Korean J Med Educ 2008, Vol. 20, No. 4: 321-331 DOI: 10.3946/kjme.2008.20.4.321 Original Article 환자의사회적유형에따른환자만족도, 치료순응도, 그리고의사의의사소통유형지각차이 부산대학교의학전문대학원인문사회의학실, 의료최고경영자과정 1, 예방의학교실 2, 진단검사의학교실 3 의학교육실 4, 고려대학교의과대학재활의학교실 5, 의학교육학교실 6 김성수 조덕영 1 박병규 5 황인경 2 장철훈 3 이영미 6 윤소정 4 Differences in Patients Awareness of Doctors Communication Styles, Patients Satisfaction, and Patients Compliance among Patient Social Styles Sung Soo Kim, Duk Young Cho 1, Byung Kyu Park 5, Hwang In Kyung 2, Chulhun L. Chang 3, Young-Mee Lee 6 and So Jung Yune 4 Departmetnts of Social Studies of Medicine, Medical Management 1, Preventive Medicine 2, Laboratory Medicine 3, Medical Education 4, Pusan National University College of Medicine, Busan, Departments of Physical Medicine & Rehabilitation 5, Medical Education 6, Korea University College of Medicine, Seoul, Korea Purpose: It has been well known that doctor-patient communication is a key to the better doctor-patient relationship. However, in Korea, there has not been much researches on the causal factors influencing the doctor-patient communication as well as on patient satisfaction and compliance. This study attempts to investigate the relationships between patient social styles and doctors' communication styles as well as patient outcomes. Methods: Patient subjects were recruited from two mid-size local hospitals. The questionnaires consist of social styles, patient-perceived doctors' communication, and patient satisfaction/compliance measures. One hundred ninety useable data were analyzed. Results: For those highly satisfied patients, patients with analytic style showed the highest percentage of viewing their doctors as highly empathic. On the other hand, for those patients with high compliance, expressive style patients showed the highest rates of regarding their doctors as highly affective. And amiable style patients are most likely to view their doctors as highly cognitive. For analytic style patients, cognitive had positive effects on patient satisfaction. For amiable style patients, doctors' cognitive had positive influence on patient compliance. For expressive style patients, doctors' affective empathic communication had positive effects on both patient satisfaction/compliance while cognitive had positive effects only on patient compliance. Conclusion: The results show that the different social styles of patients might influence on the fact how the patients perceive their doctors' communication as well as how much they are satisfied and compliant. Thus, when we as an medical educators need to realize the importance of this mechanism and bring this learning into classrooms. Key Words: Communication, Physician-patient relations, Patient satisfaction, Patient compliance Received: July 9, 2008 Accepted: October 7, 2008 Corresponding Author: Sung Soo Kim tigerkss@pnu.edu - 321 -
Korean J Med Educ Vol. 20, No. 4: 321-331, December 2008 서 론 순응도에영향을미치는변인을살펴보고자한다. 의료의질은의사소통기술에많은부분의존하고있으며, 환자는의사의임상적능력에불만을갖기보다는의사의의사소통기술부족에불만을갖는경우가많다 (Richards, 1990). 효과적인환자-의사간의의사소통은환자의만족도와치료순응도를높이는주요한요인이며 (Simpson et al., 1991), 의사가갖추어야할직업전문성중한부분으로간주되고있다 (Audit Commission, 1993; General Medical Council, 1993; Department of Health, 1995; Royal College of Physicians of London, 1997; Meryn, 1998). 특히의사의공감적의사소통능력은환자의만족도와순응도에큰영향을미친다고알려져있다 (DiMatteo & Hays, 1980; DiMatteo et al., 1980; Linn & Wilson, 1980; Linder- Pelz, 1982; Hojat et al., 2002). 국내에서도의사의의사소통능력을증진시키기위한노력들이계속되어왔으나 (Kim et al., 2002; Choi et al., 2004; Kim et al., 2006; Lee et al., 2007), 환자변인을중심으로의사의의사소통능력에영향을미치는요인을분석하는연구는부족하다. 의사환자간의의사소통은의사의의사소통유형, 환자의의사소통유형과인구학적인특성, 그리고의사환자간의조화등에의해영향을받으므로환자변인을중심으로의사소통에대한연구가활발히이루어져야할것이다 (Street et al., 2007). 진료실에서환자가의료면담에임하는태도는환자의사회적유형에따라다르고, 이는환자-의사관계형성에영향을미치게된다는면에서, 의사가환자의사회적유형에따라적절하게대처할수있는방법이연구되어야할것이다. 따라서이연구에서는 1 Merrill과 Reid의사회적유형 (social styles) 을이용하여, 환자를의사소통유형별로주도형 (Driver), 표현형 (Expressive), 우호형 (Amiable), 그리고분석형 (Analytic) 으로나누고 (Fig. 1), 2 환자의의사소통유형별로환자가인식하는의사의공감적의사소통능력, 환자만족도, 그리고치료순응도의차이를비교하고, 3 의사소통유형별환자의만족도와치료 대상및방법 1. 대상 1개광역시에소재하고있는 2개의이차병원의외래환자들을대상으로설문조사를실시하였다. 설문조사를위해서조사원 3명을선발하여설문조사방법에대해교육한후각병원외래에방문하여환자들에게설문지를배포하고설명하게하였다. 설문응답지는 212부가수거되었는데그중분석이가능한자료는 190부였다. 환자의의사소통유형에따른환자만족도, 치료순응도, 그리고환자유형별로의사의의사소통유형을어떻게지각하고있는지그차이를알아보았다. 연구대상은남자가 54명, 여자가 136명이었고, 평균연령은 39.0세이었다. 평균교육수준은고등학교졸업이었고가구당월평균수입은약 200~300만원이었다. 사회적유형별로환자를분류한결과는 Table 1에제시된바와같이, 우호형 (n=81, 42.63%) 이가장많았으며, 다음으로분석형 (n=54, 28.42%), 표현형 (n=40, 21.05%), 그리고주도형 (n=15, 7.90%) 의순이었다. 2. 연구도구연구도구로는환자의성별, 연령, 교육수준, 가구당월평균수입, 초진시의사선택이유와재진희망여부및재진희망이유등을묻는문항들과함께, 환자의의사소통유형검사항목 (social style inventory) (Merrill & Reid, 1991), 그리고환자가인식한의사의공감능력척도 (patients' perceived physician measure, PPEM) (Kim et al., 2004) 로구성되었다. 본연구에서사용된의사의공감척도의신뢰도 (Cronbach α) 는하위영역별로인지적공감.81, 정서적공감.82였으며, 전체신뢰도는.88이었다. 3. 자료분석환자유형별분포를알아보기위하여빈도분석을 - 322 -
Sung Soo Kim, et al: Patient Social Styles and Doctors Communication Styles Task Focus: Doing and Thinking Less responsive Controls emotions Analytical Patient Task-oriented Prefers to work alone Slow response: accuracy important Likes to organize, solve puzzles Likes details, Precise measuring Relationships are a lower priority Past-oriented: likes tradition Dislikes change: prefers stability Avoids conflict Driving Patient Task-oriented Likes to be in control Rapid response: quick decisions Prefers immediate, direct action Wants bottom-line results ASAP! Not tactful in relationships Present-or future-oriented Seeks to manage change More authoritarian under stress Amiable Patient Relationship-oriented Likes to be member of a group Slower response; wants to please Loyal, supportive, empathic Senses others' needs and concerns Good at one-on-one relationship Focus on the prefers Avoids change: prefers the familiar Avoids conflict Expressive Patient Relationship-oriented Likes to stand out in a group Rapid, unique response: impulsive Verbal, humorous, creative Dislikes dullness or routine Motivating and persuasive Future focus, visionary Enjoys change: sees opportunity Uses personal attack in conflict Relationship Focus: Relating and Feeling More responsive Emotes Fig. 1. The four basic social styles of patients (Reid & Merrill, 1981). Table 1. The Pattern of the Patients' Social Style Social styles n(%) Analytical 54 (28.42) Driver 15 (7.90) Amiable 81 (42.63) Expressive 40 (21.05) Total 190 (100.00) 실시하였으며, 환자유형별로동일한의사에게재진을받고자하는이유를교차분석으로알아보았다. 이때환자유형별사례수가적어결과를일반화하기에어려움이있다는점을감안하여, 비모수적방법인 Fisher exact test를실시하였다. 환자의유형별로환자가인식한의사의공감적의사소통능력과환자만족도, 그리고치료순응도차이는일변량분석 (one-way ANOVA) 을통해알아보았다. 보다구 - 323 -
Korean J Med Educ Vol. 20, No. 4: 321-331, December 2008 Table 2. Reasons for Revisiting the Same Doctor n (%) Doctor reputation Equipped with advanced medical devices Close to home Kind explanation Others' recommendations Etc. Total χ 2a) Analytical 7 (14.53) 2 (4.17) 7 (14.58) 20 (41.67) 2 (4.17) 10 (20.83) 48 (100.00) Driver 2 (16.67) - 4 (33.33) 4 (33.33) - 2 (16.67) 12 (100.00) Amiable 8 (10.81) - 18 (24.32) 40 (54.05) 2 (2.70) 6 (8.11) 74 (100.00) Expressive 3 (8.33) - 5 (13.89) 22 (61.11) - 6 (16.67) 36 (100.00) Total 20 (11.76) 2 (1.18) 34 (20.0) 86 (50.59) 4 (2.35) 24 (14.12) 170 (100.00) a) χ 2 by Fisher exact test. 17.12 (p=.31) 체적으로환자만족도검사점수의상위 30% 에해당하는집단을고만족도환자집단으로하고, 치료순응도검사점수의상위 30% 에해당하는집단을고치료순응도환자집단으로분류하여, 각집단내환자유형분포를교차분석으로분석하였다. 그리고환자의만족도와순응도에영향을미치는요인을알아보기위하여, Pearson 상관분석과입력식 (Enter) 중다회귀분석을사용하였다. 통계분석은 SPSS 12.0 프로그램을사용하였으며, 분석결과의통계적유의성은유의수준 5% 미만으로정하였다. 결과 1. 환자유형별로동일한의사에게재진을받고자하는이유동일한의사에게재진을받고자하는이유에대해연구대상이되었던환자들중 50.59% 는의사가친절하게설명을잘해주기때문이라고답했다 (Table 2). 이는다른재진이유인의사의평판 (11.76%), 최신의료기기 (1.18%), 집에서가까움 (20.0%) 에비해유의하게높은비율이었다. 의사의친절한설명으로재진을선택한다고응답한경우를환자유형별로비교하면, 분석형 41.67%, 주도형 33.33%, 우호형 54.05%, 표현형 61.11% 로유형별차이는유의하지않았다 (χ 2 =17.12, p=.31). 2. 환자가인식한의사의공감적의사소통능력, 환자만족도, 그리고치료순응도의환자유형별차이 Table 3에서보는바와같이, 환자가인식한의사의정서적공감적의사소통능력 (F=.68, p=.57) 과인지적공감적의사소통능력에서는환자유형별로유의한차이가나타나지않았다 (F=.83, p=.48). 또한환자의유형별환자만족도에있어서도유의한차이가나타나지않았다 (F=1.83, p=.14). 그러나환자순응도에있어서는환자유형별로의미있는차이가나타났다 (F=2.67, p=.04). 환자순응도에대한환자유형별사후분석결과분석형, 우호형, 그리고표현형그룹과주도형간에의미있는차이가있는것으로나타났다. 주도형 (M=7.07, SD=1.39) 의치료순응도가분석형 (M=8.00, SD=1.15), 우호형 (M=7.86, SD=1.20), 표현형 (M=7.73, SD=.99) 에비해유의하게낮았다. 1) 유형별환자만족도와치료순응도환자유형별로보이는만족도와치료순응도를보다구체적으로분석하기위하여, 환자만족도및치료순응도의총점에서상위 30% 에해당하는점수를받은환자들을각각고만족도환자집단과고치료순응도환자집단으로나누고각집단내환자의사회적유형별빈도를조사하였다. - 324 -
Sung Soo Kim, et al: Patient Social Styles and Doctors Communication Styles Table 3. Differences in Patients' Awareness of Doctors' Communication Styles, Patients' Satisfaction / Compliance among Patient Social Styles M (SD) n Affective Cognitive Patients' satisfaction Patients' compliance M(SD) Scheffe 1. Analytical 2. Driver 3. Amiable 4. Expressive Total 54 15 81 40 190 25.61 (4.19) 24.20 (4.18) 24.98 (3.76) 25.33 (2.86) 25.17 (3.75) 11.94 (2.01) 11.20 (2.14) 11.93 (1.53) 11.90 (1.41) 11.87 (1.71) 21.56 (3.01) 19.93 (3.53) 22.42 (5.13) 21.56 (2.51) 21.80 (4.05) 8.00 (1.15) 7.07 (1.39) 7.86 (1.20) 7.73 (.99) 7.81 (.99) 1-3-4, 2 F=.68 F=.83 F=1.83 F=2.67 a) a) p<.05. Table 4. Patient Satisfaction/Compliance by Patient Social Styles n (%) Social styles Patients with high satisfaction Patients with high compliance Analytical Driver Amiable Expressive Total 16 (30.77) 4 (7.69) 21 (40.38) 11 (21.15) 52 (100.00) 43 (32.58) 8 (6.06) 56 (42.42) 25 (18.94) 132 (100.00) χ 2a) 12.15 b) 39.94 c) a) χ 2 by Fisher exact test, b) p<.01, c) p<.001. Table 4에서와같이, 고만족도환자집단에서는환자유형별로분포의차이를보였다 (χ 2 =12.15, p=.007). 고만족도환자집단중에서는우호형의빈도가전체 56명중 21명으로 37.50% 로가장높았고, 다음이분석형 (n=16, 28.57%), 표현형 (n=10, 17.86%), 그리고주도형 (n=9, 16.07%) 의순서로나타났다. 또한고치료순응도환자집단에있어서도유형별로유의한차이를보였으며 (χ 2 =39.94, p=.000), 우호형 (n=56, 42.42%), 분석형 (n=43, 32.58%), 표현형 (n= 25, 19.94%), 그리고주도형 (n=9, 6.82%) 순의빈도로나타났다. 3. 환자의만족도와순응도에영향을미치는요인 1) 환자만족도, 치료순응도, 환자가인식한의사의공감적의사소통능력, 그리고환자특성간의상관환자가인식한의사의정서적공감능력과환자만 족도간에는유의한정적상관관계가나타났으며 (r=.53, p<.01), 환자의순응도와의사의정서적공감능력과의관계에서도정적상관관계가나타났다 (r=.45, p<.01). 즉환자가의사의정서적공감능력을높게인식하면할수록, 환자의만족도는높을수있으며, 의사의처방지시를잘따를수있는것으로나타났다. 의사의인지적공감능력의경우에도환자의만족도 (r=.52, p<.01) 및환자의순응도 (r=.44, p<.01) 와모두유의한상관관계를보였다. 즉환자가의사의인지적공감능력을높이평가할수록환자의만족도와순응도는높아질수있다. 또한환자의만족도와환자의순응도사이에유의한상관관계가있으므로 (r=.38, p<.01), 환자의만족도가환자의처방지시이행에긍정적인영향을줄수있다고볼수있다 (Table 5). - 325 -
Korean J Med Educ Vol. 20, No. 4: 321-331, December 2008 Table 5. Correlation among Patient Satisfaction/Compliance, Patients' Awareness of Doctors' Communication Styles, and Characteristics of Patients Variables Satisfaction Compliance Gender Age Education Income Affective Cognitive Gender Age Education Income Compliance.53 b).52 b) -.17 a).18 a) -.15 a) -.18 a).38 b).45 b).44 b) -.09.17 a).09 -.05 - -.14 -.12 -.04 -.02.02 -.09.22 b).12.04 - -.15 a) -.15 a).17 a) -.05 -.09 -.01 -.15 a) -.15v.39 b).09 -.08 -.54.02 -.15 a).39 b) - -.05 a) p<0.05, b) p<0.01. 2) 환자유형별만족도와순응도에영향을미치는요인환자유형별로만족도와순응도에영향을미치는요인을알아보기위하여만족도와순응도각각을종속변인으로하는입력식중다회귀분석을실시하였다. 환자유형중주도형은사례의수가적어분석에서제외하였다. a. 분석형환자가인식한의사의인지적공감능력과정서적공감능력, 그리고환자의성별, 연령, 교육, 수입은환자의만족도를 67% 설명하는것으로나타났으며 (R 2 =.67, AdjustedR 2 =.63, p<.001), 치료순응도는 29% 설명할수있는것으로나타났다 (R 2 =.29, AdjustedR 2 =.19, p<.05). 그중의사의인지적공감능력 (β=.60, t=3.80, p<.001) 과수입 (β=-.28, t=-2.66, p<.05) 은환자만족도에유의한영향을미치며, 환자의만족도는환자의치료순응도에유의한영향을주는변인으로나타났다 (β=.56, t=2.60, p<.05) (Table 6). 즉, 분석형의환자만족도와치료순응도에대한회귀모형의요약은다음과같다. 환자만족도 =8.04+0.13*[ 정서적공감 ]+0.90*[ 인지적공감 ]-0.31*[ 성별 ]+0.01*[ 나이 ]+0.36*[ 교육수준 ]-0.62*[ 수입 ] 치료순응도 =4.10-0.05*[ 정서적공감 ]+0.02*[ 인지적공감 ]-0.49*[ 성별 ]+0.01*[ 나이 ]-0.00*[ 교육수준 ]-0.16*[ 수입 ]+ 0.22*[ 환자만족도 ] b. 우호형우호형의경우환자가인식한의사의인지적 정서적공감능력과환자의성별, 연령, 교육, 수입은환자의환자만족도 (R 2 =.27, AdjustedR 2 =.21, p<.01) 와치료순응도 (R 2 =.42, AdjustedR 2 =.36, p<.001) 에유의한영향을주는것으로나타났으며, 각각 27%, 42% 의설명력을보였다. 환자의만족도에유의한영향을주는변인은밝혀지지않았으나, 의사의인지적공감능력은환자의순응도에영향을미치는것으로나타났다 (β=.52, t=3.80, p<.001) (Table 6). 우호형의환자만족도와치료순응도에대한회귀모형의요약은다음과같다. 환자만족도 =8.24+0.36*[ 정서적공감 ]+0.59*[ 인지적공감 ]-2.48*[ 성별 ]+0.06*[ 나이 ]-0.04*[ 교육수준 ]-0.03*[ 수입 ] 치료순응도 =1.40+0.25*[ 정서적공감 ]+0.41*[ 인지적공감 ]+0.03*[ 성별 ]+0.01*[ 나이 ] + 0.01*[ 교육수준 ] + 0.00*[ 수입 ]+0.02*[ 환자만족도 ] c. 표현형환자가인식한의사의인지적 정서적공감능력, 그리고환자의성별, 연령, 교육, 수입은환자의만족도 (R 2 =.66, AdjustedR 2 =.59, p<.001) 와치료순응도 (R 2 =.40, AdjustedR 2 =.26, p<.05) 에유의한영향을주는것으로나타났으며, 의사의정서적공감능력 (β= - 326 -
Sung Soo Kim, et al: Patient Social Styles and Doctors Communication Styles Table 6. Factors Influencing Patients' Satisfaction and Compliance by Patient Social Styles Predictors Patient satisfaction Patient compliance B β t AdjustedR 2 F B β t AdjustedR 2 F Affective.13.18 1.11 -.05 -.19 -.78 Cognitive.90.60 3.80 c).02.03.11 Gender -.31 -.05 -.48.63 16.19 c) -.49 -.19-1.36 Age.01.04.51.01.08.65.19 2.73 a) Education.36.15 1.40 -.00 -.00 -.01 Income -.62 -.28-2.66 a).16.19 1.11 Patient satisfaction - - - - -.22.56 2.60 a) B β t AdjustedR 2 F B β t AdjustedR 2 F Affective.36.26 1.71.03.08.56 Cognitive.59.18 1.16.41 b).52 3.80 c) Gender -2.48 -.21-1.97.21 b) 4.58.03.01.10 Age.06.15 1.36.01.14 1.41.36 7.47 c) Education -.64 -.14-1.24.01.01.12 Income -.03.01 -.05.00.00.01 Patient satisfaction - - - - -.18.08.74 B β t AdjustedR 2 F B β t AdjustedR 2 F Affective.30.35 2.55 a).15.43 2.16 a) Cognitive.99.57 4.20 c).00.00.02 Gender -.41 -.08 -.72.59 10.13 c).15.07.49 Age -.02 -.11-1.00 -.00 -.03 -.19 Education.25.13 1.15.33.43 2.83 b) Income.06.04.32.01.14.10 Patient satisfaction.04.10.43 a) p<.05, b) p<.01, c) p<.001..26 2.93 a).35, t=2.55, p<.05) 과인지적공감능력 (β=.57, t=4.20, p<.001) 이모두환자의만족도에유의한영향을주는것으로나타났다. 그리고정서적공감능력 (β=.43, t=2.16, p<.05) 과교육수준 (β=.43, t= 2.83, p<.01) 이환자의순응도에유의한영향을미치는것으로나타났다 (Table 6). 회귀모형에대한요약은다음과같다. 환자만족도 =2.16+0.30*[ 정서적공감 ]+0.99*[ 인지 - 327 -
Korean J Med Educ Vol. 20, No. 4: 321-331, December 2008 적공감 ]-0.41*[ 성별 ]-0.02*[ 나이 ]+ 0.25*[ 교육수준 ]+0.06*[ 수입 ] 치료순응도 =1.96+0.15*[ 정서적공감 ]+0.00*[ 인지적공감 ]+0.15*[ 성별 ]-0.00*[ 나이 ]+ 0.33*[ 교육수준 ]+0.01*[ 수입 ]+0.04* [ 환자만족도 ] 고찰환자의의사소통유형을이해하는것은의료면담을보다효과적으로진행하는데도움이될수있다. 의사와환자의의사소통유형이서로유사하거나조화를이룰때환자만족도는더욱증가하며, 환자의성격이나성향은의사의환자중심상호작용에결정적인역할을하게된다 (Aita et al., 2004). 효율적으로대화하기위해서는환자의특성에맞게적응하려는노력이필요하며, 이러한적응적행동은의사와환자의입장차이에서비롯되는오해를극복하는데도움을줄수있다 (Sherman, 1981; Yeakley, 1983; Carey et al., 1985; Marioles et al., 1993; Allen & Brock, 2000). 따라서환자의유형을이해하고이에맞는적응적행동지침을개발하여적용하는것은효과적인대화를위해필수적이라고할수있다. 환자의의사소통유형을구분하는방법으로 Merrill과 Reid의사회적유형 (social styles) 이있다 (Merrill & Reid, 1991). 사회적유형은 상대방과상호작용하면서보이는행동 으로, 개인의신념이나가치등을표현하는방식을말하며, 각개인의유형을주도형 (Driver), 표현형 (Expressive), 우호형 (Amiable), 그리고분석형 (Analytic) 으로나눈다 (Fig. 1). 이러한분류는어느유형이더좋고나쁜지를설명하는것이아니라, 유형별로특성이다르며나름의강점과약점을가진다는것이다. 유형이무엇인가보다는그유형을어떻게사용할것인가가더중요하므로각유형에서보이는일련의동에만고착되어서는안될것이다. 따라서자신의유형과는관계없이다양한상황이나대화상대에맞추는사회적행동방식을취하는것이중요하다. 환자의사회적유형은의료면담상황에서환자가보이는말투나행동특성을토대로확인할수있는데, 사람의행동을속도 (pace) 와중심 (focus) 의차원으로나누어분석할수있다. 속도란사람들이얼마나빨리말하는가, 어떻게언어를사용하는가, 신체언어의양은어느정도인가, 대화중에끼어들기를좋아하는가, 신체언어사용등의전체적인움직임은어느정도인가를의미한다. 이러한속도는주장적행동과직접적인관계가있다. 즉, 말하는속도가빠른 (rapid pace) 사람은자기주장이강하며, 묻기보다는말하기를선호한다. 일정하게말하는속도를유지하는사람 (measured pace) 은말하기보다는질문하는것을좋아한다. 중심은한사람이갖는흥미의초점을의미하며과업중심 (task focused) 과사람중심 (people focused) 으로구분할수있다. 과업중심인사람은자신의정서를통제하고자하는경향이있으며, 성취에우선권을둔다. 반면, 사람중심의사람은정서를표현하고자하는경향이있으며, 수용에더높은우선권을둔다. 환자의유형은두차원에서나타나는주된행동으로분석형, 주도형, 우호형, 그리고표현형으로나눌수있다. 연구의대상이되었던환자들은우호형이가장많았으며다음으로분석형, 표현형, 그리고주도형의순으로나타났다. 그러나유형에관계없이같은의사에게재진을선택하게되는이유로가장많은것은의사의친절한설명으로응답자의 50% 이상을차지하며다른이유 ( 의사의평판, 최신의료기기, 가까운거리 ) 에비해그빈도가월등히높았다. 이러한결과를통하여, 대다수환자들의재진결정은의사가어떻게환자에대한의료정보를전달하는가에따라달라질수있다고할수있다. 또한, 환자들은단순하게많은정보를제공하는의사보다는공감적이고친절하게설명하는의사를더원한다고볼수있다. 환자의유형별로치료순응도에는차이를보였으며환자가느끼는만족도가환자의처방지시이행에긍정적인영향을주고있었다. 유형별로만족도와순응도에영향을미치는요인을분석한결과분석형의환자는의사의인지적공감능력이높다고생각될때만족도가높고환자자 - 328 -
Sung Soo Kim, et al: Patient Social Styles and Doctors Communication Styles 신의수입이높은경우에는만족도가떨어지는것으로나타났다. 그리고만족도가치료순응도에미치는영향이큰것으로나타났으며, 다른유형들에비해분석형에서만족도와치료순응도가높은환자가많았다. 분석형의환자는과제지향적이며주장이적은유형으로다소수동적인성향을가진다. 정확하고꼼꼼하게자신의건강상의문제에대한정보를모으는것을중요하게여긴다. 따라서의사의인지적공감능력이환자의만족도에미치는영향은이러한맥락에서이해가가능하며, 만족도가높을수록순응도또한높을수있다. 그러나수입이만족도에미치는부적인영향관계에대해서는추후심층적연구가필요할것으로생각된다. 분석형의환자는말을천천히하고, 제스츄어가거의없으며정확하게자신의의견을표현하는특성이있다. 그리고병에대한자신의느낌이나두려움보다는사실과정보에입각한증상을이야기한다는면에서분석형환자를구별해낼수있다. 이러한분석형환자를위해서는타임테이블과같은치료계획표를제시하거나발병률이나치료율등과같은구체적인설명을해주는것이좋다. 그리고단정하고깔끔한인상을주는것이의사소통을증진시키는데도움이될것이다. 우호형환자의경우에는인지적공감이환자의치료순응도에영향을미치는주요한요인으로밝혀졌다. 따라서인지적으로공감받고있다고느낀다면우호형은치료에잘순응할수있다는것을알수있다. 우호형은자기주장이적고관계와감정을중시하는유형으로, 서두르거나급하게말하지않고따뜻하고다정한대화를나누기를좋아한다. 사람의감정이나느낌에민감하여, 대화를나누는중간중간에미소를짓거나고개를끄덕이는등의표정과행동을보이곤하는것으로쉽게구별될수있다. 우호형환자에게는그들의사소한이야기를잘들어주는것만으로도쉽게대화를나눌수있다. 그리고어떻게생각하는가를묻기보다는어떤느낌인지를묻는것이좋으며, 환자의이야기를들어주는것이좋다. 그리고무엇보다인지적인공감이중요하다는 것을본연구결과를통해알수있다. 표현형의환자는의사의정서적공감과인지적공감의사소통능력에따라만족도에영향을받으며, 만족하는것과는상관없이의사의정서적공감과자신의교육수준에따라치료순응도가달라지는것으로나타났다. 표현형은말이빠르고, 목소리가크며, 말이많고제스처가풍부한스타일로, 장신구를많이착용하거나밝은색의두드러진의상을입는것을즐긴다. 이들은관심받는것을즐기며, 사람들과이야기하고즐기는것을좋아한다. 따라서의사의공감이표현형환자의만족도에영향을미친다는것은당연한일이다. 그러나인지적공감보다는정서적공감이환자의순응도에더많은영향을미친다는면에서사실적이기보다는정서적인부분에서보다많은영향을받는다는것을알수있다. 또한환자의교육수준이높을수록환자의순응도가높은것으로나타나표현형이치료에순응하기위해서는개인의지적수준에의존한자기통제가필요하다는것을알수있다. 이러한표현형의환자를위해서는환자를적절한이름이나직함을불러주는것을통해자신을기억하고있음을인식시켜주고, 진료예약날짜를미리재인식시켜주는것이도움이된다. 또한시각적인자료를통해병을설명해주거나, 반드시약을챙겨먹을수있도록하루단위의약을보관하는통을주거나하루에한번만먹을수있도록약을처방하는것도도움이될수있다. 이상과같이환자의선호나요구를어느정도이해하는가에따라의사의환자중심행동은달라질수있으며 (Swenson et al., 2004), 환자의성격적특성과의사의환자중심행동은의미있는관계에있다 (Zandbelta et al., 2006). 이러한면에서환자의사회적유형을파악하는것은환자가의사소통시에보이는행동패턴으로환자를쉽게이해하고, 환자가원하는방식으로의사소통할수있도록해준다는점에서유용한구인임을알수있다. 그러나환자의유형에적합한대화를위해의사가자신의성격을바꾸거나변화시켜야함을의미하는것은아니며, 환자가이해하기쉽고편안함을느낄 - 329 -
Korean J Med Educ Vol. 20, No. 4: 321-331, December 2008 수있도록다양한유형의특성을이해하고그에맞는대화법을익히고활용하는것이중요하다. 이는특히의료면담법교육을시행하는데있어시사점이크다. 즉, 무조건적인공감적기술을강조하기보다는환자의행동특징으로유형을파악하는방법을이해시키고, 이후에각환자의유형에맞는의료면담기법을사용할수있도록한다면, 더욱체계적이고효과적인의료면담법교육이될수있을것이다. 예를들면, 분석형의환자에게는거짓과과장된표현을삼가하고천천히논리적으로말하는것이필요하며, 주도형의환자에게는신속하고정확하게결론적인내용을전달하는것이필요하다. 그리고우호형의환자에게는친밀한표현을자주사용하여가능한성실하게임하는것이필요하며, 표현형의환자에게는가능한열심히들어주고칭찬을많이해주는것이필요하다. 이연구에서는환자의만족도와치료순응도에영향을미치는변인으로환자가인식한의사의공감능력과환자개인의변인에만초점을맞추었다. 따라서환자와의사변인모두를고려하지못했다는제한점이있다. 또한연구대상이한지역의환자들이며, 이차병원환자들만을대상으로하였다는면에서연구결과를일반화하는데어려움이있다. 따라서추후연구에서는보다다양하고광범위한환자표집으로환자와의사변인을모두포함한다양한관점에서환자의만족도와치료순응도에영향을미치는변인을분석해야할것이다. 이연구는다양한환자의유형에맞는의사의대처행동을제시해줌으로써의과대학학생및의사들을위한의료면담법교육에기초적자료로활용될수있을것으로기대한다. ACKNOWLEDGEMENTS This work was supported by Pusan National University Research Grant, 2005. REFERENCES Aita, V., McIlvain, H., Backer, E., McVea, K., & Crabtree, B.(2004). Patient-centered care and communication in primary care practice: what is involved? Patient Educ Couns, 58, 296-304. Allen J., & Brock S.A.(2000). Health care communication using personality type: patients are different. London: Routledge. Audit Commission for Local Authorities and the National Health Service in England and Wales. (1993). What seems to be the matter? Communication between haspitals and patients. London: HMSO. Carey, J.C., Hamilton, D.L., & Shanklin, G.(1985). Psychological type and interpersonal compatibility: evidence for a relationship between communication style preference and relationship satisfaction in college roommates. J Psychol Type, 10, 36-39. Choi, C.J., Kim, J.M., & Park, Y.G.(2004). Patientcentered attitudes and communication skills in medical students after clerkship. Korean J Med Educ, 16, 169-177. Department of Health.(1995). Acting on complaints (EL(95)37). Leeds: National Health Service Executive. DiMatteo, M.R., Taranta, A., Friedman, H.S., & Prince, L.M.(1980). Predicting patient satisfaction from physicians' nonverbal communication skills. Med Care, 18, 376-387. DiMatteo, M.R., & Hays, R.(1980). The significance of patients' perceptions of physician conduct: a study of patient satisfaction in a family practice center. J Community Health, 6, 18-34. General Medical Council.(1993). Tommorrow's doctors. London: General Medical Council. Hojat, M., Gonnella, J.S., Nasca, T.J., Manginone, S., Vergare, M., & Magee, M.(2002). Physician : definition, components, measurement, and relationship to gender and specialty. Am J Psychiatry, 159, 1563-1569. - 330 -
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