慢性病管理与患通.ppt

第八届京港医学交流会议 2006-11-11～12 慢性病管理与医患沟通——如何把病人领回生命的春天 Management of Chronic Diseases and Doctor-patient Communication --how to “revitalize” our patients 高血压、糖尿病、冠心病和缺血性脑血管病等慢性病的有效管理，是社区全科医生的重要工作内容，也是一个比较困难的课题。  It is an important yet a difficult task for family physicians to efficiently manage chronic diseases like hypertension, diabetes, coronary heart diseases and ischemic cerebrovascular diseases. 因为此类疾病不但需要有效药物的治疗，有责任心的医生的随访，而且更需要病人的长期的积极配合——特别是在改变生活方式方面——这一项可以说起着决定性的作用。 Besides drug therapy and regular follow-up, the most crucial factor for effective management depends on our patients’ compliance—especially life style modifications. 而医生与病人的良好沟通是提高病人治疗依从性必不可少的途径。 Patient’s compliance depends very much on effective doctor-patient communication. 这就像世界医学教育联合会《福冈宣言》所指出的一样：所有医生必须学会交流和处理人际关系的技能。缺少共鸣（共情）应当看做与技术不够一样，是无能力的表现。因此，应当认为医患交流是医生的必修课。 As stated in <Fukuoka Pronunciamento> by World Federation for Medical Education, all doctors must learn how to communicate effectively with their patients. Lack of empathy should be regarded as incapability, or lack of skill. Hence, “doctor-patient communication” is an indispensable subject 病例1 ，张某 男性 74岁 因患糖尿病、冠心病，心肌梗死，冠脉搭桥术，术后下肢伤口感染开裂请医生出诊换药。 Case No.1, Mr. Zhang,74/M, Diabetes, CHD, old myocardial infarct, post-CABG ?lower limbs wound infection with “cracking” ?doctor consulted for home wound dressing. 初见病人情绪沮丧，右下肢大隐静脉手术伤口几乎全层开裂，宽15厘米，深约1.2厘米，有少许脓性分泌物覆盖。（图1） The patient was very depressed as layers of operated deep vein wound (for CABG) remained open. It was 15cm wide and 1.2cm deep with a little pus on it (Figure 1) 当时病人非常悲观，眉头紧锁，认为痊愈希望渺茫。查空腹血糖与餐后血糖均高于不正常。 The patient was very sad and pessimistic about the chance of recovery. His FBG and 2hrppG were all abnormal. 医生首先说明伤口愈合与血糖水平密切相关，后者又与饮食、运动情况直接联系，而情绪好坏在稳定血糖方面有不可替代的作用。 Doctor explained that wound healing was related to blood sugar level which directly relates to diet and physical activity. Moreover, mood stability is a key f