Chapter 1 Introduction to Doctor-Patient Communication PDF

Doctor-Patient Communication Dr Chengwei Qin 1995.09--2000.07 Binzhou Medical University 2000.07----Binzhou Medical University Hospital 2016.11--2017.02 Mount Sinai Hospital ， New York 2018.06-2021.01 Muhimbili National Hospital, Dar es Salaam, Tanzania 1st oct.1977 oct. 2021 ...

Doctor-Patient Communication Dr Chengwei Qin 1995.09--2000.07 Binzhou Medical University 2000.07----Binzhou Medical University Hospital 2016.11--2017.02 Mount Sinai Hospital ， New York 2018.06-2021.01 Muhimbili National Hospital, Dar es Salaam, Tanzania 1st oct.1977 oct. 2021  Chapter 1 Introduction to Doctor-Patient Communication 目 录 Section 1 Overview of Doctor-Patient Communication Section 2 Humanistic Connotation in Medicine Section 3 Doctor-Patient Relationship and Doctor-Patient Needs  掌握 Connotation of doctor-patient communication 熟悉 Social value of doctor-patient communication Purpose of doctor-patient communication 了解 Doctor-patient communication has become 重点难点 a vital topic in the medical industry Doctor-patient communication is an integral part of medicine and health-care  Section 1 Overview of Doctor-Patient Communication 医患沟通（第 2 版） I. The definition of doctor-patient communication The definition of "doctor": in a narrow sense, refers to medical personnel in health care institutions;in a broad sense, it refers to all medical workers, public health administrators, medical institutions, and medical educators. The definition of "patient": in a narrow sense, refers to patients, relatives, friends, and relevant interested people; in a broad sense, it can refer to a wide number of social groups other than "medical". To deal with doctor-patient conflicts, medical institutions not only need to face patients, but also often to face wider public opinion. Therefore, the broad concept applied to the term: patients are more conducive in the study and practice of building halmonious doctor-patient relationships. 医患沟通（第 2 版） I. The definition of doctor-patient communication The definition of "communication" is the process of establishing consensus, sharing benefits, and developing relationships between people through all-round information exchange. Communication is neither just "communication" as it is usually termed, nor a simple "skill". Its core definition is that people understand and trust each other. The comprehensive information of interpersonal communication includes four types of human languages, namely oral, written, body, and environmental language. Environmental language refers to the perceptual and sensory information of people's scenes of cultural objects that are purposefully arranged in a specific space or a physical environment, such as house structure, furnishings,paintings, flowers, and plants, cleanliness of floors and surfaces, temperature, and humidity, etc. 医患沟通（第 2 版） I. The definition of doctor-patient communication The Connotation of doctor-patient communication: In medical and health work, both doctors and patients focus on diagnosis and treatment, services, health, psychological and social factors. In addition, it places the patients as the center and the doctor as the lead, with a combination of medicine and humanities It is conducted through multi-channel exchanges of all-round information that has a variety of key characteristics. The purpose is to make the doctor and patient reach a consensus and establish a trusting and cooperative relationship, guide the medical staff to provide patients with high-quality medical services, maintain health, and promote medical development and general well-being. 医患沟通（第 2 版） I. The definition of doctor-patient communication From a narrower perspective the process of daily diagnosis and treatment,the medical staff of medical institutions communicate with patients and their relatives about diagnosis,treatment, service, health, and psychological and social-related factors, mainly in the form of medical services. It constitutes the basic link in the practice of pure medical technology and integrated medical services. It occurs in every medical service activity of all medical institutions and is the main component of communication between doctors and patients. Its important value lies in guiding the diagnosis and treatment of patients' injuries and diseases scientifically, and in the improvement of the overall level of medical and health services so that patients and society benefit and appreciate the assistance and care provided. 医患沟通（第 2 版） I. The definition of doctor-patient communication From a broader perspective, doctor-patient communication refers to the communication and exchange between medical and health professionals and all sectors of society in various ways of non-diagnosis and treatment services, mainly focusing on laws and regulations, policies and systems, ethics and morality,medical technology, and service norms, medical talent standards, and programs, etc. This would include the formulating of new medical and health policies, revising the specifications and standards of medical technology and service, handling individual cases, health education, etc. 医患沟通（第 2 版） I. The definition of doctor-patient communication 医患沟通（第 2 版） II. The meaning of doctor-patient communication A. The path to building a harmonious doctor-patient It isrelationship now widely accepted that to achieve the realization of a new medical model, the establishment of a good doctor-patient relationship, and the resolution of doctor-patient conflicts in modern society can no longer rely on a single traditional discipline, method, or solution. The factors that affect the doctor- patient relationship involve politics, economy, ideology, culture, education, law, customs, etc. The key disciplines involved are mainly philosophy, political economy, medicine, ethics, psychology, sociology, and law. And there are more marginal subjects combined with medicine, such as medical ethics, medical psychology,anthropology, and so on. 医患沟通（第 2 版） II. The meaning of doctor-patient communication B. The development of modern medicine has its inherent requirements It took over four thousand years for human medicine to develop as an essential discipline in modern society. The biomedical models featuring morphological somatic diseases dominate, and medicine is readily assisted with modern equipment. In parallel, many of the leaders in modern medicine believe that the most difficult issue to account for is the impact of many of the human hypothetical psychological and social factors on disease and health. These factors can have both causative and curative effects on many of the diseases that are presented to medical services. 医患沟通（第 2 版） II. The meaning of doctor-patient B. The development of modern medicine has its inherent communication requirements Medical scientists have found that the ability of modern medicine to diagnose and treat diseases is limited. Medical activities require more and more active participation and cooperation of patients and social groups, as well as the common thinking and language between doctors and patients. Only by building doctor-patient cooperation and sharing this understanding within a community perspective, can we realistically cope with and overcome more diseases...Doctor-patient communication can explore how to transform psychological and social factors into positive means and methods, to advance modern medicine in its quest to improve diagnosis and treatment of diseases and maintain health. 医患沟通（第 2 版） Ⅲ. The concept of doctor-patient communication A. Doctor-patient communication can be considered as the complex cognitive model and code of conduct of modern medical practice. It is an important process that links patients and staff in the medical and health services, and a platform for the integration of the medical profession, humanities, words, and deeds. It plays a role in improving the level of diagnosis and treatment technology and human services,gaining the trust and cooperation of patients and society, promoting the progress and development of medical careers, and improving social civilization. 医患沟通（第 2 版） Ⅲ. The concept of doctor-patient communication B. In recent years, the direct cause of the discordant relationship between doctors and patients is the adjustment of interests caused by market economy development, social transformation, and the collision between new and old ideas. The fundamental reason for potential conflict is that the doctors and patients have insufficient comprehensive knowledge of the human mind and body. C. Medical workers should be people-oriented, achieve the humanitarian goal of saving the dead and helping the wounded or sick, strive to take social responsibility, play a leading role in the medical industry.fully conduct doctor-patient communication, resolve doctor-patient disputes in good faith, fully implement the bio-psychological-social medical model, and take communication between doctors and patients as a bridge to rebuild the trust and cooperation relationship between doctors and patients. 医患沟通（第 2 版） Ⅲ. The concept of doctor-patient communication D. Doctor-patient communication refers to person-to-person communication, which is essentially the cognition and awareness-raising of doctors and patients. Doctors and patients should be integrated-everyone is a patient and everyone is a doctor, doctors should maintain human life and health; patients are the best assistant of medicine and doctors, and they are the root of the survival and development of doctors. E. Doctor-patient communication is not only the practice and knowledge of biomedicine, multiple humanities, and social sciences, but also an art that combines medicine, science, technology, ethics, psychology,and regulations; Doctor-patient communication has certain techniques rather than skills. It needs to be constructed and implemented from the perspective of ideas, knowledge structures, mechanisms, and regulations.  Section 2 Humanistic Connotation in Medicine 医患沟通（第 2 版） I. Medical model and gradual change The term medical model refers to the general view and behavior style of human beings concerning medicine in the practice of the treatment and prevention of disease, to increase disease resistance and improve mental health. Its underlying philosophy and ideology not only demonstrate the basic characteristics of medicine, but also express the basic theoretical premise to guide medical practice. The medical model studies the attributes, functions, structure, and development laws of medicine. 医患沟通（第 2 版） A. Biomedical model The biomedical model, which is established based on the biological sciences, refers to the medical view and methodology reflecting the law of change among etiology, host, and natural environment. However, with the changes in society and the environment, the main factors to damage human health are cardiovascular diseases, malignant tumors, accidental deaths, respiratory diseases, etc. 医患沟通（第 2 版） A. Biomedical model There are many biological factors of diseases that work through social and psychological factors. The manifestations of diseases have evolved from a single cause and effect to a multiple cause and effect. Therefore, the transition of the medical model from the biomedical model to the bio-psycho-social medical model has become an inevitable trend of medical development. 医患沟通（第 2 版） A. Biomedical model Over the last five hundred years or more, the biomedical model has made a great contribution to human beings. It has defeated and controlled most human diseases with rigorous scientific empirical thinking and medical intervention. It is precisely because of its "great achievements"that the spectrum of diseases and the spectrum of death causation have changed, and the cardio-cerebrovascular diseases, malignant tumors and diseases of the respiratory system have become prominent. Therefore, in this sense, the biomedical model will always be a central pillar of the medical model. 医患沟通（第 2 版） B. Bio-psycho-social medical model There is a sense of massive development and change globally. The role of public health and social health care is becoming increasingly prominent. The struggle between humans and diseases can no longer be individual behavior. Many diseases and health problems must be solved by taking social measures. The concept of health as a basic human right has become a global consensus. 医患沟通（第 2 版） B. Bio-psycho-social medical model In 1974, Broom proposed an environmental health medical model that includes four stimulating factors: environment, genetics, behavior and lifestyle, and health services. Further, Lalonde and Dever perfected the environmental health medical model and proposed a comprehensive health medical model combining health services and policies. In 1977, American medical expert Engel proposed the bio-psycho-social medical model based on the comprehensive health medical model. Therefore, the bio-psycho-social medical model is also called the Engel model. 医患沟通（第 2 版） 医患沟通（第 2 版） B. Bio-psycho-social medical model Engel model builds a systematic framework of disease, patient, and environment (natural environment and social environment) based on the principles of systems theory. Among them, he understood health or disease as a conceptually connected natural system that consists of people, families, communities, and humans (from atoms,molecules, cells, tissues, organs, systems to the whole human body). He believed that health reflects a high level of coordination within and between systems. The basic characteristic of the bio-psycho-social medical model is that each layer is an organic part of the biology-psychology-society system. All layers affect each other and interact up and down. The cause-effect relationship is obvious. Changes at any layer will trigger the entire system and drive the chain reaction of the 医患沟通（第 2 版） II. The meaning of modern medicine What is medicine? There are many different interpretations of the definition of medicine in ancient and modern times. " the art and science of disease prevention and treatment."--Oxford Dictionary There is no doubt that medicine has remarkable epochal and social characteristics. 医患沟通（第 2 版） II. The meaning of modern medicine Modern medicine is a scientific system and practice that studies the maintenance of human physical and mental health, the improvement of quality of life, and the extension of life. Medical practice, guided by the common human health benefits and led by medical and health personnel, requires the cooperation and participation of the whole society. It needs to integrate the physical and mental system, social system,and natural environment system, take the technology of natural sciences, and combine the behaviors of humanities and social sciences, to achieve the medical purpose of personal health and longevity and the harmonious development of the state and society through activities such as medical research, medical treatment, injury prevention, health care and medical education. It consists of a life science, multi-disciplinary knowledge system,and related practical activities. 医患沟通（第 2 版） 医患沟通（第 2 版） Ⅲ. Medical humanities and medical professionalism A. Medical humanities 1. The definition of medical humanities Medical humanities refers to an interdisciplinary subject of medicine and humanities. It is a discipline that studies the relationship between medicine and humanities,and considers and summarizes various medical phenomena and events from the perspective of humanities. The field of the humanities is intrinsically related to various relationships and activities in the medical field. 医患沟通（第 2 版） Ⅲ. Medical humanities and medical professionalism A. Medical humanities 2. Advances in medical humanities There are beliefs and important values about medical humanities that have existed and developed since ancient times. Medical humanities are generally recognized to possess some important conclusions or experiences gained from the independent thinking of long-term or former medical staff. The human environment greatly affects the direction and speed of the development of medical science. The rapid development of biomedicine has brought with its certain crises and misunderstandings in the age of modernity. 医患沟通（第 2 版） Ⅲ. Medical humanities and medical professionalism B. The current medical humanities hot issues and trends Focusing on the humanities does not underestimate the role of science in medicine. On the contrary,focusing on humanities will achieve a balance between science and humanities. 1. Narrative medicine “Narrative medicine is to build the narrative ability of clinicians (it refers to a diagnostic activity performed by doctors with narrative ability, namely a paradigm in line with narrative medicine). It is an ability to absorb, explain, and respond to stories and other human dilemmas.This ability helps clinicians to reflect on patients' empathy, professionalism, affinity (trust relationship), and self-behavior in medical activities. The core is empathy and reflection." --Charon R. of Columbia University in the United States in 医患沟通（第 2 版） Ⅲ. Medical humanities and medical professionalism B. The current medical humanities hot issues and trends 1. Narrative medicine The purpose of narrative medicine is to adjust doctor-patient relationship and listen to the voices of patients who have been rejected by scientific discourse. It is not only a new form of medicine that both patients and doctors need, but also an interdisciplinary subject of medicine and literature. It "relaxes" the tight doctor-patient relationship, and finally changes the somewhat narrow concerns of communication between doctors and patients into the larger spectrum of medical communication understood by the public. 医患沟通（第 2 版） Ⅲ. Medical humanities and medical professionalism B. The current medical humanities hot issues and trends 2. Integrated medicine Medical integration including the integration of clinical disciplines, the integration of clinical medicine and public health and preventive medicine, and the integration of medicine and humanities. It is the organic integration of the most advanced knowledge theory in various fields of medicine and the most effective practical experience in clinical specialties. It is trimmed and adjusted according to social, environmental,and psychological realities, to make it become a new medical system that is more consistent, more suitable for human health, and disease treatment. 医患沟通（第 2 版） Ⅲ. Medical humanities and medical professionalism B. The current medical humanities hot issues and trends 3. Healthy humanities The introduction of healthy humanities, a "more inclusive, more open,and more application-oriented" subject concept, enriches the content of medical humanities, expands the scope of medical humanities practice, evokes more medical care, and attract more health practitioners to pay attention to the social and human issues in the health improvement cause. The medical humanities have made considerable progress and become a more inclusive, open, and practical discipline. 医患沟通（第 2 版） Ⅲ. Medical humanities and medical C. Medical professionalism professionalism 1. The definition of medical professional ethos The so-called medical professional ethos refers to the professional norms that medical practitioners and medical communities should abide by in the course of their practice. It includes technical and ethical norms and industry autonomy. In the entire process of medical practice, medical personnel must always adhere to the unity of medical professional ethos and professionalism in medicine under and circumstances. The essence of this ethos is that the health of patients must come first and the interests of patients are given top priority. Effective communication can not only solve many diversified and complex problems in the medical process, but also is the best way to embody and implement the medical professional ethos. 医患沟通（第 2 版） Ⅲ. Medical humanities and medical professionalism C. Medical professionalism 2. The main content of the medical professional ethos i. professional standpoint, namely the world recognized humanitarianism and altruism; ii. professional purpose, namely life rescue and health service; iii. professional attitude,that is doctors must be devoted to their duties; iv. professional ideal, namely the benevolence and sincerity which is comprehensive optimized medical value. The main way of expression is professional quality, that is, the integration of scientific quality and humanistic quality; V. professional personality,namely the integration of scientific personality and humanities; vi. professional style, namely the integration of scientific style and humanities; vii. professional standards, namely the integration of scientific standards and humanities standards. 医患沟通（第 2 版） Ⅲ. Medical humanities and medical professionalism C. Medical professionalism 2. The main content of the medical professional ethos Among them: professional quality and professional personality are mainly reflected in individuals; professional style and professional standards are mainly reflected in groups. professional quality and professional styles are actual; professional personality and professional standards are deserved. 医患沟通（第 2 版） IV. Evidence-based medicine and its realization medicine (EBM) refers to "a medicine that Evidence-based adheres to the evidence." -- David Sackett, McMaster University in Canada,1992. "the prudent, accurate and wise application of the best research evidence currently available. At the same time, he combined the personal expertise and clinical experience for many years of the clinician, and the value and desire of the patient, to formulate the treatment measures for the patient."--David Sackett,2000. 医患沟通（第 2 版） IV. Evidence-based medicine and its realization The core idea of evidence-based medicine: In clinical medical practice, objective scientific basis results should be used as evidence to judge patients' conditions and make diagnosis and treatment decisions. Clinicians' professional skills should be combined with the best results obtained from current systematic studies. Clinicians should find evidence for patients, strictly evaluate and comprehensively analyze, and apply the best evidence to clinical practice. It can be seen that evidence is the cornerstone of evidence-based medicine, and evidence is the result of existing and proven research. 医患沟通（第 2 版） IV. Evidence-based medicine and its The evidence-based medicine model has the following three aspects of positive realization innovation value: i. medical case for the individual, choose the best diagnosis and treatment plan for the individual with the most responsible attitude and scientific ethos; ii. not to be constrained by relatively mature clinical theories and advanced diagnosis and treatment methods, and still to take the superb professional skills and long-term experience as the core of diagnosis and treatment; iil. to respect the patient's values and the right to choose in the medical process. This is the basic path for the transition from the biomedical model to the social- psychological-biomedical model.  Section 3 Doctor-Patient Relationship and Doctor-Patient Needs 医患沟通（第 2 版） I. Doctor-patient relationship and trend In short, the doctor-patient relationship is the interpersonal relationship developed in medical practice. In a narrow sense, it refers to the relationship between doctors and patients. In a broad sense, it refers to the relationship between health professionals(doctors, nurses, medical technicians, medical administrators, hospital logistics staff, etc.) and patients (patients, their relatives, guardians and companies or organization, etc.). For a better doctor-patient relationship, from a holistic view, we should pay more attention to the doctor-patient relationship in its broad sense. 医患沟通（第 2 版） I. Doctor-patient relationship and trend A. Non-technical aspects Non-technical aspects of the doctor-patient relationship refer only to the interpersonal relationship between doctors and patients. To be precise, it is the relationship resulting from health professionals' service attitude, their medical ethics, morals, and conduct. It embodies the most common and basic principles of interpersonal relationships: equality, respect, trust, and honesty. The health professionals' service attitude has a great influence on the efficacy of the treatment reinforcing the benefits of the relationship between doctor and patient. Therefore, non-technical aspects are a significant and major concern in a doctor-patient relationship today. 医患沟通（第 2 版） I. Doctor-patient relationship and trend B. Technical aspects Technical aspects of the doctor-patient relationship refer to the relationship developed between health professionals and patients (including their families) on technical problems in diagnosis and treatment. 1. Models of doctor-patient relationship The model of the doctor-patient relationship is the behavior pattern between doctors and patients in medical practice. 医患沟通（第 2 版） I. Doctor-patient relationship and trend B. Technical aspects 2. Activity-passivity model It is characterized by the doctor’s one-sided actions being subjected onto the patients;It is doctor-initiated and controlled. The doctors are granted autonomy and professional dominance in decision-making while the patients are regarded as dependent roles, incapable of engaging in medical treatment. This model is generally applicable to emergency medical treatment such as acute trauma,anesthesia, coma, delirium, etc. 医患沟通（第 2 版） I. Doctor-patient relationship and trend B. Technical aspects 3. Guidance-cooperation model In this model, patients can express their feelings and aspirations(even if only in some limited ways), while doctors still dominate. Patients are expected to cooperate with the doctors, accept their explanation and comply with their treatment plan. This model is characterized by"telling patients what to do". 4. Mutual participation model In this model, doctors treat the patient as an equal autonomous individual, they listen to them and respect their views. Both doctors and the patients participate in formulating and implementing the medical plan. It is characterized by "helping patients to help themselves". 医患沟通（第 2 版） I. Doctor-patient relationship and trend B. Technical aspects 5. Pros and cons of traditional doctor-patient relationship model Objectively speaking, its existence is reasonable and beneficial. As a doctor, one can generally understand that people become dysfunctional and have poor judgment after they become ill. The patients are eager to be cured and are looking forward to a full recovery soon. Along with the economic growth and social development, and popularization of science, people are getting a better education, so that their ideas are renewed. They are generally unwilling to be "controlled"like children, hoping that they can participate, more or less, in medical diagnosis and treatment. 医患沟通（第 2 版） I. Doctor-patient relationship and trend B. Technical aspects 医患沟通（第 2 版） II. Patients' needs A. Life safety needs B. Special physiological needs C. Need for information on their injury or sickness D. Need for care and belonging E. Need to be respected F. Need for high-quality survival 医患沟通（第 2 版） Ⅲ. Doctors' needs A. Needs for personal achievement B. Need respect and cooperation from patients and their families C. Need for understanding from all society D. Need for practice and learning E. Need to be respected F. Need for high-quality survival 谢谢观看