慢性病管理与患通-TheHongKongMedicalAssociation.pptVIP

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 fac