Easter David W, Beach Wayne
Department of Surgery, University of California San Diego School of Medicine, La Jolla, 92093, USA.
Curr Surg. 2004 May-Jun;61(3):313-8. doi: 10.1016/j.cursur.2003.12.006.
Core competencies in surgical education and clinical care rely on effective patient-physician communication. We aim to develop quantitative and empirical tools for understanding critical communication tasks during patient interviews.
Residents in surgical training and attending physicians were separately video recorded during stressful, first visit oncology patient interview sessions. Taped sessions (n = 16) were analyzed in detail to identify and label patient-initiated actions (PIAs), or "empathic opportunities," that call for recognition or action from the caregiver. Doctor-responsive actions (DRAs) were labeled as matching to, or missing from, each empathic opportunity. Missed empathic opportunities occurred when a PIA did not have an associated DRA. Presession and postsession surveys queried the patient's perception of how well their health-care needs were met.
Resident trainees and attending physicians missed 70% of 160 clearly identified empathic opportunities. There was no clear association with the level of physician training. This pilot study did not have enough power to discern differences in patient satisfaction.
Physicians are often not very attentive to empathic opportunities offered by patients. Individual feedback and training regarding empathic opportunities in recorded patient communication encounters may improve resident and physician core competencies. These improvements may affect patient satisfaction related to these encounters.
外科教育和临床护理的核心能力依赖于有效的医患沟通。我们旨在开发定量和实证工具,以理解患者访谈过程中的关键沟通任务。
在压力较大的首次肿瘤患者访谈过程中,分别对外科培训住院医师和主治医生进行录像。对录像片段(n = 16)进行详细分析,以识别和标记患者发起的行为(PIA),即“共情机会”,这些行为需要护理人员予以识别或采取行动。医生的反应行为(DRA)被标记为与每个共情机会匹配或不匹配。当PIA没有相关的DRA时,就会出现错过的共情机会。访谈前和访谈后的调查询问了患者对其医疗保健需求得到满足程度的看法。
住院医师培训学员和主治医生错过了160个明确识别出的共情机会中的70%。与医生的培训水平没有明显关联。这项初步研究没有足够的效力来辨别患者满意度的差异。
医生往往不太关注患者提供的共情机会。针对录制的患者沟通交流中的共情机会提供个人反馈和培训,可能会提高住院医师和医生的核心能力。这些改进可能会影响与这些交流相关的患者满意度。