题名

醫療與人文的融合－以草屯療養院之成長軌跡為驗證

并列篇名

Fusion of Medicine and Humanities-A Growth Locus of the Tsaotun Psychiatric Center

作者

張介信(Chieh-Hsin Chang)；簡以嘉(I-Chia Chien)

关键词

醫療照護 ； 健康 ； 人文精神 ； Medical care ； Health ； Humanistic spirit

期刊名称

醫學與健康期刊

卷期/出版年月

5卷2期（2016 / 09 / 01）

页次

103 - 117

内容语文

繁體中文
中文摘要

醫療工作主要的目標在維護人類健康，而健康並非僅止於沒有身體病痛而已，健康是身體心理與社會的良好和諧狀態。因此必須關注疾病的預防、治療到復健等面向，才能達到此目標。醫療工作的性質主要是立基於自然科學的理性邏輯，依據客觀的觀察分析，形成假設，最後經嚴謹的辯證，建立一致性的實證資料，再運用到每日的臨床治療。但病人在罹病時的心理感受與主觀體驗卻有極大的個別差異，因此臨床醫療工作，除了依照標準作業準則外，還須依照個別的需求，提供全方位的照護，著重以人文精神思維建立的照護模式才能達到病人的最佳福祉。而人文精神即是以人為中心，尊重自主，並以人的價值為依歸，在與病人接觸的過程中，感通生命的互動經驗，創造心靈的交流以協助病人獲得健康。同時亦須具備深刻反省的精神，以期再造價值體系，並在社會正義的原則下彌平潛在不平等，創造病人的最佳福祉。本文透過回顧草屯療養院各種醫療模式的發展，從療癒環境的建立，教學制度與人文課程的傳承，以建立良好醫病溝通互動；再依據病人的類型與不同需求，透過垂直整合的醫療模式，從急性治療、復健到社區居家治療等，提供全人照護模式，並依照社區特性深植精神健康營造；另外對於被社會排斥甚或遺忘的一群，亦秉持著尊重，平等的對待方式，創造其恢復健康的契機。因此人文思維是提升照護品質的重要機制與核心價值。在此回顧中，也再度提醒我們，醫療工作是涵化科學與人文，具備真善美精神的一門藝術。
英文摘要

The goal of medical practice is to maintain and enhance the health status of patients. Health is a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity. We must pay more attention to the multiple perspectives of medical services which typically consist of prevention, treatment and rehabilitation aimed at helping people attain the goal of health. The essence of medical service is based on scientific logic, the observation of clinical phenomenon, hypothesis formulation, and the results of research, together forming evidence-based data that can be applied in daily medical treatment. Each patient experiences different subjective suffering and has different psychological impacts when they get ill, so we must provide comprehensive care based on individual needs, not just follow up treatment following a guideline suitable for all people. In addition, we should engage with the therapeutic model in concordance with the philosophy of the humanities to help relieve the distress of these patients. Humane medicine is medical practice providing patient-centered service with an attitude of respect towards different individual values and autonomy. Humanity in medicine rises from interpersonal reciprocity creating a resonance between patient and healer together helping the patient regain health. From the point of view of the humanities, medical practitioners can and should view issues from more than one perspective including from a perspective of self and society. When providing medical care, we must consider what is best for our patients taking into account societal justice and equal and fair treatment. This article reviews the growth history of Tsao-tun Psychiatric Center reflecting the essence of humanity as expressed in medical practice. The realization of medical humanity is achieved from the establishment of healing environment in the hospital, implementation of humanities education courses and training systems, and forming healing relationships between doctor and patient in daily practice. Based on individual needs of patients in different stages, we integrate the psychiatric service vertically to provide care from the acute stage to rehabilitation stage. We also conduct outreach services to establish a continuous care system and whole person care. We extend our service to the community focusing on creative preventive medicine to enhance mental health organically to fit the needs of patients in their respective communities. For the patient who has been rejected by society because of a criminal act, we also respect their vulnerability and strength to provide the service to create the opportunity of recovery of health for them. Finally, medical humanities takes as a core value the enhancement of quality of care and utilized a patient's life experiences as its chief mechanism to satisfy the health needs. In this review of different perspectives towards treatment models, we learn to view medical work as the liberal art of healing science.
主题分类 醫藥衛生 > 預防保健與衛生學
醫藥衛生 > 社會醫學
参考文献
  1. 陳永興：醫學大學教育的反省與改革─從通識教育談起。台灣新聞報，高醫新世紀論壇。2002。Chen YS: Introspection and reform of medical university education-Starting from general education. Taiwan Shin Wen Daily News, the New Century High Medical forum. 2002. [In Chinese]
  2. (2009)。國民健康局九十六年度研究發展計畫「建構健康促進醫院網絡計畫」之健康企進醫院推動手冊。台北=Taipei:行政院衛生署國民健康局=Department of Health National Health Council。
  3. Bond, GR(2004).Supported employment: evidence for an evidencebased practice.Psychiatr Rehabil J,27,345-59.
  4. Branch, WT, Jr(2001).Small-group teaching emphasizing reflection can positively influence medical students' values.Acad Med,76,1171-2.
  5. Caldwell, BA,Fishbein, S,Woods, JD(1994).Development of an academic career ladder program in psychiatric rehabilit-ation: A field initiative.Psychosocial Rehabilitation Journal,18,55-66.
  6. Cappadocia, MC,Weiss, JA(2011).Review of social skills training groups for youth with Asperger syndrome and High functioning Autism.Res Autism Disord,5,70-8.
  7. Catalano, RF,Hawkins, J,Wells, EA,Miller, JL,Brewer, D(1990).Evaluation of the effectiveness of adolescent drug abuse treatment, assessment of risks for relapse, and promising approaches for relapse prevention.Int J Addict,25,1085-140.
  8. Connors, GJ,Maisto, SA,Zywiak, WH(1996).Understanding relapse in the broader context of post-treatment functioning.Addiction,91,S173-89.
  9. DeLeon, G.(ed)(1997).Community as Method.Westport, CT:Praeger.
  10. Engel, GL(1977).The need for a new medical model: A challenge for biomedicine.Science,196,127-36.
  11. Engel, GL(1980).The clinical application of the biopsychosocial model.Am J Psychiatry,137,535-44.
  12. Etheridge, RM,Hubbard, RL,Anderson, J,Craddock, SG,Flynn, PM(1997).Treatment structure and program services in the Drug Abuse Treatment Outcome Study (DATOS).Psychology of Addictive Behaviors,11,244-60.
  13. Evans, HM,Macnaughton, J(2004).Should medical humanities be a multi-disciplinary or an interdisciplinary study?.Med Humanit,30,1-4.
  14. Evans, M(2002).Reflection on the humanities in medical education.Med Educ,36,508-13.
  15. Galassi, Alexandra,Mpofu, Elias,Athanasou, James(2015).The-rapeutic Community Treatment of an Inmate Population with Substance Use Disorders: Post-Release Trends in Re-Arrest, Re-Incarceration, and Drug Misuse Relapse.Int J Environ Res Public Health,12,7059-72.
  16. Gill, KJ,Barrett, NM(2009).Psychiatric Rehabilitation: An Emerging Academic Discipline.Isr J Psychiatry Relat Sci,46,94-102.
  17. Guydish, J,Sorensen, JL,Werdegar, D,Chan, M,Bostron, A,Acampora, A(1999).A randomized trial comparing day and residential drug abuse treatment:18-month outcomes.J Consult Clin Psychol,67,428-34.
  18. Harada, ND,Sofaer, S,Kominski, G(1993).Functional status outcomes in rehabilitation: Implications for prospective payment.Medical Care,31,345-57.
  19. Harris, AH,McKellar, JD,Moos, RH,Schaefer, JA,Cronkite, RC(2006).Predictors of engagement in continuing care following residential substance use disorder treatment.Drug Alcohol Depend,84,93-101.
  20. Kaminer, Y,Burleson, JA,Goldberger, R(2002).Cognitivebehavioral coping skills and psychoeducation therapies for adolescent substance abuse.J Nerv Ment Dis,190,737-45.
  21. Karle, H(2008).World Federation for Medical Education Policy on international recognition of medical school's programme.Ann Acad Med Singapore,37,1041-3.
  22. Kligler, B,Maizes, V,Schachter, S(2004).Core competencies in integrative. medicine for medical school curricula: a proposal.Acad Med,79,521-31.
  23. Koenig, K,De Los Reyes, A,Cicchetti, D,Scahill, L,Klin, A(2009).Group intervention to promote social skills in school-age children with pervasive developmental disorders: Reconsidering efficacy.J Autism Dev Disord,39,1163-72.
  24. Laugeson, EA,Frankel, F,Gantman, A,Dillon, AR,Mogil, C(2012).Evidence-based social skills training for adolescents with autism spectrum disorders: The UCLA PEERS program.J Autism Dev Disord,42,1025-36.
  25. Laushey, KM,Heflin, LJ(2000).Enhancing social skills of kindergarten children with autism through the training of multiple peers as tutors.J Autism Dev Disord,30,183-93.
  26. Macnaughton, J(2000).The humanities in medical education: context, outcomes and structures.Med Humanit,26,23-30.
  27. Malkin, J(1993).Hospital interior architecture: Creating healing environments for special patient populations.New England Journal of Medicine,328,894-5.
  28. McCullough, C.(Ed)(2001).Evidence Based Design for Healthcare Facility.Sigma Theta Tau International Honor Society of Nursing.
  29. McGillicuddy, NB,Rychtarik, RG,Papandonatos, GD(2015).Skill training versus 12-step facilitation for parents of substanceabusing teens.J Subst Abuse Treat,50,11-17.
  30. Moos, RH,Finney, JW,Moos, BS(2000).Inpatient substance abuse care and the outcome of subsequent community residential and outpatient care.Addiction,95,833-46.
  31. Simpson, DD,Joe, GW,Brown, BS(1997).Treatment retention and follow-up outcomes in the Drug Abuse Treatment Outcome Study (DATOS).Psychology of Addictive Behaviors,11,294-307.
  32. Stewart, M(2001).Toward a global definition of patient centred care.BMJ,322,444-5.
  33. Ulrich, RS(2000).Effects of healthcare environmental design on medical outcomes.Design & Health World Congress & Exhibition (WCDH 2000),Stockholm:
  34. Ulrich, RS(1991).Effects of interior design on wellness: theory and recent scientific research.Journal of Health Care Interior Design,3,97-109.
  35. Warner, Richard(2013).Recovery from Schizophrenia: Psychiatry and Political Economy.Routledge.
  36. 王慧卿、劉炎秋、黃秋慧、翁慧卿(2012)。南部某醫學中心員工高血壓、高血脂及高血糖之相關性分析。中華職業醫學雜誌，19，39-48。
  37. 吳健暉、徐歆惠、何明蓉(2008)。臺灣醫學人文課程現況研究：開課調查與學生訪談。醫學教育，12，107-17。
  38. 吳培君、林育璿、許容凰(2013)。某精神專科醫院職能治療服務品質系統之建立。醫學與健康，2，63-79。
  39. 李宇宙(2002)。醫學人文教育經驗。陽明大學醫學人文課程規劃研討會
  40. 李明濱(2009)。再談醫療核心價值三不變：人文關懷、專業創新與醫療品質。臺灣醫界，52，5-6。
  41. 李慧玲、程秀娥(2013)。某精神專科醫院慢性精神病友工作訓練產值之世代研究。103年第三屆全人醫療暨整合服務研討會
  42. 胡蓮珍、袁素娟、葉必明(2005)。中部某區域醫院員工之健康體適能概況。長庚護理，16，243-51。
  43. 范珈維、張彧、潘璦琬(2007)。精神障礙者重返工作之因素探討：文獻回顧。臺灣職能治療研究與實務雜誌，3，61-71。
  44. 馮世祥、羅慶徽、陳宏一(2007)。某醫學中心員工代謝症候群盛行率與影響因子初探。中華職業醫學雜誌，14，141-7。
  45. 黃崑巖(2003)。醫學教育白皮書─台灣醫學教育之改進方向。臺北=Taipei:教育部醫學教育委員會=The Ministry of Education of Medical Education Committee。
  46. 黃崑巖(1996)。把「人」帶回醫學—論醫學院的通識教育。通識教育，3，1-16。
  47. 楊明仁、蔡瑞熊(1997)。從社會與教育制度看臺灣醫師人才的培養。醫學教育，1，21-8。
  48. 劉璧華、李慧玲(2013)。慢性精神病人工作能力進階之成效。第十一屆臺灣心理治療與心理衛生聯合會
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