坏消息的新告知41.pptVIP

壞消息的告知;影片的兩個印象;「臨床溝通技巧」下學期授課進度表 ;壞消息的告知;一位門診的複診病人，上次因排便習慣改變而被安排大腸鏡檢查。 輪到他看診時有一位較年輕的女仕率先步入，並回頭吩咐兩個較年輕的男性：「先陪爸在外頭等一下。」 然後就向你（門診醫師）說：「家父（指病人）在上週檢查大腸，檢查的醫生說腸子裡長了一個瘤子，看來像是癌症，今天是來看切片的報告，請先告訴我結果。因為家父已經七十多歲，又有心臟病，我們全家都怕他受不了刺激，所以如果是癌症，千萬不能讓他知道。」 你在電腦上查得病理報告是：adenocarcinoma, well differentiated。 你要怎麼說？ ;要說慌嗎？;說謊的時機;為何壞消息會傷害到病人？;說謊有好處嗎？;說謊有壞處嗎？;生命倫理四原則;生命倫理四原則;生命倫理四原則：一個古老笑話;生命倫理四原則;生命倫理四原則;研究倫理七原則;凡事誠實容易嗎？;一位主治醫師的告白;回顧剛才的案例 ;壞消息的告知;告知壞消息的三種方法 (Brewin 1991);The Third Way;壞消息難以告知的理由;被告知壞消息後的情緒反應;被告知壞消息後情緒反應的處理;告知壞消息—非緊急情況;告知壞消息的能力養成;告知壞消息的考量要點;告知壞消息的“SPIKES”步驟 (R. Buckman, 1992);SPIKES;SPIKES;SPIKES;SPIKES;SPIKES;SPIKES;壞消息的告知;一位門診的複診病人，上次因排便習慣改變而被安排大腸鏡檢查。 輪到他看診時有一位較年輕的女仕率先步入，並回頭吩咐兩個較年輕的男性：「先陪爸在外頭等一下。」 然後就向你（門診醫師）說：「家父（指病人）在上週檢查大腸，檢查的醫生說腸子裡長了一個瘤子，看來像是癌症，今天是來看切片的報告，請先告訴我結果。因為家父已經七十多歲，又有心臟病，我們全家都怕他受不了刺激，所以如果是癌症，千萬不能讓他知道。」 你在電腦上查得病理報告是：腺癌;處理方式;與家屬作「具同理心的溝通」;一位門診的複診病人，上次因排便習慣改變而被安排大腸鏡檢查。 輪到他看診 你在電腦上查得病理報告是：腺癌;SPIKE;壞消息的告知;錯 誤;美國人怎樣看待錯誤？;Case 1;Case 1;Case 2;Case 2;Case 3;Case 3;The Ellen Roche Story;The consent form she signed warned of coughing, dizziness, and tightness in the chest, but not death. It called hexamethonium a medication although its approval by the FDA (as a treatment for high blood pressure) had been withdrawn in 1972. Dr. Alkis Togias, the director of the experiment, apparently limited his hexamethonium research to one contemporary textbook and PubMed. ;The use of hexamethonium in the 1950s to treat high blood pressure created an evidentiary trail revealing some disturbing risks. Several articles published in print journals during the 1950s showed that hexamethonium could cause fatal lung inflammation. Unfortunately, PubMeds coverage starts in the mid-1960s. When the FDA withdrew its approval of hexamethonium in 1972, it cited the drugs substantial potential toxicity. Unfortunately, PubMed covers medical research, not FDA rulings.;Ellen Roche died on June 2, and the Roche family has apparently not yet filed a lawsuit. However, JH still faced a serious sanc