①埃里克斯·默德(Alex Mold)有三篇代表性的文章涉及此主題,其研究時段集中在20世紀80年代之前:《重新定位病患:1960-1970年代英國病人組織、消費者保護主義和自治》(Repositioning the Patient:Patient Organizations,Consumerism,and Autonomy in Britain during the 1960s and 1970s[J].Bull,Hist.Med,2013,87)、《1960-1980年病人的權利和英國國民健康服務體系》(Patients Right and the National Health Service in Britain,1960s-1980s[J].American Journal of Public Health,November.2012,Vol.102,No.11)和《瑪格麗特·撒切爾英國時期病人—消費者的形成》(Making the Patient-Consumer in Margaret Thatcher's Britain[J].The Historical Journal,Vol.54,Issue 02,June 2011.);馬曉的《中英醫患關系道德調節的比較研究》(第四軍醫大學,2002年碩士論文);余成普的《國外醫患互動中的病人地位研究述評——病人角色理論到消費者權利保護主義》(《中國醫院管理》,2008年第1期);陳勇的《從病人話語到醫生話語——英國近代醫患關系的歷史考察》(《史學集刊》,2010年第6期)。
②“以病人為中心”(Patient-Centered)一詞是1956年由薩斯(Szasz)和郝雷德(Hollender)首次提出(Alan Bleakley,Patient-Centered Medicine in Transition-The Heart of the Matter,New York and London:Springer International Publish,2014),但并未得到醫學界的充分重視。80年代,“以病人為中心”的臨床方法作為一種概念首次應用于醫學研究和教學中,其包含五個層次的含義:一是了解病人關注和需要的信息;二是指把病患看成具有一定情感、思想的“人”;三是分析病人身體問題的共同根源與醫療管理方面的相互關系;四是改善預防和提高衛生質量;五是指醫患之間建立長久的信任關系(Moira Stewart,ect,Patient-centered Medicine:Transforming the Clinical Method,Radcllife Medical Press,2003)。1983年,美國弗羅里達州的湖岸地區醫療中心首次將此概念付諸實踐。我國是在1996年11月的全國衛生工作會議上,彭佩云提出把“以病人為中心”作為醫院的辦院宗旨。
③循證醫學又稱之為實證醫學,是一種新型的醫療范式,即在醫學文獻中需求最好的證據以應用于病人的醫護。它致力于給予每一個病人盡可能最好的醫療服務(Dan Mayer.Essential.Evidence-Based Medicine,Cambridge:Cambridge University Press.2004)。1992年,循證醫學一詞由喬丹·蓋亞特(Gordon Guyatt)提出,最初指一種新型的醫學教學方式。1996年戴維·L·斯卡特(David L.Sackett)及其同事明確界定其內涵,認為循證醫學指小心謹慎地、明確地、理性運用當前的證據以確定個體病人的治療方案,在醫療實踐中,主張綜合臨床醫生的經驗和醫學研究中病人最有效的外部臨床跡象以確定治療方案。(David L.Sackett,William M.C.Rosenberg.Evidence Based Medicine:What It Is And What It Isn't:It's About Integrating Individual Clinical Expertise And The Best External Evidence,British Medical Journal,Vol.312,No.7023(Jan.13,1996)。
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(原文刊于《鄭州大學學報:哲學社會科學版》2016年第7期)