服務主導邏輯的基本精神，是經由服務的提供者與接受者之互動，進一步共同創造價值。本研究嘗試以服務主導邏的概念來詮釋醫療照護中的病患與醫師的互動關係。
研究採平行問卷調查方式，對象為南部一區域教學醫院的急性成人住院病患共計147位與其主治醫師。研究構面包括服務主導邏輯下的醫病互動、醫師的社會角色期待與價值共創－滿意度。
研究結果發現，接受開刀的病患有較高的整體服務主導邏輯下的醫病互動；大於71歲的醫師有較高的整體服務主導邏輯下醫病互動與滿意度；外科醫師與年資21年以上的醫師有較高的滿意度；病患的整體醫病互動、社會角色期待與滿意度均較醫師高；病患整體服務主導邏輯下醫療互動與價值共創－滿意度呈現顯著正相關；醫師整體服務主導邏輯下醫療互動與價值共創－滿意度呈現顯著正相關；病患的「醫病互動決策」與滿意度無顯著相關，醫師的「醫病互動決策」與滿意度無顯著相關；病患與醫師整體服務主導邏輯下醫病互動與價值共創－滿意度無顯著相關，但病患與醫師之「醫病互動參與」層面，具有顯著正相關；角色期待的滿意度總變異量調節作用為6.8％（由22.8％增加為29.6％）。
本研究結論是病患一般會積極參與和配合診療處置，期望就醫資訊透明，期待醫師能以病患為中心，也有高的滿意度，因此符合服務主導邏輯之價值共創的精神。但醫病互動與滿意度的關聯性與其影響因素仍有待釐清。醫師的角色期待則有些微的正向調節作用。

SUMMARY
The purposes of this study are to analyze the interaction between doctors and patients by the theory of service dominant logic (SDL), to clarify the factors which influence the satisfaction, and to understand the moderating effect of social role expectation of doctor. In total of 147 patients admitted to acute ward and their treating doctors are included. Three aspects are evaluated: (1) interaction between doctors and patients, (2) social role expectation of doctor and (3) satisfaction are explored. The results reveal that certain characteristics of doctors, including specialty(surgeon), age(elder) and seniority, correlate with higher satisfaction. Patients have higher mean score for participation, social role expectation and satisfaction than doctors. There are positive correlations between interaction and satisfaction in both doctors and patients except the decision making. However no correlation is found between interaction and satisfaction by paired regression analysis in doctors and patients. But the attribute of participation does correlate with satisfaction in doctors and patients. Social role expectation accounts for 6.8% of the total variance of satisfaction (from 22.8% to 29.6%). To conclude, SDL is able to interpret the relationship between doctors and patients. But the factors affecting the satisfaction in the doctor-patient interaction remain to be determined. Role expectation of doctor has minimal positive moderating effect on the relationship of interaction and satisfaction.

Key words: service dominant logic, value co-creation, social role, doctor-patient interaction

第一部分 中文部分
中華民國醫師公會全國聯合會，第10屆第1次會員代表大會修正文，（2012），
台北，http://www.tma.tw/。
何菲瓊 譯（2013），醫療社會學（譯自Medical sociology），台北：雙葉
書廊pp.196,214,221）。
吳明隆（2006），spss 統計應用實務，台北：五南圖書（pp.217-218）。
吳俊穎、楊增暐、 賴惠蓁 & 陳榮基(2010)，醫療糾紛民事訴訟時代的來臨:
台灣醫療糾紛民國91年至96年訴訟案件分析，臺灣醫學，第十四卷第四
期，pp.359-369。
吳俊穎、賴惠蓁& 陳榮基(2009)，台灣的醫療糾紛狀況，臺灣醫學，第十三
卷第一期，pp.1-8。
傅鍾仁 & 張錫惠 (2002)，我國醫療服務品質滿意度之實證研究，台灣管理學
刊，第一卷第二期，pp.317－340。
葉肅科 (2013)，醫療社會學新論，台北：三民書局 (pp.6-7)。
蘇俊嘉 (2007)，病患參與治療決策之探討--以乳癌婦女為例. 臺灣大學醫療機
構管理研究所學位論文。

第二部分 外文部分
Akaka, M. A., & Chandler, J. D. (2011),“Roles as resources: A social roles perspective of change in value
networks,”Marketing Theory, 11(3) pp.243-260.
Arora, N. K., & McHorney, C. A. (2000),“Patient preferences for medical decision making: who really wants to
participate?”Medical care, 38(3) pp.335-341.
Association, W. M. (1983), Declaration of Geneva: World
Medical Association.
Barker, K. K. (2008),“ Electronic support groups, patient-
consumers, and medicalization: The case of contested
illness,” Journal of Health and Social Behavior, 49(1)
pp.20-36.
Baron‐Epel, O., Dushenat, M., & Friedman, N.
.2001),“Evaluation of the consumer model: relationship
between patients' expectations, perceptions and
satisfaction with care,”International Journal for
Quality in Health Care,13(4) pp.317-323.
Beck, R. S., Daughtridge, R., & Sloane, P. D.
(2002),“Physician-patient communication in the primary
care office: a systematic review,”The Journal
of the American Board of Family Practice, 15(1) pp. 25-
38.
Benbassat, J., Pilpel, D., & Tidhar, M. (1998).“Patients'
preferences for participation in clinical decision
making: a review of published surveys,” Behavioral
medicine, 24(2) pp. 81-88.
Bettencourt, L. A. (1997), “Customer voluntary performance:
customers as partners in service delivery.”Journal of
retailing, 73(3) pp. 383-406.
Biddle, B. J. (1986),“ Recent development in role theory,”
Annual review of sociology, 12 pp 67-92.
Blanchard, C. G., Labrecque, M. S., Ruckdeschel, J. C. &
Blanchard, E. B .(1990), “Physician behaviors, patient
perceptions, and patient characteristics as
predictors of satisfaction of hospitalized adult cancer
patients, ”Cancer,65(1) pp.186-192.
Blomqvist, Å. (1991),“The doctor as double agent:
information asymmetry, health insurance, and medical
care,”Journal of Health Economics,10(4)pp411-432.
Boyer, C. A. & Lutfey, K. E. (2010),“Examining Critical
Health Policy Issues within and beyond the Clinical
Encounter Patient–Provider Relationships and
Help-seeking Behaviors, ”Journal of Health and Social
Behavior, 51(1 suppl) S80-S93.
Brody, D. S., Miller, S. M., Lerman, C. E., Smith, D. G. &
Caputo, G. C. (1989), “Patient perception of
involvement in medical care.”Journal of General
Internal Medicine, 4(6) pp.506-511.
Brody, D. S., Miller, S. M., Lerman, C. E., Smith, D. G.,
Lazaro, C. G. & Blum, M. J. (1989),“The relationship
between patients' satisfaction with their physicians
and perceptions about interventions they desired and
received,” Medical care, 27(11) pp.1027-1035.
Buetow, S., Jutel, A. & Hoare, K. (2009),“Shrinking social
space in the doctor–modern patient relationship: A
review of forces for, and implications of,
homologisation, ”Patient education and counseling, 74
(1) pp.97-103.
Cassell, E. J. (1986),“The changing concept of the ideal
physician.” Daedalus, 115(2) pp.185-208.
Charles, C., Gafni, A., & Whelan, T. (1999), “Decision-
making in the physician–patient encounter: revisiting
the shared treatment decision-making
model.”Social science & medicine, 49(5) pp. 651-661.
Chen, K. Y., Yang, C. M., Tsai, S. H., Chiou, H. Y., Lin,
M. R. & Chiu, W. T.(2012).“Medical malpractice in
Taiwan: injury types, compensation, and
specialty risk,”Academic emergency medicine, 19(5)
pp.598-600.
Cleary, P. D. & McNeil, B. J. (1988),“Patient satisfaction
as an indicator of quality care,”Inquiry: a journal of
medical care organization, provision and financing, 25
(1) pp.25-36.
Conrad, P. (2008), The medicalization of society: On the
transformation of human conditions into treatable
disorders. JHU Press.
Coulter, A. (1997),“Partnerships with patients: the pros
and cons of shared clinical
decision-making, ”Journal of Health Services Research, 2
(2) pp.112-121.
Crawford, M. J., Rutter, D., Manley, C., Weaver, T., Bhui,
K., Fulop, N. & Tyrer, P.(2002),“Systematic review of
involving patients in the planning and
development of health care,”British Medical Journal, 325
(7375) pp. 1263-67.
Dardanoni, V. & Wagstaff, A. (1990),“Uncertainty and the
demand for medical care, ”Journal of Health Economics, 9
(1) pp.23-38.
Deakin, T., McShane, C., Cade, J. & Williams, R. (2005),“
Group based training for self-management strategies in
people with type 2 diabetes mellitus, ”Cochrane
Database Syst Rev, 2.pp.1-91.
Deber, R. B. (1994),“Physicians in health care management:
The patient-physician partnership: changing roles and
the desire for information,”Canadian Medical
Association Journal, 151(2) pp.171-176.
DiMatteo, M. R. & Hays, R. (1980),“The significance of
patients' perceptions of physician conduct,”Journal of
community health, 6(1) pp.18-34.
Emanuel, E. J. & Emanuel, L. L. (1992),“Four models of the
physician-patient relationship,”JAMA, 267(16) pp. 2221-
2226.
Engel, G. L. (1977),“The need for a new medical model: a
challenge for biomedicine,”Science, 196(4286) pp.129-
136.
Engel, G. L. (1979),“The biopsychosocial model and the
education of health professionals,”General hospital
psychiatry, 1(2) pp.156-165.
Eysenbach, G., & Jadad, A. R. (2001),“Evidence-based
patient choice and consumer health informatics in the
Internet age,”J Med Internet Res, 3(2) pp.289-308
Ford, R. C. & Fottler, M. D. (2000),“Creating customer-
focused health care organizations, ”Health Care
Management Review, 25(4) pp.18-33.
Freidson, E. (1970). Professional dominance: The social
structure of medical care: Transaction Publishers.
Frosch, D. L. & Kaplan, R. M. (1999),“Shared decision
making in clinical medicine: past research and future
directions,”American journal of preventive medicine, 17
(4) pp.285-294.
Fyrberg, A. & Jüriado, R. (2009),“What about interaction?:
Networks and brands as integrators within service-
dominant logic,”Journal of Service Management, 20(4)
pp.420-432.
Gafni, A., Charles, C. & Whelan, T. (1998),“The physician
–patient encounter: the physician as a perfect agent
for the patient versus the informed treatment decision-
making model,”Social science & medicine, 47(3) pp. 347-
354.
Garrity, T. F. (1981),“Medical compliance and the clinician-
patient relationship: a review”Social Science &
Medicine. Part E: Medical Psychology, 15(3) pp. 215-
222.
Gill, L., White, L. & Cameron, I. D. (2011),“ Service co-
creation in community-based aged healthcare,”Managing
Service Quality, 21(2)pp. 152-177.
Golin, C. E., DiMatteo, M. R., & Gelberg, L. (1996),“The
role of patient participation in the doctor visit:
implications for adherence to diabetes care,”
Diabetes care, 19(10) pp.1153-1164.
Gillon, R. (1985),“Medical oaths, declarations, and
codes,”British medical journal (Clinical research ed.),
290(6476), pp.1194－1195.
Grönroos, C. (2011),“Value co-creation in service logic: A
critical analysis,” Marketing Theory, 11(3) pp. 279-
301.
Grönroos, C. & Voima, P. (2013),“Critical service logic:
making sense of value creation and co-creation,”Journal
of the Academy of Marketing Science, 41(2 )pp.133-150.
Greenfield, S., Kaplan, S. & Ware, J. E. (1985),“Expanding
patient involvement in care: Effects on patient
outcomes,”Annals of Internal Medicine, 102(4) pp. 520-
528.
Greenfield, S., Kaplan, S. H., Ware Jr, J. E., Yano, E. M.
& Frank, H. J. (1988), “Patients’ participation in
medical care,”Journal of General Internal Medicine, 3
(5) pp. 448-457.
Griffiths, F., Cave, J., Boardman, F., Ren, J.,
Pawlikowska, T., Ball, R.& Cohen, A. (2012),“Social
networks–The future for health care delivery.”Social
Science & Medicine, 75(12) pp.2233-2241.
Guadagnoli, E. & Ward, P. (1998),“Patient participation in
decision-making,” Social Science & Medicine, 47(3)
pp.329-339.
Guevara, J. P., Wolf, F. M., Grum, C. M. & Clark, N. M.
(2003),“Effects of educational interventions for self
management of asthma in children and adolescents:
systematic review and meta-analysis.”British Medical
Journal,326(7402) pp.1308-1309.
Hayes-Bautista, D. (1976),“Modifying the treatment: patient
compliance, patient control and medical care,”Social
Science & Medicine, 10(5) pp.233-238.
Haywood, K., Marshall, S., & Fitzpatrick, R.
(2006),“Patient participation in the consultation
process: a structured review of intervention
strategies,”Patient Education and Counseling, 63(1) pp.
12-23.
Hippocrates, Works trans., Francis Adams (New York; Loeb)
vol. I, pp.299-301.
Ishikawa, H., Hashimoto, H., & Kiuchi, T. (2013),“The
evolving concept of “patient-centeredness” in patient
–physician communication research,” Social Science &
Medicine, 96 pp.147-153.
Katz, J. (2002). The silent world of doctor and patient:
JHU Press.
Kenkel, D. (1990), Consumer health information and the
demand for medical care. The Review of Economics and
Statistics,72(4) pp.587-595.
Kinard, B. R. & Capella, M. L. (2006),“Relationship
marketing: the influence of consumer involvement on
perceived service benefits,”Journal of Services
Marketing, 20(6) pp.359-368.
Kravitz, R. L., Bell, R. A., Azari, R., Kelly-Reif, S.,
Krupat, E. & Thom, D. H.(2003),“Direct observation of
requests for clinical services in office practice:
what do patients want and do they get it?”Archives of
Internal Medicine,163(14) pp1673-1681.
Krupat, E., Rosenkranz, S. L., Yeager, C. M., Barnard, K.,
Putnam, S. M. & Inui, T.S. (2000),“The practice
orientations of physicians and patients: the effect of
doctor–patient congruence on satisfaction,”Patient
Education and Counseling, 39(1) pp.49-59.
Larsen, D. E. & Rootman, I. (1976),“Physician role
performance and patient satisfaction,”Social Science &
Medicine, 10(1) pp.29-32.
Linder-Pelz, S. (1982a),“Social psychological determinants
of patient satisfaction: a test of five
hypotheses,”Social Science & Medicine, 16(5), pp.583-
589.
Linder-Pelz, S. (1982b),“Toward a theory of patient
satisfaction,”Social science & medicine, 16(5) pp.577-
582.
Lochman, J. E. (1983),“Factors related to patients'
satisfaction with their medical care,”Journal of
Community Health, 9(2) pp.91-109.
Lusch, R. F. & Vargo, S. L. (2006),“Service-dominant logic:
reactions, reflections and refinements,”Marketing
Theory, 6(3) pp.281-288.
Mead, George H. (1934), Mind, Self and Society. Chicago:
University of Chicago Press
Mills, P. K. & Morris, J. H. (1986),“Clients as “partial”
employees of service organizations: Role development in
client participation,”Academy of Management Review, 11
(4) pp. 726-735.
Nordgren, L. (2008),“The performativity of the service
management discourse:“Value creating customers” in
health care,”Journal of Health Organization and
Management, 22(5) pp. 510-528.
Nordgren, L. (2009),“Value creation in health care services
–developing service productivity: experiences from
Sweden,”International Journal of Public Sector
Management, 22(2) pp. 114-127.
Normann, R. & Ramirez, R. (1993),“Designing interactive
strategy, Harvard Business Review, 71(4) pp. 65-77.
Normann, R. & Ramirez, R. (1998), Designing interactive
strategy: From value chain to value constellation:
Wiley New York/Chichester.
Ong, L. M., De Haes, J. C., Hoos, A. M. & Lammes, F. B,
(1995),“Doctor-patient communication: a review of the
literature,”Social Science & Medicine, 40(7) pp. 903-
918.
Ong, L.M., Visser, M. R., Lammes, F. B. & De Haes, J. C,
(2000)“ Doctor–patient communication and cancer
patients’ quality of life and satisfaction,”Patient
Education and Counseling, 41(2), 145-156.
Parasuraman, A., Zeithaml, V. A. & Berry, L. L. (1985),“ A
conceptual model of service quality and its
implications for future research,”Journal of
marketing,49(4) pp.41-50.
Parsons, T. (1975),“The sick role and the role of the
physician reconsidered.” The Milbank Memorial Fund
Quarterly. Health and Society, 53(3) pp.257-278.
Parsons, T. (1991). The social system: Psychology Press.
Parsons, T. & Fox, R. (1952),“Illness, therapy and the
modern urban American family,”Journal of Social Issues,
8(4) pp.31-44.
Pascoe, G. C. (1983),“Patient satisfaction in primary
health care: a literature review and
anlysis,”Evaluation and program planning, 6(3) pp.185-
210.
Petrova, M., Dale, J. & Fulford, B. K. (2006),“Values-based
practice in primary care: easing the tensions between
individual values, ethical principles and best
evidence,”British Journal of General Practice, 56(530)
pp.703-709.
Porter, M. E. (2010),“What is value in health care? New
England Journal of Medicine, 363(26) pp.2477-2481.
Porter, M. E. & Teisberg, E. O. (2004),“Redefining
competition in health care,” Harvard Business Review, 82
(6) pp.64-77.
Prahalad, C. K. & Ramaswamy, V. (2002),“The co-creation
connection,” Strategy and Business, 27 pp.50-61.
Prahalad, C. K., & Ramaswamy, V. (2004a),“Co-creating
unique value with customers,”Strategy & Leadership, 32
(3) pp.4-9.
Prahalad, C. K. & Ramaswamy, V. (2004b),“Co‐creation
experiences: The next practice in value
creation,”Journal of Interactive Marketing, 18(3)
pp.5-14.
Ramaswamy, V. (2011),“It's about human experiences and
beyond, to co-creation,”Industrial Marketing
Management, 40(2) pp.195-196.
Ross, C. K., Frommelt, G., Hazelwood, L. & Chang, R. W.
(1987),“The role of expectations in patient
satisfaction with medical care,”Journal of Health Care
Marketing, 7(4) pp16-26..
Sánchez-Fernández, R. & Iniesta-Bonillo, M. Á.(2007),“The
concept of perceived value: a systematic review of the
research,”Marketing Theory, 7(4), 427-451.
Say, J. B. & Biddle, C. C. (1851). A treatise on political
economy: J. Grigg.Say, R., Murtagh, M., & Thomson, R.
(2006),“Patients’ preference for involvement in medical
decision making: a narrative review,”Patient Education
and Counseling, 60(2) pp.102-114.
Say, R. E. & Thomson, R. (2003),“The importance of patient
preferences in treatment decisions-challenges for
doctors,” British Medical Journal,327(7414) pp.542-545.
Segall, A. & Burnett, M.(1980),“Patient evaluation of
physician role performance”Social Science & Medicine.
Part A: Medical Psychology & Medical Sociology, 14(4)
pp.269-278.
Smith, A. & Garnier, M. (1845). An Inquiry into the Nature
and Causes of the Wealth of Nations: Nelson.
Solomon, M. R., Surprenant, C., Czepiel, J. A. &
Gutman, E. G. (1985),“A role theory perspective on
dyadic interactions: The service encounter,”Journal of
Marketing, 49(1) pp.99-111
Stewart, M. (2001),“Towards a global definition of patient
centred care: the patient should be the judge of
patient centred care,”British Medical Journal,
322(7284) pp.444.
Stewart, M. A. (1995),“Effective physician-patient
communication and health outcomes: a review,”Canadian
Medical Association Journal, 152(9) pp.1423-1433.
Street Jr, R. L., Gordon, H. & Haidet, P.
(2007),“Physicians’ communication and perceptions of
patients: is it how they look, how they talk, or is it
just the doctor?”Social Science & Medicine, 65(3) pp.
586-598.
Swenson, S. L., Buell, S., Zettler, P., White, M., Ruston,
D. C. & Lo, B (2004), “Patient‐centered
communication,”Journal of General Internal Medicine,
19(11) pp.1069-1079.
Szasz, T. S. & Hollender, M. H. (1956),“A contribution to
the philosophy of medicine: The basic models of the
doctor-patient relationship,”Archives of Internal
Medicine, 97(5) pp.585-592
Thompson, A. G. & Suñol, R. (1995),“Expectations as
determinants of patient satisfaction: concepts, theory
and evidence,”International Journal for Quality in
Health Care, 7(2), pp.127-141.
Tsai, W.-C., Kung, P.-T. & Chiang, Y.-J.
(2004),“Relationship between malpractice claims and
medical care quality,”International Journal of Health
Care Quality Assurance, 17(7) pp.394-400.
Vargo, S. L. & Akaka, M. A. (2009),“Service-dominant logic
as a foundation for service science:
clarifications,”Service Science, 1(1) pp.32-41.
Vargo, S. L. & Lusch, R. F. (2004),“Evolving to a new
dominant logic for marketing,”Journal of Marketing, 68
(1) pp. 1-17.
Vargo, S. L. & Lusch, R. F. (2008a),“From goods to service
(s): Divergences and convergences of
logics, ”Industrial Marketing Management, 37(3) pp. 254-
259.
Vargo, S. L. & Lusch, R. F. (2008b),“Service-dominant
logic: continuing the evolution,”Journal of the Academy
of Marketing Science, 36(1) pp.1-10.
Vargo, S. L., Maglio, P. P. & Akaka, M. A. (2008),“On value
and value co-creation: A service systems and service
logic perspective,”European Management Journal, 26(3)
pp. 145-152.
Wagner, E. H., Barrett, P., Barry, M. J., Barlow, W. &
Fowler Jr, F. J. (1995), “The Effect of a Shared
Decisionmaking Program on Rates of Surgery for
Benign Prostatic Hyperplasia Pilot Results,”Medical
Care, 33(8) pp.765-770.
Weingarten, S. R., Henning, J. M., Badamgarav, E., Knight,
K., Hasselblad, V. & Ofman, J. J. (2002),“Interventions
used in disease management programmes for patients with
chronic illness which ones work? Meta-analysis of
published reports.”British Medical Journal, 325(7370)
pp. 925-932.
Wensing, M., Jung, H. P., Mainz, J., Olesen, F. & Grol, R.
(1998),“A systematic review of the literature on
patient priorities for general practice care. Part 1:
Description of the research domain,”Social Science &
Medicine, 47(10),1573-1588.
Williams, B. (1994),“Patient satisfaction: a valid
concept?”Social Science & Medicine, 38(4) pp.509-516.
Zeithaml, V. A. (1988),“Consumer perceptions of price,
quality, and value: a means-end model and synthesis of
evidence,”The Journal of Marketing, 52(3）pp2-22.