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期内，分析医务人员与患者（其家属）关系中经常出现家长式干预的话语。在本研究中，使用17个类别来分析医生和患者的话语记录，对医疗访谈和知情同意进行定量分析。17个类别如下：医务人员叙述：[A]直接话语，(1)解释，(2)纠正误解，(3)回应，(4)说服。] [B。间接话语，(5)提问，(6)接受病人的情绪，(7)建议。自发的叙述，(8)抱怨痛苦，痛苦和感受，(9)请求/提议，（10）问题][B]。被动叙述，（11）回应，（12）回应说服，（13）回应建议]其他：（14）病人和家属之间的叙述，（15）叙述……更多的是医务人员之间的叙述，（16）独白，（17）沉默。对4名医生记录的13例病例的谈话进行分析，澄清了以下几点。(1)医生自述率平均为52.2%，较以往研究数据有所下降。医生们独家解释了这种家长式的医疗采访，这比预期的要少。(2)通过对13例病例的分析，可以明显地看出，患者叙事率与医生带来患者叙事率、医生带来患者叙事率与患者连续叙事率、医生叙事率与医生带来患者叙事率之间存在如下关系：(3)医务人员在医学访谈或知情同意中起到告知患者病情和治疗信息的作用。当医生意识到自己作为信息提供者的角色时，医生往往在医患对话中采取主动，并不断地解释，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