Sobel D S
Kaiser Permanente Northern California, Oakland 94612, USA.
Prog Brain Res. 2000;122:393-412.
Evidence is mounting that addressing the psychosocial needs of patients makes economic and health sense. If there were a drug or surgical procedure that could reduce ambulatory care visits, decrease postsurgical length of stay, reduce c-section rates, or decrease death rates from cancer, this medical intervention would be widely accepted and utilized with little hesitation. The beliefs and biases that delay and retard the use of psychosocial interventions need to be challenged (Engel, 1977; Williamson et al., 1991). This brief review of mind-body interventions suggests that health care providers can ill afford to treat patients simply as disordered machines whose health can be restored with physical or chemical interventions alone. Indeed, a burgeoning interest in alternative and complementary medicine with a focus on non-drug, non-surgical interventions as well as the exploding field of lay literature and self-help groups suggests that many patients are ready, willing, and even demanding that mind-body health techniques be considered as part of health care (Friedman et al., 1997). While the health care system cannot be expected to address all the psychosocial needs of people, clinical intervention can be brought into better alignment with the emerging evidence on the health and cost-effectiveness of mind-body interventions. Mind-body medicine is not something separate or peripheral to the main tasks of medical care but should be an integral part of evidence-based, cost-effective, quality health care.
越来越多的证据表明,满足患者的心理社会需求具有经济意义和健康意义。如果有一种药物或外科手术能够减少门诊就诊次数、缩短术后住院时间、降低剖宫产率或降低癌症死亡率,这种医疗干预措施将会被广泛接受并毫不犹豫地加以使用。那些延误和阻碍心理社会干预措施使用的观念和偏见需要受到挑战(恩格尔,1977年;威廉姆森等人,1991年)。这篇对身心干预措施的简要综述表明,医疗保健提供者绝不能仅仅将患者视为功能紊乱的机器,认为仅通过物理或化学干预就能恢复其健康。事实上,对替代医学和补充医学的兴趣日益浓厚,其重点在于非药物、非手术干预措施,同时大众文学和自助团体领域也在迅速发展,这表明许多患者已经准备好、愿意甚至要求将身心保健技术视为医疗保健的一部分(弗里德曼等人,1997年)。虽然不能期望医疗保健系统满足人们所有的心理社会需求,但临床干预可以更好地与关于身心干预措施的健康和成本效益的新证据保持一致。身心医学并非医疗保健主要任务之外或边缘的东西,而应成为循证、具有成本效益的优质医疗保健的一个组成部分。