MEDICAL COMMUNICATION Jean Chow M D KMC M

醫病溝通 MEDICAL COMMUNICATION Jean Chow M. D. (KMC), M. A. (NKNU)

醫病溝通模式 Low Physician Control High Low Patient Control High Default Paternalism Consumerism Mutuality Roter & Hall, 1996

醫病溝通模式：Paternalism

醫病溝通模式：Consumerism

What behaviors should be avoided? 1. Being unduly dominant 過度支配性 2. Angry 發怒 3. Nervous 緊張 4. Directive 發號施令

What behaviors can link to positive patient outcomes? Verbal 言語上的行為 Nonverbal 非言語上的行為

Verbal behaviors 1. Empathy 與患者保持同理心 2. Reassurance 令患者安心 3. Support 支持 4. Patient-centered questioning 以患者為中 心的問診

Verbal behaviors 5. Friendliness 保持友善 6. Courtesy 禮貌應對 7. Explanation 耐心解釋 8. Positive reinforcement 正向地強化

Verbal behaviors 9. Humor 幽默 10. Psychosocial talk 社會心理層面的言談 11. Time in health education and information sharing 給予時間做衛教並分享資訊

Verbal behaviors 12. Orientating the patient to the examination 說明檢查內容 13. Summarization 總結 14. Clarification 澄清、進一步說明

Behaviors that link to positive patient outcomes Dr Albert Mahrabian in “The body language”: Effectiveness of Spoken Communication

Nonverbal behaviors 1. Head nodding 點頭 2. Forward lean 身體前傾 3. Direct body orientation 身體方向

Nonverbal behaviors 4. Uncrossed legs and arms 勿盤腿、勿兩臂 交叉 5. Arm symmetry 雙手姿勢對稱 6. Less mutual gaze 減少雙向凝視

Kalamazoo Consensus 1. Open the discussion 開啟討論 2. Gather information 收集資訊 3. Understand the patient's perspective 理解患者想法 4. Share information 分享資訊 5. Reach agreement on problems and plans 對患者的問題及治療計畫達成共識 6. Provide closure 結束會談

有意識的操作 Consciousness Application Schmidt (1994): 4 senses of “consciousness” 1. Awareness 2. Attention 3. Intentionality 4. Control

Consciousness as Awareness

Consciousness as Awareness

Consciousness as Attention

Consciousness as Attention

Consciousness as Attention

Consciousness as Intentionality

Consciousness as Intentionality

Consciousness as Intentionality

Consciousness as Control

Consciousness as Control

Consciousness as Control

Consciousness as Control To do or not to do? A matter of decision Doing the right thing right. A matter of control

Reference • Hawken, S. J. (2005). Good communication skills: Benefits for doctors and patients. • Makoul G. for Participants in the Bayer–Fetzer Conference on Physician–Patient Communication in Medical Education. Essential elements of communication in medical encounters: the Kalamazoo consensus statement. Acad Med. 2001 Apr; 76(4): 390 -3. • Beckman HB, Frankel RM. The effect of physician behavior on the collection of data. Ann Intern Med 1984; 101: 692– 6. • Marvel MK, Epstein RM, Flowers K, Beckman HB. Soliciting the patient’s agenda: have we improved? JAMA 1999; 281: 283– 7. • Beck RS, Daughtridge R, Sloane PD. Physician-patient communication in the primary care office: a systematic review. J Am Board Fam Pract 2002; 15: 25– 38. • Roter, DL, & Hall, JA (1996). Patient provider communication. In K. Glanz, F. M. Lewis, & B. K. Rimer (Eds. ) Health behavior and health education: Theory, research, and practice (2 nd ed. , pp. 206 -226). San Francisco: Jossey-Bass. • Roter DL, Hall JA. Physician gender and patient-centered communication: a critical review of empirical research. Annu Rev Public Health 2004; 25: 497– 519. • English in Medicine, Glendinning & Holmstrom, 3 rd Ed, Cambridge University Press Happy Communicating!