《医患交流课件》由会员分享，可在线阅读，更多相关《医患交流课件（77页珍藏版）》请在金锄头文库上搜索。
1、医患交流医患交流 Why, What , HowWhy, What , Howwww中国特色的医患关系中国特色的医患关系uu令人堪忧令人堪忧uu矛盾升级矛盾升级uu暴力残酷暴力残酷 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（
2、6刀） 和一名护士（20刀）医患关系恶化到如此血腥的地步，医患关系恶化到如此血腥的地步，在人类历史上是罕见的在人类历史上是罕见的!医患关系的基本要素医患关系的基本要素l六个 “ C” 选择 ( choice) 称职 ( competence) 交流( communication) 同情 ( compassion) 连贯性( continuity) 利益不冲突( no conflict of interest) l医生与患者：I-you, not I-It交流贯穿整个医疗过程交流贯穿整个医疗过程Doctor-patient communicationDoctor-patient communic
3、ation l l从病史采集到完成治疗从病史采集到完成治疗l l医生与患者建立关系医生与患者建立关系在有效的交流基础之上在有效的交流基础之上Patient-physician communication is an integral part of clinical practice. -TravalineTravalineIs there a problem?Is there a problem?Evidence suggests that problems with physician- patient communication are common:54% of problems 29
4、:suppl.2-S23-S29Neurol. Sci. 2002;29:suppl.2-S23-S29有效交流的五个原则有效交流的五个原则 （Effective communicationEffective communication）uEnsures interaction not just transmissionuReduces unnecessary uncertaintyuRequires planning, thinking in terms of outcomesuDemonstrates dynamismuFollows a helical rather than a lin
5、ear model交流技能包括交流技能包括内容交流技能（content skills）What doctors do?过程交流技能（process skills）How do you do?感知交流技能（perceptual skills）What they are thinking 297:1638-91998;297:1638-9GreenhalghGreenhalgh P. Old bones. Br Med J 1999;318 P. Old bones. Br Med J 1999;318：13611361uu学术会议证明学术会议证明Prof. J, Spencer, univers
6、ity of NewcastleProf. J, Spencer, university of Newcastle骨科医生沟通能力骨科医生沟通能力l l风湿病风湿病2222例，骨科疾病例，骨科疾病2626例，骨折例，骨折2222例例l l4 4名风湿病医生，名风湿病医生，5 5名骨科医生名骨科医生l l时间：时间：23min23min（风湿）（风湿）vsvs 10.3min10.3min（骨科）（骨科）vsvs 4min4min（骨折（骨折）l l满意度：满意度：1717分（风湿）分（风湿）vsvs 1515分（骨科）分（骨科）vsvs 1414分（骨折）分（骨折）J.ONeill，J.R.W
7、illams Doctor-patients communication in a musculoskeletal unit: relationship between an observer-rated structured scoring system and patient opinion. Rheumatology 2003;42:1512-1522AdamsonAdamson评价医疗纠纷量与患者评价医生的交流技能的关系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AdamsonAdamson研究患者评价医生交流技能研究患者评价医生交流技能Co
8、mmunication Communication uuA basic clinical skillA basic clinical skilluuA series of learned skills A series of learned skills uuA set of procedures for improving outcomes A set of procedures for improving outcomes of careof carel lThere is no achievement ceiling you can There is no achievement cei
9、ling you can never “arrive” never “arrive” ， and then just forget and then just forget about maintaining mastered skills or about maintaining mastered skills or learning even better ones.learning even better ones. l lLearning, maintaining, and enhancing Learning, maintaining, and enhancing them is a
10、 life-long task.them is a life-long task.Suzanne M. KurtzSuzanne M. KurtzuuFormal training programs have been created to enhance Formal training programs have been created to enhance and measure specific communication skills.and measure specific communication skills.uu Many of these efforts, however
11、, focus on medical schools Many of these efforts, however, focus on medical schools and early postgraduate years and, therefore, remain and early postgraduate years and, therefore, remain isolated in academic settings. isolated in academic settings. uuThus, the communication skills of the Thus, the
12、communication skills of the busy physicianbusy physician often remain poorly developed, and the need for often remain poorly developed, and the need for established physicians to become better communicators established physicians to become better communicators continues.continues.Kurtz SM. Doctor-pa
13、tient communication: principle and practicesHow to Communicate with Patients Reminders for the Busy PhysicianThe Accreditation Council for Graduate Medical Education recommends that physicians become competent in five key communication skillsulistening effectivelyueliciting information using effecti
14、ve questioning skillsuproviding information using effective explanatory skillsucounseling and educating patientsumaking informed decisions based on patient information and preference医疗纠纷中交流不良的影响医疗纠纷中交流不良的影响 （impact of miscommunication)impact of miscommunication)uu医疗纠纷医疗纠纷医患关系不良医患关系不良多种原因多种原因 医源损伤医源损
15、伤 疏忽疏忽uu并不是所有医疗错误均并不是所有医疗错误均 纠纷纠纷medical disputemedical dispute 诉讼诉讼lawsuitlawsuit学习有效的交流技术学习有效的交流技术网球达到大师的水平网球达到大师的水平要练习技巧和方法要练习技巧和方法而不是总的概括而不是总的概括如不注意医患交流技术，如不注意医患交流技术，也有退步的可也有退步的可能能Does Competence in Delivering Bad News Make a Difference to Patients?Physician competence in delivering bad Physicia
16、n competence in delivering bad news influencesnews influences 焦虑焦虑 压抑程度压抑程度 希望希望 治疗决定治疗决定decision makingdecision making 对疾病的调整对疾病的调整Lee.Lee. Enhancing Physician-Patient Communication American Society of Hematology Enhancing Physician-Patient Communication American Society of HematologyIn a study of 100 patients withIn a study of 100 patients with breast cancer surveyed 6 months after surgerybre
