問診開場階段言談技巧：“稱名、正身、就位、暖身”

Discourse Strategies in Opening Stage of Medical Interviews: Name Exchange, Clarification of Companion Role, Seating Arrangement, and Verbal Warm-up

10.6145/jme.200903_13(1).0007

蔡美慧(Mei-Hui Tsai)；盧豐華(Feng-Hwa Lu)

開場階段 ； 情境寒暄語 ； 病人之陪同者 ； 身份引介 ； 空間安排 ； 座位安排 ； opening stages ； situational greeting ； patient companion ； identity presentation ； spatial arrangement ； seating arrangement

Journal of Medical Education

13卷1期（2009 / 03 / 01）

60 - 72

繁體中文

把握互動當下每一刻是建立與病人長期信任合作關係的基礎，但醫師常因為時間壓力而省略問診一開始的開場階段。本文針對台灣問診情境，建議「稱名、正身、就位、暖身」之開場階段言談技巧。「稱名、正身」：除了以病人的名字稱呼對方外，醫師也應自我介紹、澄清陪同者與病人關係。正式引介每位參與者，不只是尊重認同對方參與的表現、拉近不對等醫病關係、也是後續話題適切性指標。「就位、暖身」；除了邀請病人就坐，陪同者也應有適當的座位安排，然後在時間允許下，善用傳統的「情境寒暄」與病方閒話家常。中國人的日常互動不習慣於一開始介紹彼此，透過情境寒暄語也可巧妙的達到引介身份的目的。上述四個言談技巧目的在於塑造尊重、友善、對等、舒適的問診開場階段，幫助初診病人卸除心防與緊張，期能做到門診互動第一刻就建立良性醫病關係。

Any interaction with patients contributes to establishing a long-term trusting doctor-patient relationship. However, under time pressure, doctors tend to skip the opening stage in outpatient interviews. Based on findings from previous research in Taiwanese doctor-patient encounters, the authors call medical professionals' attention to four interviewing skills in the opening stage: name exchange, clarification of companion role, seating arrangement, and verbal warm-up. An official identity presentation, which includes greeting patients with their (full) names, introducing oneself to the patient, and clarifying the companion's relationship with the patient, not only displays the doctor's acknowledgement of each interactant's participation, but also serves as a criterion for what counts as appropriate topics in later conversation. After interacants are introduced, doctors invite both patient parties to be seated and extend some verbal warm-up, such as chatting, before they move on to the main business. Also, the clarification of the companion's identity, which many doctors may find uncomfortable, can be skillfully done with traditional Chinese 'situational greetings'. An opening stage with a considerate and friendly warm up helps reduce the tension and defensiveness some patients have when meeting their doctors for the first time.