醫病溝通 蔡淳娟

Outline Background What is Dc-Pt communication? How to teach and learn on Dc-Pt communication ? Calgary Cambridge Guide University of Washington Family Medicine Patient-centered Care Practice

Doctor-Patient Communication: Principles and Practices Can. J. Neurol. Sci. 2002; 29: Suppl. 2 – S23-S29 Suzanne M. Kurtz

Doctor-Patient Communication 1970 vs. today 1970 年代只教醫師三件事 : –Medical knowledge –Physical examination –Medical problem solving 若今天仍然如此，那就會這樣 ……..

Underlying assumptions 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

Teach and Learn in Communication –Systematic delineation and definition of skills –Observation of learners with patients –Well-intentioned, detailed, descriptive feedback –Practice and rehersal of skills –Planned reiteration and deepening of skills

Categories of skills Promoting collaboration and partnership Ensuring increased –Accuracy –Efficiency –Supportiveness Enhancing patient and physician satisfaction Improving health outcomes

Approaches to communication Shot-put approach: the well-conceived message Frisbee approach: interaction, feedback, relationship, confirmation, common ground

Principles that characterize effective communication Ensures an interaction rather than a direct transmission process Reduces unnecessary uncertainty Requires planning and thinking in terms of outcomes Demonstrates dynanism Follows the helical model

The Framework of the Calgary Cambridge Guide The Framework of the Calgary Cambridge Guide Initiating the Session –Establishing initial rapport –Identifying the reasons for the patients’ attendance Gathering Information –Exploration of problems –Understanding the patient’s perspective –Providing structure to the consultation Building the relationship –Developing rapport –Involving the patient

The Framework of the Calgary Cambridge Guide Explanation and Planning –Providing the correct amount and type of information –Aiding accurate recall an understanding –Achieving a shared understanding: incorporating the patient’s perspective –Planning: shared decision making –Options in explanation and planning –If discussing opinion and significance of problems –If negociating mutual plan of action –If discussing investigations and procedures Closing the session

Cases for Change Cases for Change University of Washington Family Medicine Patient Centered Care Purpose: … This interactive web tool is designed to help you begin to integrate health behavior change counseling skills into your routine patient centered communication practice. These skills will be reinforced by reading, practice and faculty feedback during the clerkship. Course Credit: This is primarily a learning tool. Completion of this case to the best of your abilities is required to receive credit for the clerkship. Beyond that, your specific responses will not affect your clerkship grade. We strongly suggest you do this module during the third week of your rotation.

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