医患交流精品课件.ppt

医患交流Why,What,How,1,.,中国特色的医患关系,令人堪忧矛盾升级暴力残酷,2,2001年7月13日湖南中医学院附属第一医院王万林医生惨遭他曾医治的病人杀害2003年8月24日武汉市同济来福门诊部2名医务人员被刺死、4名被刺伤2004年2月11日四川大学华西医院李宁医生被砍伤，致粉碎性开放性颅骨骨折、失血性休克2005年8月12日福建中医学院戴春福医生在该院附属“国医堂”医院出诊时被患者用刀捅死2010年6月12日和13日山东齐鲁医院患者家属两天在同一地点（办公司）杀死一名医生（6刀）和一名护士（20刀）,3,4,医患关系恶化到如此血腥的地步，在人类历史上是罕见的!,5,6,医患关系的基本要素,六个“C”选择(choice)称职(competence)交流(communication)同情(compassion)连贯性(continuity)利益不冲突(noconflictofinterest)医生与患者：I-you,notI-It,7,交流贯穿整个医疗过程Doctor-patientcommunication从病史采集到完成治疗医生与患者建立关系在有效的交流基础之上,8,Patient-physiciancommunicationisanintegralpartofclinicalpractice.,-Travaline,9,.,Isthereaproblem?,Evidencesuggeststhatproblemswithphysician-patientcommunicationarecommon:54%ofproblems29:suppl.2-S23-S29,29,有效交流的五个原则（Effectivecommunication）,EnsuresinteractionnotjusttransmissionReducesunnecessaryuncertaintyRequiresplanning,thinkingintermsofoutcomesDemonstratesdynamismFollowsahelicalratherthanalinearmodel,30,交流技能包括,内容交流技能（contentskills）Whatdoctorsdo?过程交流技能（processskills）Howdoyoudo?感知交流技能（perceptualskills）Whattheyarethinking297:1638-9GreenhalghP.Oldbones.BrMedJ1999;318：1361学术会议证明Prof.J,Spencer,universityofNewcastle,61,骨科医生沟通能力,风湿病22例，骨科疾病26例，骨折22例4名风湿病医生，5名骨科医生时间：23min（风湿）vs10.3min（骨科）vs4min（骨折）满意度：17分（风湿）vs15分（骨科）vs14分（骨折）,J.ONeill，J.R.WillamsDoctor-patientscommunicationinamusculoskeletalunit:relationshipbetweenanobserver-ratedstructuredscoringsystemandpatientopinion.Rheumatology2003;42:1512-1522,62,Adamson评价医疗纠纷量与患者评价医生的交流技能的关系,107名医生，2030名患者，62项指标,63,Adamson研究患者评价医生交流技能,64,65,CommunicationAbasicclinicalskillAseriesoflearnedskillsAsetofproceduresforimprovingoutcomesofcare,66,Thereisnoachievementceilingyoucannever“arrive”，andthenjustforgetaboutmaintainingmasteredskillsorlearningevenbetterones.Learning,maintaining,andenhancingthemisalife-longtask.,SuzanneM.Kurtz,67,谢谢,68,69,Formaltrainingprogramshavebeencreatedtoenhanceandmeasurespecificcommunicationskills.Manyoftheseefforts,however,focusonmedicalschoolsandearlypostgraduateyearsand,therefore,remainisolatedinacademicsettings.Thus,thecommunicationskillsofthebusyphysicianoftenremainpoorlydeveloped,andtheneedforestablishedphysicianstobecomebettercommunicatorscontinues.,70,KurtzSM.Doctor-patientcommunication:principleandpractices,71,HowtoCommunicatewithPatientsRemindersfortheBusyPhysician,TheAccreditationCouncilforGraduateMedicalEducationrecommendsthatphysiciansbecomecompetentinfivekeycommunicationskillslisteningeffectivelyelicitinginformationusingeffectivequestioningskillsprovidinginformationusingeffectiveexplanatoryskillscounselingandeducatingpatientsmakinginformeddecisionsbasedonpatientinformationandpreference,72,医疗纠纷中交流不良的影响（impactofmiscommunication),医疗纠纷医患关系不良多种原因医源损伤疏忽并不是所有医疗错误均纠纷medicaldispute诉讼lawsuit,73,学习有效的交流技术,网球达到大师的水平要练习技巧和方法而不是总的概括如不注意医患交流技术，也有退步的可能,74,DoesCompetenceinDeliveringBadNewsMakeaDifferencetoPatients?,Physiciancompetenceindeliveringbadnewsinfluences焦虑压抑程度希望治疗决定decisionmaking对疾病的调整,Lee.EnhancingPhysician-PatientCommunicationAmericanSocietyofHematology,75,Inastudyof100patientswithbreastcancersurveyed6monthsaftersurgery,诊断时的谈话决定对疾病的适应和调整心里状态生活质量医生谈话的态度比信息更为重