全科医学教学课件：03全科医学中医患关系与沟通（英文课件）

GeneralPracticeDoctor-patientrelationship

IntroductionNowadays,therelationshipbetweendoctorsandpatientsisbecomingworseandworse.Whatmakethedoctor-patientrelationshipbecomesostrainedAnincreasingnumberofpatientscomplainthatdoctorsalwayshavebadmanner,thatit’sdifficult

toapproachthem（医生难接近）andthatmedicalexpenseistoohightostand（医疗费用高昂）.Asaresult,therehavebeenmanymedicaldisputes（医疗纠纷）.

TypesofDoctor-Patientrelationship医患关系的模式

Stopandthink！Inwhatwaysarerelationshipsbetweendoctorsandtheirpatientsdifferentfromothersocialrelationships(e.g.betweenstudentandlibrarianorbetweenpassengerandbusdriver?)Perhapspatienthasjustmetherdoctor,but

withinsecondsshetells

thedoctorvery

intimatepersonaldetailsaboutherhealth.（患者需要告知医师健康隐私问题）ANDwithinaminutes,sheispreparedtoremove

herclothesandsubmittoaphysical

examination.（患者需要暴露躯体接受体格检查）

Patientsarelikelytorelyonthedoctorsbecauseoftheirlowereducationandsocialstatusandtheirhighdependencyonmedicaldeliberation,andobediencetoauthority;whiledoctorsdominatetheconsultationprocessandthedecision-makingbecausetheyarethelegalizedprofession,i.e.supportedbyoursocialinstitution.Thestatusandpowerofphysiciansmayencouragepatient’sdependencyand,influencehowtheyperceivetheirhealth.

（医生的地位与权力有助于加强患者的依从性，并提高其对健康问题的认识）Currentpracticeof“Consultation”Disadvantagesofthecurrentpractice

Restrictsthepatient’sinclinationtohelpthemselves.（限制患者的自助性）

Restrictsthepatientsingivingtheirownopinion.（限制患者的自主意识）

Reinforcesthepatient’ssickrole.（强化患者的弱势地位）

Reinforcesthehierarchicalrelationshipbetweendoctorandpatient.（强化医-患层级关系）

Assumesthedoctorknowseverythingaboutthepatientsratherthan

thepatientknowinghisorherownconditionbetter(e.g.pain)(削弱患者对自身病情的了解)Parsons’analysisoftherolesofpatientsanddoctorsReprintedwithpermissionfromTheFreePressfromParsons(1951).RelationshipswithpatientsTomorrow’sDoctors(GMC2003)

Typesofdoctor-patientrelationships医患关系的类型ThetraditionalDoctor-PatientrelationshipDoctorTakesonroleof“parent”Patientsubmissive（患者被动服从）ButcurrentlyshifttowardsMutuality（现向“互动型”模式转换）Paternalism医师权威式“IfI’vetoldyouonceItoldyou1,000times,stopsmoking!!”ThePaternalisticApproachDoctor—historyexaminationinvestigationresultsina‘differential’diagnosis.Patient-ideas/expectations/feelings

resultsinanunderstandingofpatientsbeliefs.

Patient-centredclinicalinterview以病人为中心的临床访谈Patient-controlledconsultation“You’repaidtodowhatItellyou!!”Physicianandpatientmoralmode医师及病人道德模式“Mutualparticipation,bothnegotiateandsharekeydecisions!!”

Barrierofgoodcommunication有效沟通的障碍

Educationallevel

Sex

Differentlanguages

Membershipofanethnicminority

Patientsbarrierstoeffectivecommunication

Lackofspecificknowledge

Lackofcounsellingskills

lackoftime

lackofappropriateresources

Doctors’barrierstoeffectivecommunicationSocialclass,genderðnicityPatientscanhaveadifferentsocialclass,genderorethnicbackground

fromthatofthehealthprofessional,hencecanfindcommunicationdifficult.Socialclassdifferencesbetweendoctorsandpatientscaninfluencetheirinteraction.Experiencesbasedonsocialclassbackgroundcaninfluence/changeexpectations.DevelopingagoodrelationshipHavean“open”attitude:whateverisgoingonbetweenusininteractionisimportantandintimate,nomatterwhatisbeingdiscussed.

对交谈内容抱以“接纳”的态度Developintheintervieweeafeelingthathe/sheisbeingtreated.

让患者感到正在被治疗Concentrateallyourattentionontheinterviewee.

全神关注地聆听Helptheintervieweetoexpressthosecontentswhichareimportantforthediagnosis

协助患者阐述有利于病情诊断的内容:

—Createacalmandunhurriedatmosphere

—Listenkindlywithempathy—Donotexpresssurprise

Artofinterview

沟通技巧Firstminutes…Trynottobelate…ConcentratefullyandonlyatthepatientTakecareofthepatientscomfortOrganizetheenvironmentPayattentiontothephysicaldistanceIntroduceyourself…TheArtofaskingquestions

Thefirstquestion:general,open,refertotheinterviewee’sgenerallifesituationorthepresentingproblem:—Whatbringsyouhere?—WhatcanIdoforyou?—Whatisyourproblem?

—Whyareyouhere?(inthehospital)

—Couldyoutellmeabitmoreabout

…TheArtofaskingquestionsNarrowingdownthequestions(generaltospecific)Progression(relativelybenigntopersonal)DirectquestionsLeadingquestions(indirect)Postponedquestions(changeofcontext,bettermoment)Projectivequestions(“somepeople…”,descriptionofinterpersonalsituation)Language…Thelanguagemustbematchedto:—interviewee’sintellectuallevel—verbalskills—personalexperienceAvoidtheprofesionallanguageandshorteningsNonverbalsignalsThedoctor'sclothesEyeexpressionBodypostureNonverbalsignalsThedistanceofdoctor-patientConsultingroomenvironmentSimlingWhentheinterviewcomestoaclose…

Checkwhetherallproblemshavebeendiscussedandleavesometimefortheirdiscussion确认是否遗漏问题并预留讨论时间Whentimeisup–communicateitdirectlyinsteadofconstantlycheckingthetimeor“suggesting”thatyouhavetogo(e.g.Bygatheringthenotesimpatiently)直接告知患者咨询结束，避免以不耐烦的行为或语言驱离患者Trytosummarizetheinterview对问询内容作小结Finishtheconversationstressingyourinterestintheintervieweeandinwhathasbeensaid结束谈话时强调对患者本人及谈话内容的兴趣Youcanaskthepatienttoevaluatetheconversation尝试让患者对访谈内容进行评估Saygood-bye,getupandthanktheintervieweeforcoming.礼貌告别

Recommendation

Recommendation

(CommunicationandDiagnosis)“Patientswhofeelatease