20. Robert Buckman,
MB,PhD,FRCP,FRCP( C )
Medical Oncologist and
Associate Professor of Medicine,
Toronto-Bayview Regional Cancer
Centre, University of Toronto, Canada
London:Pan books, 1994
21. 基本的醫病溝通模式CLASS
• Context:準備好傾聽病人的心聲:坐下、
放輕鬆、肢體接觸、隱私、參與的人
• Listening Skills:發問-封閉式、開放式;
稱職的聽眾:讓病人說、盡量不打斷、鼓
勵的語助詞;聽到了:重述最後一句話中
的關鍵字、
澄清、摘要
• Acknowledgement of Emotions:先處理情
緒、再處理需要說明的事。
• Strategy:說明選項
• Summary:
– Buckman R. How to break bad news – A guide for healthcare
professionals. London:Pan books, 1994; --Practical Plans for
Difficult Conversations in Medicine. JHU press, 2010
23. Communication
Hourglass
–
Dr.
Robert
Buckman
2010
Patient’s:
Symptoms, prognosis, Concerns
side effects, family,
finance, more …
Clinician’s:
Optimal management,
risk-benefit, sequelae,
more …
Clinician-Patient
meeting
Medical
Supportive
(person-centered):
Symptom management,
social support,
psychotherapy/ psychiatry,
more …
Management
Plan
(condition-centered):
Optimal disease
management, risk
-benefit, side effects,
more …
48. 會談的本質包括:
• 披露訊息:
你把訊息帶給病人.
• 治療性對話: 傾聽並且瞭解病人
對這訊息的反應並給予適當回應
Buckmann R. How to break bad news – A guide for healthcare
professionals. London:Pan books, 1994
78. 檢視
醫病對談
的目標
clinical encounter with the patient/family
1. 從病人處收集資料;鑑別診斷的基礎
2. 將訊息傳遞給病人;以討論治療計畫
3. 構築彼此關係;建立信賴關係、獲
得病人與病家信任
4. 支持病人與家人渡過疾病所帶來的
危機(to support the patient and the family
through the crisis of his/her illness)
-R.Buckman,
W.F.Baile in:. Gynecologic Oncology 5th ed, 2010, p.820
79. Prescribing the Doctor as Part
of the Treatment
醫師的角色
不只是提供治療
醫生本身就是治療的一部分
– Robert Buckman, Practical Plans for Difficult
Conversations in Medicine. John Hopkins U.
press, 2010