如何與病人及家屬溝通

INTERACTION WITH PATIENT AND FAMILY

如何與病人及其家屬溝通

Most patients are anxious and frightened. Medical workups and records often fail to include essential information about the patient’s origins, schooling, job, home and family, hopes and fears. Without this knowledge, it is difficult for the physician to gain rapport with the patient or to develop insight into the illness. The ideal physician patient relationship is based on thorough knowledge of the patient, on mutual trust, and on the ability to communicate with one another. What the patient most need is a tactful, caring physician who is willing to take time to address their concerns and explain their illness using language they are able to understand.

大多數(shù)病人在看病時會感到焦慮和害怕。而醫(yī)療檢查和記錄常常會遺漏某些必重要信息，如病人出身、教育情況、工作、住所和家庭、希望和害怕等。不了解這些，醫(yī)生就很難與病人關(guān)系融洽也無法對疾病有更深入的了解。理想的醫(yī)患關(guān)系是建立在對病人充分的理解、相互信任和相互交流的基礎(chǔ)上的。病人所需要的是一位老練、有同情心的醫(yī)生，他愿意花時間來傾聽他們的想法，并用病人能夠理解的話語向他們解釋病情。

The physician’s physical appearance and clothing can influence the success of the interview. Although many physicians in China wear white coats, often they are wrinkled or soiled. This may convey a sense of carelessness or even incompetence to the patient. The physician should always dress neatly and wear an ID badge with his name and position (i.e. Attending, Resident). Such attire shows respect for the patient and the medical profession. Just like bankers, businessmen or government legislators, we are professionals who deal with the public and our clothing attire demonstrates our attitude of respect towards our patients.

醫(yī)生的外觀和服飾能影響交談的成功與否。在中國，很多醫(yī)生都穿白大褂，但這些白大褂常常是皺巴巴的，或是帶有污漬。這會使病人覺得醫(yī)生粗心甚或不稱職。醫(yī)生應(yīng)該衣著整潔，佩帶寫有姓名和職務(wù)的胸牌(如主治醫(yī)生、住院醫(yī)生等)。這樣的穿著表明你對病人及對醫(yī)生職業(yè)的尊重。與銀行職員、業(yè)務(wù)人員或是公務(wù)員一樣，我們同樣也是面對大眾的專業(yè)人士，我們的穿著表明了我們對病人的尊重。

Although patients expect their doctors to be knowledgeable and competent clinicians, they also need their doctors to be reassuring, supportive and sympathetic.

雖然病人都希望自己的醫(yī)生是有知識能用途的臨床醫(yī)師；但他們同時也需要醫(yī)生會安慰人、樂于助人、富有同情心。

One of the first goals of interaction with the patient is to “build a relationship” with the patient. "The patient with a good relationship with his physician will be more likely adhere to the physician’s advice. It’s helpful to spend the first few minutes of the medical encounter getting to “know” the patient. Such questions as “where do you live? What is your occupation?” may not only be important to help discern the diagnosis, but can convey a real sense of viewing the patient as a person rather than just a “disease” to be eradicated!

和病人互動的首要目標(biāo)是要與病人“建立一種關(guān)系”。“與醫(yī)生關(guān)系好的病人更愿意聽醫(yī)生的話�！痹诳床∵^程中先花費(fèi)幾分鐘時間去了解病人是很有幫助的。有些問題，如“你住哪里？你做什么工作”等，不僅對明確診斷十分重要，而且可以讓病人真正感覺到自己被看作“人”，而不是一種要根除的“疾病”。醫(yī)學(xué) 全在.線提供

The physician’s nonverbal skills and behavior are one of the most important determinants of the quality of the overall doctor-patient relationship. The physician’s nonverbal cues such as eye contact, body posture, voice tone may either convey an attitude of concern or impatience. While maintaining direct eye contact with the patient, the concerned physician will lean forward towards the patient while speaking to them. He may also place his hand on their shoulder while trying to reassure them.

醫(yī)生的肢體語言和行為舉止也是醫(yī)患關(guān)系質(zhì)量的決定因素之一。醫(yī)生的肢體語言，如眼神接觸、身體姿勢、說話音量等，都可以傳達(dá)出他的態(tài)度是關(guān)心或不耐煩。醫(yī)生若是關(guān)心病人，在和病人的眼神保持直接接觸的同時，他還會在說話時身體前傾。他還會把手放在病人的肩頭，盡量去安慰病人。

“A sympathetic look, an attentive silence, and a hand on the shoulder can all accomplish a great deal toward letting the patient know the doctor is emotionally in tune with the patient's distress.”

“充滿同情的注視、默默地注意傾聽、將手放在病人肩頭，這些都足以使病人感到醫(yī)生對病人痛苦的真切情感。”

Clear communication with the patient is critically important not only to avoid misunderstandings, but also to help guide decisions regarding diagnostic tests and therapy. Furthermore, as patients become better acquainted with the physician team, they develop rapport and respect for them. This not only facilitates care, but allows the patient to receive efficient, high-quality care. The patient is more willing to accept treatment options that may involve significant complications if they truly trust their physician team.醫(yī).學(xué)全.在.線m.bhskgw.cn

與病人進(jìn)行清楚的交流非常重要，因?yàn)檫@不僅可以避免誤解，而且有助于指導(dǎo)診治方案的制定。而且，當(dāng)病人與醫(yī)生小組更熟悉時，他們就會與醫(yī)生關(guān)系更和諧，更尊敬醫(yī)生。這不僅有助于護(hù)理，也有利于病人得到高效優(yōu)質(zhì)的服務(wù)。如果病人真正信任他的醫(yī)生，他在接受可能產(chǎn)生嚴(yán)重并發(fā)癥的治療方案時也會更愿意。

Interaction with the patient's family is also vitally important. The physician must spend time with the family trying to explain the patient's diagnosis, treatment plan and prognosis. In fact in our hospital there must be written documentation in the chart within 72 hrs. of admission that there has been a discussion with the family. This must be co-signed by a family member. These must be explained in simple language that the family can understand. In China, family takes major responsibility for making decisions regarding patient care and they are required to sign the consent form for patient procedures.

與患者家人的溝通也很重要。醫(yī)生必須花時間向患者家人說明病人的診斷、治療方案和預(yù)后。實(shí)際上，在病人入院72小時內(nèi)，醫(yī)院病歷中就必須要有書面記錄，證明與病人家屬進(jìn)行了病情討論。這份記錄還必須由一位家屬的共同簽名。記錄必須語言簡潔，家人能夠理解。在中國，病人家屬在決定病人護(hù)理上負(fù)主要責(zé)任，并要求其簽署同意書方可進(jìn)行醫(yī)療操作。

In summary, effective interaction and communication with the patient at the bedside and with the family is the “cornerstone” or foundation of successful patient rounds. No matter how much preparation and organization preceded this interaction, if this encounter is not handled courteously and properly, patient rounds will not truly "benefit" the patient and will result in serious misunderstandings. Further this could prompt the patient and family to request discharge from the hospital against medical advice and even result in future legal action against the hospital and physician.

總之，與家屬及病人在床邊的有效交流與溝通是查房成功的基礎(chǔ)。不管你在交流前作了怎樣的準(zhǔn)備與組織，如果見面時表現(xiàn)得不禮貌不得體，查房就不可能使病人真正“獲益”，它反而會導(dǎo)致嚴(yán)重的誤解。并可能促使病人和家屬反對醫(yī)療建議，要求出院，甚至造成今后對醫(yī)院和醫(yī)生采取法律行動。