctor-patient relationship overcome, and how do they communicate with each other and build trusting relationship? It is thought that empathy can play a part in that. Of course, a doctor can comfort his or her patient directly through sympathy but there is a limit to understanding the patient s expression or mind, that is, the inner world of the patient. With sympathy, one can comfort the other, but with empathy, the possibility of understanding the other person s loneliness and suffering, and thereby interacting with each other is explored. Thus, in doctor-patient relationship, while sympathy of a doctor for his or her patient may lead to pity and a psychological distance between the two may occur, empathy allows a doctor to understand the patient s situation, thereby enabling mutual communication between the two. The significance of empathy can also be empathized in patient-doctor relationship through empathy in that as the patient can be understood as a personal subject, the doctor, in turn, can objectively understand the person who is the doctor himself by empathizing with the patient. In other words, a personal relationship can be formed in the doctor-patient relationship that we are constantly referring to. As mentioned by Stein, empathy allows a doctor to understand the inner world of the patient such as pain, sadness and anxiety, and the doctor himself who understands the patient objectively looks back at the empathetic doctor himself as he empathizes with the patient. With that knowledge, it is therefore concluded that the personal relationship between a doctor and a patient become possible as the gap between the two is resolved when empathy allows them to experience each other personally, thus facilitating their self-awareness, self-reflection and a deepened relationship between the two.

한의학에서의 환자-의사 관계

김근우 ( Geun Woo Kim ) 대한한방신경정신과학회 2007 동의신경정신과학회지 Vol.18 No.3

Objectives : This study aimed for desirable cure through the investigation of The Patient-Doctor Relationship in Eastern Medicine.Methods : Research materials is data of the patient, the doctor and the Patient-Doctor Relationship in Eastern Medicine bibliography except medical theory and clinical contents.Results and Conclusion :.1. Relatively the doctor`s position origin from exorcist has it over patient`s that.2. In spite of clinical doctor, Confucian physician have Confucianism and the ethics so they set The Patient-Doctor Relationship in Eastern Medicine essentially.3. Each of doctor(the doctor-doctor relationship) emphasize the partnership in the Patient-Doctor Relationship.4. Patient`s choice for doctor is source of the Patient-Doctor Relationship basically and the choice are prudent.5. The patient must carry into practice psychological and body medical affairs related to health preserving6. For desirable Patient-Doctor Relationship, doctor`s inquire is considered with temper and circumstance and a consultation room are also required stability.7. Poor Patient-Doctor Relationship are come about when patient is not trust doctor, patient is not follow doctor`s order and doctor`s indifference to patient.

신진학자 연구논문 : 유방암 환자들의 치료과정에서 환자-의사 관계의 관계적 체험과 의미 탐색: 감정 체험과 인지적 관점을 바탕으로

이혜범 ( Hae Bum Lee ) 한국교육인류학회 2013 교육인류학연구 Vol.16 No.1

본 연구는 유방암 완치 판정을 받은 환자들의 이야기를 통해 그들의 치료과정에서 나타난 환자-의사 관계의 소중한 의미를 탐색하기 위함이다. 질병의 주체인 환자들의 관점에서 경험한 환자-의사 관계는 그 동안 의사 중심의 교육을 받고 의사의 관점으로만 진료를 경험했던 의사들에게 관점의 변화를 일으키고 현상에 대한 새로운 의미를 찾게 할 수 있으리라 본다. 연구는 다섯 명의 유방암 생존자들과의 심층 인터뷰, 투병기, 환자의 이야기를 담은 영화 등을 분석하는 현상학적 연구방법으로 진행되었다. 환자들이 질병을 경험하는 가운데 맺는 환자-의사의 관계는 단순히 겉으로 드러나는 표면적인 ``관계 맺음``을 넘어 환자가 질병을 어떻게 받아들이고 극복할지를 좌우하는 매우 중요한 부분이었다. 의사의 사소한 언행 하나에도 환자들은 큰 영향을 받았으며 특히 유방암 환자들의 경우는 유방 절제술로 인해 여성으로서의 자존감 저하와 대인기피, 우울증 등 다른 암 환자에 비해 정신적인 스트레스가 큰 만큼 의사의 따뜻한 말 한 마디와 공감 및 지지가 질병을 극복하는 데 실질적인 힘이 되었다. 연구자는 본 연구를 통해 유방암 환자들이 치료과정에서 경험하는 환자-의사 관계는 암 진단 초기에는 환자가 질병을 받아들이는 자세를 결정하고 힘든 치료과정 속에서는 긍정적인 마음으로 치료 의지를 갖고 질병을 극복할 수 있도록 도움을 준다는 것을 알 수 있었다. 또한 정신적인 스트레스가 큰 유방암 환자들에게는 치료 과정은 물론 특별히 치료 후까지도 의사와의 지속적인 긍정적 관계 형성이 저하된 자존감을 회복하고 건강한 삶으로 복귀하는 데 도움이 된다는 것을 알 수 있었다. The purpose of this study is to search for the true meaning of doctor-patient relationship as it appeared in the course of treatment of breast cancer patients. The Patients` view about "Doctor-patient relationship" could make doctors look at a different sides and find new meanings for doctor-patient relationship. We used the phenomenological method of looking through and analyzing the five breast cancer patients` in depth interviews, illness experience and films that include the patient`s story. In conclusion, doctor-patient relationship formed during patient`s disease experience must be not a cursory ``relationship`` but a very meaningful ``relationship`` that determines how the patient accepts and overcomes the disease. Patients were affected greatly by even doctor`s slight words and gestures and they often especially have experienced more mental stress than other cancer patients because of mastectomy, for example, loss of self-esteem as a woman or avoidance of sexual activity, social phobia, depression, etc. The doctor`s comforting words, empathy and support has helped them greatly in overcoming the disease. The doctor-patient relationship with breast cancer patients experienced during the treatment was an important determining factor that decides their attitude in accepting the disease and helping them have a positive attitude and overcome the disease during the hard course of disease treatment. Also, the continuous positive doctor-patient relationship after treatment helped them recover their degraded self-respect and return to a healthy life.

전공의와 환자의 의사-환자 관계에 대한 상호 인식 조사

안서원(Sowon Ahn),이영미(Young-Mee Lee),안덕선(Duck-Sun Ahn) 한국의학교육학회 2006 Korean journal of medical education Vol.18 No.3

Purpose: We specifically investigated the young doctor (residents) patient doctor-patient relationship in Korea. A society built on Confucianism, age is expected to affect even the doctor-patient relationship. Methods: 57 residents participated and answered 6 open-ended questions. 90 patients of various age participated and answered 3 open-ended and 6 close-ended questions. Results: It seems that the general problem of the doctor-patient relationships was related to attitudes and communication skills. Over 80% of the residents felt uncomfortable and received inappropriate verbal expressions and attitudes from their patients simply because they were young or younger than the patients. This negative experience resulted mostly from the residents self-perceived lack of experience and clinical competence and the patients distrust of young doctors. As for the patients, over 80% preferred middle-aged doctors to young doctors. Middleaged doctors were thought to be easier to understand, better mannered, more humane, and clinically competent. Most residents expected professional respect from their patients, while patients expected kindness and humility from the young doctors. This shows a gap in the reciprocal expectations between residents and patients. Conclusion: Young doctors are perceived as inexperienced and incompetent and, consequently, not trusted by patients in Korea. To improve the resident-patient relationship, improvement in attitude and communication skills is needed.

의사-환자의 치료적 관계에 대한 질적 사례연구

강성현,이도은,최정현,김광우,유영수,강형원,정문주 대한한방신경정신과학회 2023 동의신경정신과학회지 Vol.34 No.3

Objectives: The purpose of this study was to identify the doctor-patient relationship perceived by doctors in clinical settings and the effect of doctor-patient relationships on treatment schemes. A qualitative case study was conducted for this purpose. Methods: In-depth interviews were conducted with five oriental medicine doctors and doctors working in clinical settings using a semi-structured questionnaire. Transcription and coding were performed to analyze the data. By analyzing each case individually through within-case analysis, we attempted to find themes that emerged from the research subjects’ experiences with establishing relationships with patients. Afterward, a cross-case analysis was conducted to identify the meaning of the experiences through commonalities and differences. Results: Within-case analysis confirmed the thoughts and emotions of the research participants in recognizing, defining, and participating in doctor-patient relationships while delivering treatments. Case-to-case analysis derived two themes, seven categories, and 20 meaningful units for doctor-patient relationships. Conclusions: The study found that a doctor-patient relationship regarding patient treatment could be established based on the doctor’s ‘professional qualifications’ and ‘human qualities’. In the future, it is necessary to present an educational model for relationship-based intervention techniques and personality maturity. Follow-up research should be conducted to enable the establishment of therapeutic relationships between doctors and patients.

사상의학(四象醫學)에서의 의사-환자의 관계에 대한 연구

반덕진,박성식,Ban, Duk-Jin,Park, Seong-Sik 사상체질의학회 2008 사상체질의학회지 Vol.20 No.1

1. Objectives We analyze Doctor-Patient Relationship in anthropological medicine, medical sociology Oriental Medicine and find out solutions about problems of Modern Medicine which are dehumanized through the meaning of Doctor-Patient Relationship in Sasang Constitutional Medicine. 2. Methods We consider various studies which are related with doctor-patient relationship from models of the Doctor-Patient Relationship, anthropological medicine, medical sociology and Oriental Medicine. And we compare and analyze Sasang Constitutional Medicine's meaning of doctor and patient through Sasang Constitutional Medicine's view of treatment and philosophy. 3. Results and Conclusions 1) In various studies, Doctor-Patient Relationship have been dualistic perspective which is divided into doctor and patient, and lay emphasis on relationship between them. 2) In Sasang Constitutional Medicine, anyone might be a patient because they are human being, anyone might be a doctor as cure their own disease. In other words, doctor and patient are not separated but united. A point of regarding human is the core of illness and cure can present new direction that solves problems of dualistic perspective Modern Medicine.

발표논문 : 환자의 자기결정권에 관한 연구-의사,환자관계의 유형을 중심으로-

박태신 ( Tae Shin Park ) 연세법학회(구 연세법학연구회) 2014 연세법학 Vol.24 No.-

오늘날 의사·환자의 관계가 오히려 더욱 소원해지는 경향 속에서 환자의 권리 확보를 위하여 주요한 주제로 환자의 자기결정권이 거론되고 있다. 따라서 이 논문에서는 환자의 자기결정권이 무엇이고 그것을 둘러싼 문제점으로 어떠한 것이 있으며 어떻게 생각하여야 하는지의 문제가 논의되고 있다. 환자는 누구라도 기본적으로 자신의 신체나 정신에 일어날 일에 대하여 스스로 결정할 있다는 자기결정권을 가지는데 여기에는 ① 자기의 생명·신체의 처분에 관한 사항, ② 가족의 형성·유지에 관한 사항, ③reproduction에 관한 사항, ④ 기타 사항 등이 있다. 그런데 위와 같은 자기결정권의 내용과 관련해서는 ① 자기결정권을 이것과 함께 사용되는 많은 다른 개념과 구분하여야 하는 문제, ②자기결정권의 내용·의의에 관한 것, ③ 자기결정권이 수단적 가치인지, 목적적 가치인지의 문제 및 ④ 자기결정권과 관련하여 논의되는 여러 가지 문제 등의 논점이 있으나 여기에서는 환자의 자기결정권이라고 하는 한정된 범위에서 ⓐ환자의 자기결 정권을 헌법상 인권으로 볼 수 있는지, ⓑ 자기결정권을 사법상 권리로 인정할 경우 의사와 환자의 관계, ⓒ 의사·환자관계의 유형으로서 은혜유형, 계약유형, 신탁유형이라고 하는 3가지 이념형을 제시하고 그 중 신탁유형을 바탕으로 의사·환자관계를 생각하여야 한다고 하는 점 그리고 그와 같은 시각에서 바라 볼 때, 환자의 자기결정권과 관련한 여러 가지 문제를 어떻게 볼 수 있는지를 살펴보았다. 결론적으로 우리나라에서 더 이상 환자의 자기결정권을 헌법적인 수준에서 논하는 것보다도 사법적인 수준에서 그 의의와 한계를 원만하게 논의할 필요가 있고 의사·환자관계를 신탁유형으로 파악하는 것이 환자의 자기결정에 관한 문제를 생각할 때 유익한 견해를 제공해 준다고 하는 점을 논증하기 위한 노력을 하였다. 미국의 특정조사가 보여주는 바와 같이 환자는 더욱 많은 정보를 요구하는 것이 현실이지만 자기결정이 바람직하지 않다고 하는 환자가 많다고 하는 점에 비추어 신탁유형은 그 희망을 실현하기 위한 기반으로 될 수 있을 또한 지적하였다. Relationship of physician and patients become estranged more than before. On the basis of such recognition, we need to and have to discuss the patient`s right to self-determination. In the midst of the discussions, theory and precedents to recognize the right to self-determination of a patient as a private law will being become the mainstream. The patient basically has a self-determination to decide for themselves on what will happen to his body and spirit. However, the contents and significance of the rights have not been clearly explained. Because there is a change in the doctor and patient relationship itself. In relation to this, the scholars have been discussed ① the self-determination and many of the concepts to be distinguished, ② the issues in the contents` significance of the right to self-determination and ③ the right of self￢determination to be used in its own value or in order to achieve other value problem. However, in this paper, I describe the general requirements for self-determination, and set the type of the doctor-patient relationship. And as the type, I have written the favor type, the contract type and the trust type. After that, I have asserted that the system of trust type must be considered as the relationship between the doctor` patient. In addition, I have concluded that discussing the right of self-determination of the patient in private law level is needed to be able to faithfully understand its significance and limitations. And to grasp the type of trust, the doctor and patients relationship were supposed to know the fact that give us useful resolution method to problems such as patient self-determination. That we have considered the doctor and patient as the trust type will give us the useful things. Because the self-determination are also all control of the information and appropriate medical care, it serves as a means for ensuring that the appropriate trust execution is carried out by a doctor.

환자-의사 관계에 대한 의대생의 태도

박재현 한국의학교육학회 2007 Korean journal of medical education Vol.19 No.3

Purpose: This study investigated the attitudes of medical students toward physicians and the roles which the doctors and patients should play in the health care process. Methods: Attitudes toward the patient-doctor relationship of 436 medical students of the K university in Seoul were measured using the Patient-Practitioner Orientation Scale(PPOS), a validated instruments designed to measure individual preferences toward various aspects of the patient-doctor relationship. The PPOS was composed of Sharing(sharing information, take part in decision making) and Caring(respect one's feelings, interpersonal relationship) subscale. Total PPOS scores can range from patient-centered(egalitarian, whole person oriented) to disease- or doctor-centered(paternalistic, less attuned to psychosocial issues). Socio-demographic data including gender, age, school year, marital status, undergraduate major, student's and her/his family medical background and specialty choice were collected and it was investigated the possible impact of socio-demographic factors on students' attitudes. Results: The PPOS score was 3.82. The Sharing and Caring scores were 3.74 and 3.90, respectively. Female gender and students of graduate entry program were significantly associated with patient-centered attitudes. Age, school year, marital status, academic background, student's and her/his family medical background, and specialty choice did not show significant associations with PPOS scores. Conclusion: Female and graduate students showed more patient-centered attitudes than male and undergraduate students, respectively. Given the emphasis placed on patient-centered care in the current medical environment, our results suggest further research to explore the dynamics in medical education that may foster or inhibit student attitudes toward patient-centered care.

환자와 의사의 환자 중심 태도 차이

김민정 한국의학교육학회 2013 Korean journal of medical education Vol.25 No.2

Purpose: There have been studies on the patient-centeredness of medical students and physicians in South Korea, but no result has presented the patient-centered attitude of patients and doctors. So, this study intended to compare the attitudes of patients and doctors toward the roles that patients and physicians should play in the health care process. Methods: One hundred and fifteen doctors and 264 patients participated in this survey using a structured questionnaire, including sociodemographic data and Patient Practitioner Orientation Scale (PPOS). The PPOS comprises sharing (sharing information, take part in decision making) and caring (respecting one's feelings, interpersonal relationships) subscales. Results: The PPOS scores of the doctors and patient were 3.02 and 3.20. In detail, the doctors’ sharing and caring scores were and 3.02 and 3.48, and the those of patients were 3.14 and 3.12, respectively. This results are enough to demonstrate that patients are likely to be patient-centered with regard to sharing and that doctors tend to be patient-centered in terms of caring. Conclusion: The patients’ desire to obtain medical information and take part in decision making (sharing) are greater than those of doctors. Doctors had more patient-centered attitude than patients in terms of respects for one's feelings and interpersonal relationships (caring).

Visual analysis of doctor-patient relationship problems based on R language(1995-2022)

Shengnan Pang,Ruo Si,Yurong Bao,Yubo Xiao 중앙대학교 영상콘텐츠융합연구소 2023 TechArt :Journal of Arts and Imaging Science Vol.10 No.3

This study used R language technology to study the trend of doctor-patient relationship research from 1995 to 2022, based on a collection of doctor-patient relationship literature in the Web of Science database. The analysis was conducted from the perspective of doctor-patient relationship-related literature statistical general trend, then from the perspective of researchers, high-yield countries or regions of the overall situation, high-frequency keywords and keyword clustering visualization, and after the visual atlas longitudinal analysis of the literature topic of evolution, finally through the analysis of the world’s first highly cited literature summary and verifying the direction of doctor-patient research. This study identified that, although doctor-patient research in China started late, the quality of the literature could be improved. China attaches great importance to cooperative research and plays a vital role in communication in doctor-patient research. Finally, countries worldwide believe that one of the core aspects of the doctor-patient relationship lies in the transmission and communication between doctors and patients.