Baeza H, Weil K
Hospital del Salvador, Facultad de Medicina, Universidad de Chile, Santiago, Chile.
Rev Med Chil. 1998 Oct;126(10):1255-61.
The aims of medical interview are to obtain diagnostic information, to obtain an empathetic communication with the patient, to educate him about his disease and to establish a personal link allowing a lasting relationship. We analyze some features of communication with patients. Individualized communication, recognizing his identity and personal aspects, "looking from the patient". Context, a shared but not mentioned value, part of the world of emotions and ideas. An analog and digital language, the former precise in words and the latter more diffuse, with gestures, not verbal. Coherence, as the similitude between what we think, feel and say. If there is no coherence, communication is impaired. Emotions, always present, rending communication more valid and real. We need to recognize, express and respond to emotions. An emotionless patient becomes a distant and impersonal object, an "it". When emotions are incorporated the patient is a "him" with whom I share and dialog. Empathy is an emotional comprehension, a personal bond. It improves relationships and creates links. Compassion is a variation of empathy that includes spiritual aspects and values. Negative emotions as rage, frustration and aggression creates communicational difficulties. We must recognize, express and clarify them to improve the situation. Difficult patients with whom communication is difficult such as confuse, agitated, terminal, elder, manipulating or hypochondriac subjects. The idea of transference and counter transference in these complicated situations is analyzed.
医学问诊的目的是获取诊断信息，与患者进行共情交流，对其进行疾病教育，并建立一种能维系长久关系的个人联系。我们分析了与患者沟通的一些特点。个性化沟通，识别患者的身份和个人情况，“从患者的角度看问题”。背景，一种共享但未言明的价值观，是情感和思想世界的一部分。模拟和数字语言，前者用词精确，后者更具弥散性，伴有手势等非言语表达。连贯性，即我们的所思、所感与所言之间的相似性。如果缺乏连贯性，沟通就会受到损害。情感始终存在，使沟通更有效、更真实。我们需要识别、表达并回应情感。没有情感的患者会变成一个遥远而冷漠的对象，一个“它”。当情感融入其中时，患者就是一个“他”，我可以与他分享并对话。共情是一种情感理解，是一种个人联系。它能改善关系并建立纽带。同情是共情的一种变体，包含精神层面和价值观。愤怒、沮丧和攻击性等负面情绪会造成沟通困难。我们必须识别、表达并澄清这些情绪以改善状况。还分析了在与困惑、烦躁、晚期、年长、爱操纵他人或疑病症患者等沟通困难的患者交流时的移情和反移情概念。
