| 摘要: | 「醫療」在人的一生中佔了不可或缺的歷程，幾乎沒有人可以免除接受醫療服務，也因此造就了醫療產業的獨特性。而過去的醫病互動中，專業人員基於其專業知識來指導病患進行較具成效的治療活動，使得醫病互動的過程中充滿著託付式的順從。但隨著台灣人民教育程度全面提升、資訊科技長足發展、與消費意識轉變等社會文化脈絡因素的改變，已經不再像過往的互動歷程。現今資訊科技跟科技產業的進步，資訊可以透過網路傳遞，讓醫師跟病人可以達到零距離的互動，達到病人健康改善的目的。也讓我們了解到以資訊科技為輔的醫療照護服務模式已成為未來醫療產業發展的重要趨勢，亦成為一另類之醫療服務選擇，為了可以提早因應網路醫病互動的模式，本研究的目的為了解現在的醫病互動與線上的醫病互動中有甚麼差異，以活動理論為基礎，來分析以資訊科技為中介探討虛擬世界網路醫病互動系統，並發展其雛形。 本研究以批踢踢實業坊（PTT）作為線上的研究場域，研究者會在線上觀察一段時間，了解鄉民之間的互動歷程後，尋找最適當的受訪者並加以訪問，挑選的受訪者中皆以資深鄉民抬面上討論較頻繁的作者與回覆者為主，經受訪者同意後，藉由面訪、電子郵件、Line等方式進行訪談。一共十位，使用PTT的年資大多超過5年以上。 透過活動理論獲得虛擬世界中與實際的醫病環境活動下的活動系統衝突，矛盾一：去儀式化的互動環境－從原先實際的醫病互動環境中轉換到了虛擬世界，在這個虛擬世界裡，失去了原先在實際環境中固定的互動儀式；矛盾二：難以判斷角色的互動情境－當我們把活動的場域轉換到了虛擬世界時，所面對的人、事、物都是沒有感官知覺上的認知時，無從對專業人員有個明確的判定；矛盾三：熟悉的陌生人－使用者在長時間使用下對於平台產生了習慣上的信任與接受，但在互動的歷程中又恢復了理性的思考，並對於陌生人產生了警惕。 本研究以活動理論解析使用者在網際網路中與他人的醫病互動，並以脈絡探索分析及探討其文化背景下的真實原貌。其所探索到的矛盾衝突會隨其文化脈絡與歷程中不斷的變動與發展，為了使現行發展的平台中所產生的矛盾容易的掌握與修正，並以此提出具體建議來有效的解決目前所產生的矛盾問題，本研究有以下建議，包括科技中介醫療作為醫療服務發展策略思維；連結實體與串聯虛擬的醫病互動關係；社群化科技中介醫病互動。
The term of "medical care" is indispensable in one's life, and that makes no one being able to exempt from getting medical services. It also makes the healthcare industry having the irreplaceable role in the modern human living. In the past, the physician-patient interaction is mainly based on the interpretations of expertise from the medical professionals, or so called “entrusted compliance”. However, with the progress of social-cultural perspectives on generally improved educational level, information technology development, and consumer awareness, such kind of interaction by entrusted compliance should be changing is widely discussed. For example, healthcare related knowledge is widely distributed through internet, and makes an imagination of dispelled health information gap from physician-patient interaction. Under the circumstances, implementations of information technology into healthcare services become an important way to improve health outcome. That is, the purpose of this study was to explore and applied activity theory to compare the physician-patient interactions between ICT mediated and real world interaction. Through selection, we take the Professional Technology Temple (PTT) as the main research field. We as the participant observed and experienced the interaction through PTT, and found qualified respondents to join the inquiry. All of respondents are senior participants in PTT for more than 5 years.Through the activity theory, we examined the experience of online physician-patient interactions from the social-cultural perspective. The research found three commonly existed contradictions through comparing from real world and ICT-mediated. First of the contradiction is characterized as de-ritualized interactive environment, which reflects the ICT-mediated physician-patient interaction dispelled the rituals of original interaction form the real world. The second contradiction is characterized as the ambiguity for recognizing the role in the ICT-mediated interaction. And the third contradiction is characterized as the familiar strangers in the interaction. Through the use of activity theory and contextual inquiry, we explored the ICT-mediated physician-patient interaction in PTT for the social-cultural perspective. In conclusion, we provide suggestion for policy making and service design based on the solving of the contradictions. That include the suggestion on the redesign of ICT mediated physician-patient interactions; integration from the real physician-patient interaction to ICT-mediated interaction, and constructing the extension of the ICT-mediated community. |
