面对癌症医学何为.pptVIP

面对癌症：医学何为？——Dr.E. L. Trudeau的启示 何铁强 2010年2月24日 Dr. E.L. Trudeau Dr. Edward Livingston Trudeau was diagnosed with tuberculosis in 1872.? He decided to spend the little time he believed he had left in his life enjoying the wilderness.? He went to Lake Saranac in the Adirondack Mountains of upstate New York.? Instead of wasting away, however, Trudeau improved!? He credited his newfound health to the environment at Lake Saranac.  Edward Livingston Trudeau (1848-1915) Lower Saranac Lake Viewed from the upper deck. Little Red The original cure cottege built in 1884. Guiding Principles: To cure sometimes, to relieve often, to comfort always By Gutzon Borglum, creator of Mt. Rushmore. Relocated from the original sanitarium to the Institutes library courtyard. The Trudeau Institute A view from Lower Saranac Lake 苏珊·桑塔格（Susan Sontag,1933-2004) 您有过不愉快的经历吗? 作为医务人员； 作为患者 或者作为…… 当医师成为病人时的希望Acad Med 81(5):447-453, 2006 在床边谈，不是在护理站 询问我有无问题 多一点解释 告诉我整个过程 有好的非语言沟通 也有非医师人员帮忙 明确对我谈论“深刻的”问题，不要论断 若我未遵循医嘱，不要太严厉 多谈些非医疗的事务 医患沟通的目标 增加 患者合作度 增进 正确性 效率 支持 增加满意度 改善病情/预后 基本认知 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 沟通的形式 Shot-put approach: 单方向接受 Frisbee approach: 交互式，给回馈，有共同出发点 沟通的层次 寒喧 谈无关紧要的事 理性沟通 感性沟通 沟通的要诀 并非存心说服对方， 而是抛开成见、偏见， 尊重对方立场与意见， 理性地、诚恳地双向沟通 原则 第一印象胜过一切 友善、专注 站在患者的角度着想 安慰就是良药 1. 永远先说“我可以” 2. 倾听、让生气的患者把话讲完. 3. 礼貌称呼病人 4. 微笑 5. 多说请、谢谢、对不起、注意您的声调. 6. 确认一下是否满足病人的需要. 7. 做到超过病人所期待的就是最好的安慰 应如何说“坏消息” ? Why ? (决定要告知吗 ? ) When ? (何时最恰当? ) Who ? (告诉谁? ) Where ? (挑适当场合) How ? (如何进行?) What ? (针对患者的需要) CORE COMPETENCIES Patient care (compassionate, appropriate, effective) Evaluated through: direct observation, clinical outcomes, patient presentations, bedside rounds, Morning Report presentations. Medical knowledge (biomedical, clinical, cognate sciences, and their application)