A Research on Paternalism in Educational Settings: Discourse Analysis Between Medical staff and Patient (his/her Family)

本研究的目的是在为期两年的研究中，分析家长式干预经常出现的医护人员与患者（家属）之间的关系中的话语.本研究采用17个类别对医患谈话录音进行分析，对医患谈话与知情同意进行定量分析。这17个类别如下。医务人员叙述：[A。直接对话，（1）解释，（2）纠正误解，（3）回应，（4）说服。[B.间接话语，（5）问题，（6）接受病人的情绪，（7）建议/忠告]病人的叙述：[A。自发叙述，（8）抱怨痛苦，痛苦和感受，（9）请求/建议，（10）问题] [B。被动叙述，（11）回应，（12）对劝说作出回应，（13）对建议作出回应]其他：（14）患者和家属之间的叙述，（15）叙述 关于我们 医护人员之间，（16）独白，（17）沉默.对4位医生记录的13例病例的话语进行分析，澄清了以下问题。(1)医生叙述的平均比率为52.2%，较以往研究所提供的资料为低。这种家长式的医疗采访，完全由医生解释，比预期的要少。(2)通过对13例病例的分析，发现病人叙述率与医生叙述率、医生叙述率与病人连续叙述率、医生叙述率与医生叙述率之间存在相关性。(3)医务人员在医疗面谈或知情同意中发挥提供有关患者疾病和治疗信息的作用。如果医生意识到自己作为信息提供者的角色，医生往往会在医生与患者之间的对话中采取主动，并不断解释，以使患者了解自己的病情。少

The purpose of this research is, in two-year research period, to analyze the discourse in the relationship between the medical staff and the patient (his/her family) in which the paternalistic intervention often arises.1. In this research, using 17 categories to analyze the recorded discourses of doctors and patients, the quantitative analysis of the medical interview and informed consent was made. The 17categories are as follow. The medical staffs narratives: [A. direct discourse, (1) explanation, (2) correcting the misunderstandings, (3) response, (4) persuasion.] [B. indirect discourse, (5) question, (6) accepting the patient's emotion, (7) recommendation/advise] The patient's narratives: [A. spontaneous narratives, (8) complaining the pain, sufferings, and feelings, (9) request/proposal, (10) question] [B. passive narratives, (11) response, (12) responding to the persuasion, (13) responding to the recommendation] Others: (14) narratives among the patient and family, (15) narratives … More among the medical staff, (16) monologue, (17) silence.2. The analysis of the discourses of 13 cases recorded by 4 medical doctors clarified the following. (1) The average rate of doctor's narratives was 52.2% which was comparatively lower than past data presented by the preceding researches. Such paternalistic medical interviews as explained exclusively by the doctors were less than expected. (2) Through the analysis of the 13 cases, it was made evident to show the correlation in the following relationships between the rate of patient's narratives and the rate of doctor-bring-about-patient's narratives, between the rate of doctor-bring-about-patient's narratives and the rate of continuous patient's narratives, and between the rate of doctor's narratives and the rate of doctor-bring-about-patient's narratives. (3) The medical staff plays the role of giving the information about the patient's disease and the treatment in the medical interview or informed consent. In case that the doctor is conscious of his/her role as information-giver, the doctor tends to take initiative in the discourse between the doctor and the patient, and to explain continuously in order to make the patient understand his/her own conditions of illness. Less