行医需要怎样的人文关怀?

更新日期:2018-09-26
宏景USMLE

现代医学经历了从“生物医学模式”,到“生物心理社会医学”模式的转变,我们在日常的行医过程中,也会常常听到“人文关怀”这个词,也有越来越多的医学院,采用OSCE方式作为毕业考核的过程中,将“人文关怀”作为一个计分点纳入计分规则中,那么人文关怀到底在哪些方面体现?是不是做到轻声说话,面带微笑就足够了呢?我们今天刚刚讨论了一个有趣的题目。 

A 43 year-old woman comes to the office due to abdominal pain, general weakness, decreased appetite, and diziness. She says the pain is “ruining my life” and is worried that her previous physicians may have missed something. Over the past several years, the patient has been hospitalized 3 times similar symptoms. No etiology for the pain has been identified despite extensive workups, including several abdominal CT scans and an exploratory laparotomy. The patient described chronic abdominal pain since adolescence and is concerned as the non-prescription analgesics she takes are ineffective. She has no history of psychiatric diagnoses or substance abuse. Physcial examination, vital signs, and laboratory tests, including chemistry panel, complete blood count, and urinalysis, are within normal limits. Which of the following is the most appropriate course of action?

A. Gastroenterology consult

B. Medical hospitalization

C. Prescribing and opioid analgesics

D. Psychiatry consult

E. Repeat abdominal CT scan

F. Scheduling regular outpatient office visits

是否有非常多同行选了D, psychiatry consult呢?但是有趣的是,正确答案是E, Scheduling regular outpatient office visits。对于“疑病症”的患者,最好的方法,竟然不是让他转诊精神科医生,而是给他安排在同一个医生处,规律随访,以此一方面可以安慰他紧张的情绪,与此同时可以最大程度的避免过度检查和不必要的专科转诊。

各位同行在平时的门诊过程中,可能也见过不少这样过于忧虑的病人,告诉,这不过是“心病”而已,大可以坐在家里不用再复诊,或者直接去看精神科医生,如果病人能够因此解除焦虑,也就罢了,但是多数情况下,这样对他说,不仅不能解除焦虑,可能还会让病人产生“没有人知道我的痛苦,没有人看得出我生了什么怪病”的孤独感。所以我觉得,真正的人文关怀,除了语气轻柔,态度温和之外,还要真正能够站在病人的生理,以及心理的角度,去寻求能够解决他问题的最佳方式。如果他无论如何就是很怀疑自己生了重病,最好的方式,可能只是默默陪着他看病而已。

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