揭開病人面具－從傾聽病人開始

Listening as a Way to Reveal Patients' Hidden Agendas

10.6145/jme.200409_8(3).0011

蔡美慧(Mei-Hui Tsai)；曹逢甫(Feng-Fu Tsao)；盧豐華(Feng-Hwa Lu)

醫病溝通 ； 隱藏就醫動機 ； 帶面具的病人 ； 傾聽 ； 中性回應詞 ； doctor-patient communication ； hidden agendas ； listening ； nuetral feedback

Journal of Medical Education

8卷3期（2004 / 09 / 01）

336 - 349

繁體中文

問診的主要任務之一在於了解病人就醫動機，並提供正確診斷以提高病人滿意度，然而若醫師未能在看診時洞察求醫動機，則所提供的處置與建議也就難符合病人需求。這不僅令醫病雙方同感挫折，也是醫療資源浪費。爲何醫師未能在看診過程了解病人就醫動機（即未能揭開病人面具）？本文從四個角度檢視這個問題：(1)爲何病人帶面具，(2)未揭開面具的可能後果，(3)帶面具病人有哪些躋迹象循，(4)醫師應如何揭開病人的面具？在第四議題我們提出四個洞察病人求醫動機的步驟與方式：透過一開始的寒暄問暖，提供病人「語言暖身」的機會，建立與病人的信任關系使其卸下心防；在主訴階段透過「開放式問句」詢問病人之適；在聆聽敘述時，可透過「中性回應詞」（例如「嗯哼」、「然後」），以保持中立且不打斷的聆聽態度並取得病人就醫問題全貌；若上述步驟未能導出動機，則可視情況以開放式問句詢問病人，例如「汝感覺是什麽原因予汝這呢難苦欽？」或「汝敢有希望講阮按那共汝幫助？」

Two major goals in medical interviewing are seeking and providing solutions for patients' primary concerns. Follow-up treatment plans and patient compliance, however, do not work as efficiently as expected, since doctors fail to reveal patients' primary agendas during the interview. Why do doctors fail to understand patients' hidden agendas in medical visits? This issue is examined in terms of four aspects: 1) why patients hide their agendas; 2) what the possible outcome is if the agendas are not revealed; 3) what the signs are of hidden agendas; and 4) how doctors encourage agenda revelation. To solve problems resulting from hidden agendas, we propose a four-step procedure for discovering agendas. Beginning the interview with a casual but sincere greeting right after patients walk into the consultation room provides patients a chance for verbal warm-up and is helpful in establishing rapport with patients. Doctors then begin information gathering by using open-ended questions to elicit comprehensive information from patients. While listening to patients, doctors should maintain an open-minded and impartial attitude of listening by giving neutral feedback or continuer, such as ”m-hng” which encourages patients to continue their narrations, in response to information provided by patients. If patients agendas are not revealed at this stage, doctors may also try specific open-ended questions for clarifying agendas, such as “What do you think causes your problems?' or “What can we do to help you?” (Full text in Chinese)

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