Salmon P
Department of Clinical Psychology, University of Liverpool, UK.
Patient Educ Couns. 2000 Jan;39(1):105-13. doi: 10.1016/s0738-3991(99)00095-6.
Many patients seek physical treatment for physical symptoms in the absence of physical pathology and incur symptomatic interventions that are ineffective, costly and iatrogenic. It is therefore important to understand how decisions to provide physical intervention can arise in consultations in the absence of physical pathology. Existing models of doctor-patient communication are ill-suited to understanding these consultations. A series of studies has provided the components of an alternative approach that is based on understanding consultation from the patients' perspective. Specifically, these studies have delineated: sources of patients' perception of their authority over doctors; what patients seek by consulting their doctors; and ways that patients use their authority to influence doctors to provide what they seek. Patients' authority reflects primarily their own sensory and infallible knowledge of symptoms. Their influence derives from descriptions of subjective symptoms and from additional strategies including descriptions of the psychosocial effects of symptoms, catastrophising and requesting treatment. This analysis suggests directions for future research and medical training.
许多患者在没有身体病理学依据的情况下，因身体症状寻求物理治疗，并接受了无效、昂贵且具有医源性的对症干预措施。因此，了解在没有身体病理学依据的情况下，如何在会诊中做出提供物理干预的决定非常重要。现有的医患沟通模式并不适合理解这些会诊。一系列研究提供了一种基于从患者角度理解会诊的替代方法的组成部分。具体而言，这些研究已经阐明：患者对医生的权威感的来源；患者向医生咨询的目的；以及患者利用其权威影响医生提供其所寻求的东西的方式。患者的权威主要反映了他们自身对症状的感官认识以及确凿无疑的了解。他们的影响力来自主观症状的描述以及包括症状的心理社会影响的描述、灾难化思维和请求治疗在内的其他策略。这一分析为未来的研究和医学培训指明了方向。
