
顾建文
医疗治疗的有效性取决于医患关系的质量,而这又取决于医患对疾病和治疗达成共识的程度。本文利用会话分析(CA)工具,在精神病会诊背景下探究这一问题。CA 的 “修复” 框架可分析人们处理言语、听力和理解问题的过程,这些问题在精神病治疗中尤为关键,因为患者和医护人员需就幻觉和妄想等有争议的含义进行沟通。若患者感觉不被理解,往往会不配合治疗,治疗效果也差。本文概述了两项研究,第一项研究表明患者对精神科医生话语的澄清或修复与患者更好地依从治疗相关;第二项研究显示强调理解患者精神病体验重要性的培训可增加精神科医生的自我修复。这表明修复是医患沟通中建立共识的重要机制,有助于建立更好的治疗关系和提高治疗依从性。修复反映出对沟通的更多投入和参与,可提高沟通质量和效果。减少精神科医生与精神病患者之间潜在的误解是从医患双方角度增强治疗的低成本方式,对于改善这些通常与精神科医生和医疗服务关系不佳的患者的长期治疗效果至关重要。
The effectiveness of medical treatment depends on the quality of the patient - clinician relationship, which in turn depends on the extent to which the patient and clinician reach a consensus on the disease and treatment. This article uses the tools of conversation analysis (CA) to explore this issue in the context of psychiatric consultations. The CA "repair" framework can analyze the processes by which people handle speech, hearing, and understanding problems. These problems are particularly crucial in the treatment of psychosis, as patients and healthcare providers need to communicate about the disputed meanings of hallucinations and delusions. If patients feel not understood, they often do not comply with treatment, and the treatment outcome is also poor. This article outlines two studies. The first study shows that patients' clarification or repair of psychiatrists' talk is associated with better patient adherence to treatment. The second study reveals that training that emphasizes the importance of understanding patients' psychotic experiences can increase psychiatrists' self - repair. This indicates that repair is an important mechanism for building consensus in doctor - patient communication, contributing to better therapeutic relationships and improved treatment adherence. Repair reflects greater commitment and engagement in communication, and can improve the quality and effectiveness of communication. Reducing potential miscommunication between psychiatrists and psychotic patients is a low - cost way to enhance treatment from both the doctor's and patient's perspectives, and is crucial for improving the long - term treatment outcomes of these patients who usually have poor relationships with psychiatrists and healthcare services.

在医疗领域,医患之间高质量的沟通对于治疗效果有着深远影响。尤其是在精神病治疗这一特殊领域,医患沟通的质量更是直接关系到患者的治疗依从性和最终治疗结果。因为精神病的复杂性和特殊性,使得患者与医护人员之间在对病情的理解和交流上存在诸多挑战。
二、医患关系与沟通理解的关联治疗效果与医患关系质量医疗行为的有效性与医患关系的质量紧密相连。良好的医患关系建立在双方对疾病和治疗有共同理解的基础上。在精神病治疗中,这种理解尤为关键,因为精神病涉及到患者复杂的心理和精神状态,如幻觉和妄想等症状,这些症状的理解和解释对于治疗方案的制定和实施至关重要。如果医患之间不能达成有效的理解,治疗过程就可能受到阻碍。理解不一致导致的问题当患者感觉自己没有被医生理解时,他们往往会对治疗方案产生抵触情绪,表现为不依从治疗。这种不依从可能包括不按时服药、不参加治疗疗程等行为,进而导致治疗效果不佳。在精神病患者中,这种现象更为突出,因为他们的病情本身可能影响其对治疗的接受程度,而沟通不畅则加剧了这一问题。三、会话分析(CA)中的 “修复” 框架“修复” 框架的原理会话分析中的 “修复” 框架为我们研究医患沟通中的问题提供了有力工具。它主要关注人们在言语交流过程中出现的说话、听力和理解方面的问题处理机制。在正常的对话中,当信息传递出现障碍时,参与对话的人会通过一定的方式来修复这种障碍,以保证交流的继续和理解的达成。在精神病治疗沟通中的重要性在精神病治疗的沟通情境中,“修复” 机制的重要性更加凸显。例如,当患者向医生描述自己的幻觉体验时,医生需要准确理解患者所表达的内容,而患者也需要理解医生对这些症状的解释和治疗建议。如果在这个过程中出现理解偏差,就需要通过 “修复” 机制来重新建立理解,否则可能会影响治疗的方向和效果。
综上所述,在医患沟通,特别是精神病治疗的医患沟通中,误解是一个需要重视的问题。会话分析中的 “修复” 机制为我们理解和解决这一问题提供了新的视角和方法。通过进一步研究和应用这一机制,我们可以提高医患沟通质量,改善治疗关系和依从性,从而为患者提供更优质的医疗服务,尤其是对于那些患有精神病的患者,改善沟通可能是改善他们长期治疗效果的关键因素。
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