傳統上，「困難病人」常被視為溝通挑戰的來源，然而，近年來的研究強調，許多溝通困境源自醫病雙方的期望、認知與價值觀落差。本篇將探討醫病溝通的核心議題，並分析市場化對醫病關係與醫療專業性的影響。醫病溝通不僅涉及資訊傳遞，更是一種高度情緒化且包含倫理決策的互動過程。此外，市場化趨勢下，醫療機構雖日益重視病人滿意度，但將醫療行為簡化為服務業可能導致醫病衝突增長，甚或影響醫療專業判斷與資源的合理配置。醫療行為不同於一般市場交易，其核心應建立於實證醫學與專業倫理，而非完全以病人需求為導向。因此，醫療人員應在展現同理心的同時，維持專業界線，以確保臨床決策的科學性與醫病關係的穩定。本篇再進一步探討如何在醫學教育與臨床實務中，幫助醫療人員在關懷病人的同時避免過度情感負擔，減少職業倦怠，並發展適當的應對策略，以提升醫療服務品質，尤其是在面對高齡患者時的溝通與照護。未來應透過更多本土化的實證研究，深入探討醫病溝通在不同臨床情境下的挑戰與解方，期能協助醫療人員在專業自主性與病人需求之間取得適切平衡，最終達成以病人為中心的全人醫療目標。
(台灣家醫誌2025; 35: 143-150) DOI: 10.53106/168232812025093503001

關鍵詞：醫病溝通、共享決策、困難互動、醫療市場化、專業信任

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¹國防醫學大學三軍總醫院家庭暨社區醫學部家庭醫學科
²國防醫學大學醫學院醫學系
³國防醫學大學源遠書苑
受理日期：114年2月5日 修改日期：114年4月3日 同意刊登：114年4月21日
^*通訊作者：王志嘉 通訊地址：台北市內湖區成功路二段325號國防醫學大學三軍總醫院家庭暨社區醫學部
E-mail：tsghccwang@gmail.com

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Professional Autonomy amid Healthcare Marketization: Navigating Empathy and Boundaries in Doctor-Patient Relationships
 
Daphne Yih Ng^1,2 and Chih-Chia Wang^1,2,3*
 

Traditionally, "difficult patients" have often been blamed for presenting particular challenges in medical communication. However, growing evidence suggests that many such difficulties stem from discrepancies in expectations, perceptions, and values between healthcare professionals and patients. This paper explores the core issues of doctor-patient communication and analyze how healthcare marketization impacts physicians’ professional autonomy and their relationship with patients. Communication in healthcare involves not only information transmission but also emotionally charged and ethically complex interactions. While the trend of marketization has prompted healthcare institutions to emphasize patient satisfaction, reducing healthcare into a service business risks exacerbating doctor-patient conflicts and compromising professional judgment and the rational allocation of medical resources. Medical practice differs fundamentally from general market transactions in that it is grounded in evidence-based medicine and professional ethics, rather than solely driven by patient/customer demands. In this context, healthcare professionals must balance empathy with professional boundaries to ensure both the scientific integrity of clinical decisions and the stability of the doctor-patient relationships. This paper further examines how medical education and clinical practice can support professionals in delivering compassionate care while avoiding emotional overload, preventing burnout, and developing sustainable coping strategies to enhance the overall quality of healthcare services, particularly in the communication with and care of older adults. Future research should prioritize more localized empirical studies to delve into communication challenges and solutions across diverse clinical settings, enabling healthcare professionals to achieve a workable balance between professional autonomy and patient needs, ultimately advancing patient-centered, holistic care.
(Taiwan J Fam Med 2025; 35: 143-150) DOI: 10.53106/168232812025093503001

Key words: challenging interactions, doctor-patient communication, medical marketization, professional trust, shared decision-making (SDM)
 

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¹Division of Family Medicine, Department of Family and Community Medicine, Tri-Service General Hospital,
National Defense Medical University, Taipei, Taiwan.
²School of Medicine, College of Medicine, National Defense Medical University, Taipei, Taiwan.
³Yuanyuan Liberal Arts College, National Defense Medical University, Taipei, Taiwan.
Received: February 5, 2025; Revised: April 3, 2025; Accepted: April 21, 2025.
^*Corresponding author