INTERACTION WITH PATIENT AND FAMILY

如何与病人及其家属沟通

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.

大多数病人在看病时会感到焦虑和害怕。而医疗检查和记录常常会遗漏某些必重要信息，如病人出身、教育情况、工作、住所和家庭、希望和害怕等。不了解这些，医生就很难与病人关系融洽也无法对疾病有更深入的了解。理想的医患关系是建立在对病人充分的理解、相互信任和相互交流的基础上的。病人所需要的是一位老练、有同情心的医生，他愿意花时间来倾听他们的想法，并用病人能够理解的话语向他们解释病情。

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.

医生的外观和服饰能影响交谈的成功与否。在中国，很多医生都穿白大褂，但这些白大褂常常是皱巴巴的，或是带有污渍。这会使病人觉得医生粗心甚或不称职。医生应该衣着整洁，佩带写有姓名和职务的胸牌(如主治医生、住院医生等)。这样的穿着表明你对病人及对医生职业的尊重。与银行职员、业务人员或是公务员一样，我们同样也是面对大众的专业人士，我们的穿着表明了我们对病人的尊重。

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

虽然病人都希望自己的医生是有知识能用途的临床医师；但他们同时也需要医生会安慰人、乐于助人、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!

和病人互动的首要目标是要与病人“建立一种关系”。“与医生关系好的病人更愿意听医生的话。”在看病过程中先花费几分钟时间去了解病人是很有帮助的。有些问题，如“你住哪里？你做什么工作”等，不仅对明确诊断十分重要，而且可以让病人真正感觉到自己被看作“人”，而不是一种要根除的“疾病”。医学 全在.线提供

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.

医生的肢体语言和行为举止也是医患关系质量的决定因素之一。医生的肢体语言，如眼神接触、身体姿势、说话音量等，都可以传达出他的态度是关心或不耐烦。医生若是关心病人，在和病人的眼神保持直接接触的同时，他还会在说话时身体前倾。他还会把手放在病人的肩头，尽量去安慰病人。

“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.”

“充满同情的注视、默默地注意倾听、将手放在病人肩头，这些都足以使病人感到医生对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.医.学全.在.线www.med126.com

与病人进行清楚的交流非常重要，因为这不仅可以避免误解，而且有助于指导诊治方案的制定。而且，当病人与医生小组更熟悉时，他们就会与医生关系更和谐，更尊敬医生。这不仅有助于护理，也有利于病人得到高效优质的服务。如果病人真正信任他的医生，他在接受可能产生严重并发症的治疗方案时也会更愿意。

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.

与患者家人的沟通也很重要。医生必须花时间向患者家人说明病人的诊断、治疗方案和预后。实际上，在病人入院72小时内，医院病历中就必须要有书面记录，证明与病人家属进行了病情讨论。这份记录还必须由一位家属的共同签名。记录必须语言简洁，家人能够理解。在中国，病人家属在决定病人护理上负主要责任，并要求其签署同意书方可进行医疗操作。

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.

总之，与家属及病人在床边的有效交流与沟通是查房成功的基础。不管你在交流前作了怎样的准备与组织，如果见面时表现得不礼貌不得体，查房就不可能使病人真正“获益”，它反而会导致严重的误解。并可能促使病人和家属反对医疗建议，要求出院，甚至造成今后对医院和医生采取法律行动。