医患沟通中白谎策略的运行机制

Operating Mechanism of White-Lie Strategies in Doctor-Patient Communications

摘要: 白谎策略作为一种善意的沟通手段，成为临床医患沟通的常用方式。该研究立足医患日常交际场景，梳理医患沟通中白谎策略的具体表现形式，深入剖析白谎策略的内在运行逻辑，同时探究对白谎策略运用产生影响的因素，进而提出规范白谎运用的路径。研究发现，医患沟通中的白谎策略主要表现在病情告知、治疗方案沟通和医患日常交流三方面。其运行受到心理、伦理和社会文化机制的共同作用。其中，患者年龄、心理状态、病情严重程度及家属态度等患者因素，以及医生的职业道德、沟通能力和医疗环境等因素，均会影响医生对于白谎策略的选择与实施。研究认为，通过提升医生沟通能力、明确白谎使用边界、加强医患信任建设以及推进共享决策，能促进白谎策略的规范运用。

Abstract: White lies, as a benevolent communicative strategy, have become common in clinical doctor-patient communication. This study focuses on everyday doctor-patient interactions, examining the manifestations of white-lie strategies, analyzing their underlying mechanisms, and exploring factors influencing their use. Based on these findings, it further proposes approaches to regulating white-lie application in medical settings. The results show that white-lie strategies are mainly manifested in disease disclosure, treatment-plan communication, and routine doctor-patient interactions. Their application is jointly shaped by psychological, ethical, and socio-cultural mechanisms. In addition, patient-related factors, including age, psychological state, severity of illness, and family attitudes, as well as physician-related and environmental factors such as professional ethics, communication competence, and the medical environment, all influence physicians’ decisions regarding the selection and implementation of white-lie strategies. The study suggests that improving physicians’ communication skills, clarifying the boundaries of white-lie use, strengthening doctor-patient trust, and promoting Shared Decision-Making can contribute to the appropriate application of white-lie in medical communication.