在社会经济发展、医疗市场竞争日趋激烈、人民健康意识不断增强的社会背景下, 医患沟通的问题和不良后果日益凸显。怎样与患者进行有效沟通，了解患者的需求， 在尊重患者知情权和选择权的基础上，赢得患者的支持，推动医疗工作的有效进行， 避免形成各种医患纠纷，让患者可以放心诊疗，让医生可以安心工作，是本文研究的 出发点。 本文通过研读国内外相关医患研究的文章和著作，网络查询相关学术期刊和国家 政策法规，依据现有的理论、事实和需要，实地走访医务人员、患者及医院管理专家， 掌握第一手资料，通过文献研究法、专家访谈法、问卷调查法的形式，找出医患沟通 中出现的问题，并且通过信任理论、委托代理理论、人际关系理论及构建沟通过程模 型，分析总结出对医患沟通起到负面作用的三大原因，进而提出改善对策。 患者对服务态度、医疗技术水平、医生与患者之间交流的不同感受程度和医护人 医德医风的情况是当前患者与医务人员之间发生矛盾的主要影响因素，在当前就医环 境下，医患沟通改进必须从医方、患方、社会几个主体入手，互相协助，共同构建和 谐的就医环境。从医方层面来说，要加强内部管理，改善医德医风，提高诊疗水平； 从患方层面来说，要提高自身医学常识，正确维权；从社会方面来说，要做到共同协 作，正确引导，从而减少医患纠纷的发生，让医患关系走上良性发展的轨道。 关键词：医患沟通；原因分析；改进对策I ABSTRACT Under the social background of social economic development, increasingly fierce competition in medical market, and people's increasing awareness of health, the problem of doctor-patient communication and adverse consequences are increasingly prominent. How to effectively communicate with patients, understand the needs of patients, win the support of patients on the basis of respecting patients' right to know and right to choose, promote the effective implementation of medical work, and avoid any disputes between doctors and patients, It is the starting point of this study that patients can be safely treated and doctors can be relieved to work. In this paper, I have studied the articles and works related to doctor-patient research at home and abroad, searched related academic journals and national policies and regulations on the Internet, and, according to the existing theories, facts and needs, visited medical personnel, patients and hospital management experts to obtain first-hand information，By means of literature research, expert interview and questionnaire, problems in the communication between doctors and patients are found ， Through the trust theory, principal-agent theory, interpersonal relationship theory and the construction of communication process model, three reasons of negative effect on the doctor-patient communication were analyzed and summarized, and then the improvement measures were proposed. The main factors influencing the current conflict between patients and medical staff are the service attitude, medical technology level, different feelings of communication between doctors and patients, and the medical ethics of medical staff，Under the current medical environment, the communication and improvement between doctors and patients must start from the medical party, patient party and social subjects, and help each other to build a harmonious medical environment together. From the medical side, we should strengthen internal management and improve the level of diagnosis and treatment. From the perspective of patient, we should improve our medical knowledge and safeguard rights correctly. From the perspective of society, we should work together and guide properly so as to reduce the occurrence of doctor-patient disputes and put the doctor-patient relationship on the track of sound development.II KEY WORDS: Doctor-patient communication，The investigation and study，Improvement countermeasures1 目 录 第一章 绪论...................................................................................................1 第一节 研究背景及选题意义...................................................................................... 1 一、研究背景......................................................................................................... 1 二、研究的意义..................................................................................................... 1 第二节 国内外研究现状............................................................................................ 3 一、国外研究现状................................................................................................. 3 二、国内研究现状................................................................................................. 4 第三节 研究思路及方法............................................................................................ 4 一、研究思路......................................................................................................... 4 二、研究方法......................................................................................................... 5 第二章 理论依据及沟通过程模型...............................................................6 第一节 理论依据........................................................................................................ 6 一、信任理论......................................................................................................... 6 二、委托代理理论................................................................................................. 7 三、人际和谐理论................................................................................................. 8 第二节 沟通过程模型................................................................................................ 9 一、沟通的概念..................................................................................................... 9 二、医患沟通的概念........................................................................................... 10 三、沟通过程模型在医患沟通中的应用........................................................... 10 第三章 A 医院医患管理及沟通存在的问题.............................................13 第一节 A 医院简介................................................................................................ 13 一、A 医院基本情况及战略目标....................................................................... 13 二、A 医院人力资源配置情况........................................................................... 14 第二节 研究基础工作.............................................................................................. 14 一、调查准备....................................................................................................... 14 二、调查过程....................................................................................................... 142 三、调查结果........................................................................................................15 第三节 调查研究发现的问题...................................................................................18 一、医患双方个人原因........................................................................................18 二、沟通效果不佳................................................................................................19 三、网络舆情负面影响........................................................................................19 第四章 产生问题原因分析.........................................................................21 第一节 医院层面原因.................................................................................................21 一、医院管理问题................................................................................................21 二、医疗水平局限................................................................................................21 三、医患沟通不畅................................................................................................21 四、医德医风滑坡................................................................................................22 第二节 患者层面原因.................................................................................................22 一、不合理的预期..............................................