为何最优化患者对医生更警惕?道德推脱的中介作用

doi:10.3724/SP.J.1041.2026.0057

摘要/Abstract

摘要：

患者普遍存在的警惕心理容易诱发其负性行为, 对医患关系构成潜在威胁。本研究基于医患互动视角, 探讨最优化决策对患者警惕心理的影响及其机制。三项研究发现：1)最优化决策显著增强患者对医生医德和医术的警惕; 2)道德推脱在二者之间起中介作用, 即最优化决策通过激发患者的道德推脱而强化其对医生的警惕; 3)医生的友善行为起调节作用, 不仅未能缓解最优化患者的警惕, 反而通过强化道德推脱进一步加剧其警惕程度。本研究通过引入道德推脱理论, 构建最优化决策与患者对医生警惕之间的心理机制, 不仅拓展了警惕和最优化决策人际沟通的研究, 同时为预防和缓解医患矛盾提供新思路。

关键词: 患者对医生的警惕, 最优化决策, 道德推脱, 医患互动

Abstract:

Growing social uncertainties have heightened public psychological defensiveness, with particularly pronounced effects in clinical encounters where patients exhibit heightened vigilance toward doctors. This vigilance elicits cognitive and physiological stress responses that, while not immediately causing overt conflict, gradually undermine relational resilience and increase confrontation risks. Thus, patient vigilance constitutes a critical form of “psychological latent risk,” facilitating the transition from psychological opposition to behavioral conflict. Yet how individual decision-making traits influence this vigilance remains unclear. Our research investigates how maximization orientation affects patient vigilance through moral disengagement, and how doctor friendly behavior moderates this relationship.

Study 1 preliminarily examined the effect of maximization orientation on patient vigilance and the mediating role of moral disengagement using a sample of patients surveyed after their clinical visits. Participants self-reported their maximization orientation, vigilance toward doctors, moral disengagement, and common ingroup identity. They were also asked to predict doctors’ potential behaviors across eight typical medical scenarios, with their vigilance quantitatively assessed through standardized coding of these predictions. Results confirmed maximization orientation increased vigilance through moral disengagement (supporting H1-H2), while excluding common ingroup identity as an alternative explanation.

Study 2 conducted a field survey of patients who consulted the same target doctor to further examine the relationships among maximization orientation, moral disengagement, and patient vigilance toward doctors, as well as the moderating role of doctor friendly behavior. Participants completed pre-consultation measures assessing maximization orientation and demographic variables, followed by post-consultation evaluations of doctor friendly behavior, vigilance, moral disengagement, and control variables. Vigilance toward doctors was measured using the identical subjective prediction method employed in Study 1. The results not only replicated the mediation effect observed in Study 1 but also revealed that doctor friendly behavior significantly moderated the moral disengagement pathway (supporting H1-H4), thereby establishing external validity for our full theoretical model.

Study 3 employed a 2 (maximization: maximizing vs. satisficing) × 2 (friendly behavior: present vs. absent) between-subjects design to experimentally test the full model, thereby providing causal evidence for the proposed relationships. After successful manipulation and verification of the maximization mindset, participants read eight typical medical scenarios (with or without doctor-friendly behaviors) and assessed the likelihood of doctors engaging in behaviors that could harm patients’ interests, which served as our measure of vigilance. Subsequently, participants reported their moral disengagement and demographic information. The results provided causal evidence for our theoretical model, robustly confirming all hypothesized relationships (H1-H4).

Collectively, this study reveals that maximization orientation heightens patient vigilance through moral disengagement, thereby advancing social vigilance research, uncovering novel interpersonal consequences of maximization orientation, and extending moral disengagement theory through empirical evidence of its extra-moral motivational effects. Importantly, this study proposes a comprehensive prevention framework for doctor-patient conflicts, comprising: (1) establishing a “prevention-first” conflict management principle; (2) incorporating maximization orientation into risk early-warning indicator systems; (3) integrating the impact of patients’ maximization orientation into healthcare professionals’ communication training; and (4) developing targeted clinical interventions based on the moral disengagement mechanism.

Key words: patients’ vigilance towards doctors, maximization, moral disengagement, doctor-patient interaction

中图分类号:

B849:C91

徐梓豪, 朱冬青, 闫小敏. (2026). 为何最优化患者对医生更警惕?道德推脱的中介作用. 心理学报, 58(1), 57-73.

XU Zihao, ZHU Dongqing, YAN Xiaomin. (2026). Why are maximizing patients more vigilant toward doctors? The mediation role of moral disengagement. Acta Psychologica Sinica, 58(1), 57-73.

图/表 7

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变量	M	SD	1	2	3	4	5	6	7	8	9	10
1.性别^a	(—)	(—)	(—)
2.年龄	33.69	9.26	0.01	(—)
3.先验态度	5.02	1.23	−0.06^**	−0.10^**	(0.83)
4.感知竞争	2.77	1.32	0.09^**	−0.15^**	0.05^**	(0.80)
5.问诊质量	5.06	1.37	−0.10^**	−0.06^**	−0.04^**	−0.12^**	(—)
6.疾病严重程度	3.95	1.36	−0.05	−0.04^**	−0.06^**	0.06^**	−0.02	(—)
7.最优化决策	4.68	1.02	−0.09^**	−0.02	0.01	0.07^**	0.07^**	0.03^*	(0.82)
8.友善行为^b	0.74	0.43	−0.06^**	−0.10^**	−0.10^**	0.05^**	0.14^**	0.01	0.30^**	(—)
9.道德推脱	3.73	1.07	−0.06^**	−0.06^**	−0.01	0.08^**	0.02	0.04^**	0.68^**	0.39^**	(0.86)
10.对医生的警惕^c	0.19	0.39	−0.02	−0.01	0.00	0.00	0.03^*	−0.01	0.40^**	0.07^**	0.44^**	(—)

变量	M	SD	1	2	3	4	5	6	7	8	9	10
1.性别^a	(—)	(—)	(—)
2.年龄	33.69	9.26	0.01	(—)
3.先验态度	5.02	1.23	−0.06^**	−0.10^**	(0.83)
4.感知竞争	2.77	1.32	0.09^**	−0.15^**	0.05^**	(0.80)
5.问诊质量	5.06	1.37	−0.10^**	−0.06^**	−0.04^**	−0.12^**	(—)
6.疾病严重程度	3.95	1.36	−0.05	−0.04^**	−0.06^**	0.06^**	−0.02	(—)
7.最优化决策	4.68	1.02	−0.09^**	−0.02	0.01	0.07^**	0.07^**	0.03^*	(0.82)
8.友善行为^b	0.74	0.43	−0.06^**	−0.10^**	−0.10^**	0.05^**	0.14^**	0.01	0.30^**	(—)
9.道德推脱	3.73	1.07	−0.06^**	−0.06^**	−0.01	0.08^**	0.02	0.04^**	0.68^**	0.39^**	(0.86)
10.对医生的警惕^c	0.19	0.39	−0.02	−0.01	0.00	0.00	0.03^*	−0.01	0.40^**	0.07^**	0.44^**	(—)

变量	道德推脱								患者对医生的警惕
	模型1		模型2		模型3		模型4		模型5		模型6		模型7		模型8
	B	SE	B	SE	B	SE	B	SE	B	SE	B	SE	B	SE	B	SE
1.性别	−0.13^**	0.03	0.01	0.02	0.02	0.02	0.03	0.02	−0.10	0.06	−0.04	0.07	−0.05	0.07	−0.04	0.07
2.年龄	−0.01^**	0.00	−0.01^**	0.00	−0.00^*	0.00	−0.00	0.00	−0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00
3.先验态度	−0.02	0.01	−0.02^**	0.01	−0.00	0.01	0.00	0.01	0.00	0.03	0.01	0.03	0.01	0.03	0.01	0.03
4.感知竞争	0.06^**	0.01	0.02^*	0.01	0.01	0.01	0.01	0.01	0.01	0.03	−0.02	0.03	−0.02	0.03	−0.03	0.03
5.问诊质量	0.02^*	0.01	−0.02^**	0.01	−0.04^**	0.01	−0.04^**	0.01	0.05	0.02	0.02	0.02	0.04	0.02	0.03	0.02
6.疾病严重程度	0.02^*	0.01	0.01	0.01	0.01	0.01	−0.00	0.01	−0.01	0.02	−0.03	0.02	−0.03	0.02	−0.04	0.05
7.最优化决策			0.73^**	0.01	0.67^**	0.01	0.53^**	0.02			0.45^**	0.04			0.23^**	0.04
8.友善行为					0.50^**	0.02	−0.42^**	0.10
9.最优化×友善行为							0.21^**	0.02
10.道德推脱													0.44^**	0.03	0.30^**	0.04
R²/ Nagelkerke R²	0.014		0.479		0.515		0.523		0.002		0.042		0.080		0.054
ΔR²			0.465^**		0.035^**		0.008^**

变量	道德推脱								患者对医生的警惕
	模型1		模型2		模型3		模型4		模型5		模型6		模型7		模型8
	B	SE	B	SE	B	SE	B	SE	B	SE	B	SE	B	SE	B	SE
1.性别	−0.13^**	0.03	0.01	0.02	0.02	0.02	0.03	0.02	−0.10	0.06	−0.04	0.07	−0.05	0.07	−0.04	0.07
2.年龄	−0.01^**	0.00	−0.01^**	0.00	−0.00^*	0.00	−0.00	0.00	−0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00
3.先验态度	−0.02	0.01	−0.02^**	0.01	−0.00	0.01	0.00	0.01	0.00	0.03	0.01	0.03	0.01	0.03	0.01	0.03
4.感知竞争	0.06^**	0.01	0.02^*	0.01	0.01	0.01	0.01	0.01	0.01	0.03	−0.02	0.03	−0.02	0.03	−0.03	0.03
5.问诊质量	0.02^*	0.01	−0.02^**	0.01	−0.04^**	0.01	−0.04^**	0.01	0.05	0.02	0.02	0.02	0.04	0.02	0.03	0.02
6.疾病严重程度	0.02^*	0.01	0.01	0.01	0.01	0.01	−0.00	0.01	−0.01	0.02	−0.03	0.02	−0.03	0.02	−0.04	0.05
7.最优化决策			0.73^**	0.01	0.67^**	0.01	0.53^**	0.02			0.45^**	0.04			0.23^**	0.04
8.友善行为					0.50^**	0.02	−0.42^**	0.10
9.最优化×友善行为							0.21^**	0.02
10.道德推脱													0.44^**	0.03	0.30^**	0.04
R²/ Nagelkerke R²	0.014		0.479		0.515		0.523		0.002		0.042		0.080		0.054
ΔR²			0.465^**		0.035^**		0.008^**