医患交流.pptVIP

医患交流Why, What , How;中国特色的医患关系;2001年7月13日湖南中医学院附属第一医院王万林医生惨遭他曾医治的病人杀害 2003年8月24日武汉市同济来福门诊部2名医务人员被刺死、4名被刺伤 2004年2月11日四川大学华西医院李宁医生被砍伤，致粉碎性开放性颅骨骨折、失血性休克 2005年8月12日福建中医学院戴春福医生在该院附属“国医堂”医院出诊时被患者用刀捅死 2010年6月12日和13日山东齐鲁医院患者家属两天在同一地点（办公司）杀死一名医生（6刀）和一名护士（20刀）;;医患关系恶化到如此血腥的地步，在人类历史上是罕见的!!!;;Patient-physician communication is an integral part of clinical practice. ;Is there a problem?;Beckman研究：医生打断患者为18s Kurt研究：医生打断患者为23s 8%患者认为已完成 影响依从性(compliance);;医生与患者的一致性(agreement);; Training in patient-physician communication is also now objectively evaluated as a core competency in various accreditation settings Comprehensive Osteopathic Medical Licensing Examination—USA—Performance Evaluation The United States Medical Licensing Examination The American Board of Medical Specialties’ certification 1995年，WHO提出“五星级医生” “保健提供者、交际家、决策者、健康教育家、社区领导者、服务管理者”; Dr. Duffy of the American Board of Internal Medicine cited the many advances in communication skills that are used by politicians and advertisers to exert influence. Dr. Duffy indicated that Physicians must be as attentive to developing and refreshing communication skills as diagnostic therapeutic skills.;Can Communication Skills Be Taught?;Kurtz提出：Two primary factors have been responsible for this major shift in attitude and practice; Aspergren回顾180篇医患交流教育的文献 179篇文献支持可以教育和学习 学生和不同级别的医生接受能力相似 专业医师（specialist）也同样受益 ;Fallow field报道3天workshop训练用录像观察;单纯经验对提高交流技能作用有限;单纯依靠经验Experience alone is not a good teacher;从上级医师中学习交流技巧不够;谈话时间的问题; Engaging in patient-centred care does take more time while mastering the skills. When learning to ski, It took me 45 min to get down a hill that I can now easily ski in 3 min. The hill has not changed. My skill level has.;教育和训练交流技能的目的;Miller提出;知识的本身不能直接转化为行为;医患交流的第一原则FIRST PRINCIPLES OF COMMUNICATION;有效交流的五个原则（Effective communication）;交流技能包括; Stewart reviewed literature (1983-1998) analyzing patient outcomes relative to physician-patient communication (either randomized control