醫病溝通 醫病溝通 蔡淳娟蔡淳娟

OutlineOutline

• Background• What is Dc-Pt communication?• How to teach and learn on Dc-Pt

communication ?• Calgary Cambridge Guide• University of Washington Family Medicine

Patient-centered Care• Practice

Doctor-Patient Communication: Principles and Doctor-Patient Communication: Principles and PracticesPractices

Can. J. Neurol. Sci. 2002; 29: Suppl. 2 – S23-S29Can. J. Neurol. Sci. 2002; 29: Suppl. 2 – S23-S29Suzanne M. KurtzSuzanne M. Kurtz

Doctor-Patient CommunicationDoctor-Patient Communication 1970 vs. today1970 vs. today

• 1970 年代只教醫師三件事 : – Medical knowledge – Physical examination– Medical problem solving

• 若今天仍然如此，那就會這樣 …… ..

Underlying assumptionsUnderlying assumptions

• Communication is a basic clinical skill

• Communication in medicine is a series of learned skills– Not a personal trait

– Anyone can learn who wants to

• Experience can be a bad teacher

• Knowledge of skills does not translate directly into performance

Teach and Learn in Teach and Learn in CommunicationCommunication

– Systematic delineation and definition of skills

– Observation of learners with patients

– Well-intentioned, detailed, descriptive feedback

– Practice and rehersal of skills

– Planned reiteration and deepening of skills

Categories of skillsCategories of skills

• Promoting collaboration and partnership

• Ensuring increased– Accuracy– Efficiency– Supportiveness

• Enhancing patient and physician satisfaction

• Improving health outcomes

Approaches to Approaches to communicationcommunication

• Shot-put approach: the well-conceived message

• Frisbee approach: interaction, feedback, relationship, confirmation, common ground

Principles that characterize Principles that characterize effective communicationeffective communication

• Ensures an interaction rather than a direct transmission process

• Reduces unnecessary uncertainty• Requires planning and thinking in terms

of outcomes• Demonstrates dynanism• Follows the helical model

The Framework of the Calgary The Framework of the Calgary Cambridge GuideCambridge Guide

• Initiating the Session– Establishing initial rapport– Identifying the reasons for the patients’ attendance

• Gathering Information– Exploration of problems– Understanding the patient’s perspective– Providing structure to the consultation

• Building the relationship– Developing rapport– Involving the patient

The Framework of the Calgary Cambridge The Framework of the Calgary Cambridge GuideGuide

• Explanation and Planning– Providing the correct amount and type of

information– Aiding accurate recall an understanding– Achieving a shared understanding: incorporating

the patient’s perspective– Planning: shared decision making– Options in explanation and planning– If discussing opinion and significance of problems– If negociating mutual plan of action– If discussing investigations and procedures

• Closing the session

Cases for ChangeCases for ChangeUniversity of Washington Family Medicine

Patient Centered Care

• Purpose: … This interactive web tool is designed to help you begin to integrate health behavior change counseling skills into your routine patient centered communication practice. These skills will be reinforced by reading, practice and faculty feedback during the clerkship.

• Course Credit: This is primarily a learning tool. Completion of this case to the best of your abilities is required to receive credit for the clerkship. Beyond that, your specific responses will not affect your clerkship grade. We strongly suggest you do this module during the third week of your rotation.

醫病現場醫病現場