Benbassat Jochanan, Baumal Reuben
JDC-Brookdale Institute, PO Box 13087, Jerusalem 91130, Israel.
Acad Med. 2004 Sep;79(9):832-9. doi: 10.1097/00001888-200409000-00004.
The ability of medical students to empathize often declines as they progress through the curriculum. This suggests that there is a need to promote empathy toward patients during the clinical clerkships. In this article, the authors attempt to identify the patient interviewing style that facilitates empathy and some practice habits that interfere with it. The authors maintain that (1) empathy is a multistep process whereby the doctor's awareness of the patient's concerns produces a sequence of emotional engagement, compassion, and an urge to help the patient; and (2) the first step in this process--the detection of the patient's concerns--is a teachable skill. The authors suggest that this step is facilitated by (1) conducting a "patient-centered" interview, thereby creating an atmosphere that encourages patients to share their concerns, (2) enquiring further into these concerns, and (3) recording them in the section traditionally reserved for the patient's "chief complaint." Some practice habits may discourage patients from sharing their concerns, such as (1) writing up the history during patient interviewing, (2) focusing too early on the chief complaint, and (3) performing a complete system review. The authors conclude that sustaining empathy and promoting medical professionalism among medical students may necessitate a change in the prevailing interviewing style in all clinical teaching settings, and a relocation of a larger proportion of clinical clerkships from the hospital setting to primary care clinics and chronic care, home care, and hospice facilities, where students can establish a continuing relationship with patients.
医学生的共情能力往往会随着课程的推进而下降。这表明在临床实习期间有必要促进对患者的共情。在本文中，作者试图确定有助于共情的患者访谈方式以及一些会干扰共情的实习习惯。作者认为：（1）共情是一个多步骤的过程，在此过程中医生对患者担忧的觉察会引发一系列情感投入、同情以及帮助患者的冲动；（2）这个过程的第一步——察觉患者的担忧——是一项可传授的技能。作者指出，这一步骤可通过以下方式来促进：（1）进行“以患者为中心”的访谈，从而营造一种鼓励患者分享其担忧的氛围；（2）进一步探究这些担忧；（3）将它们记录在传统上预留用于记录患者“主诉”的部分。一些实习习惯可能会阻碍患者分享他们的担忧，比如（1）在患者访谈期间记录病史；（2）过早关注主诉；（3）进行全面的系统回顾。作者得出结论，要在医学生中维持共情并促进医学专业精神，可能需要改变所有临床教学环境中普遍存在的访谈方式，并将更大比例的临床实习从医院环境转移到初级保健诊所、慢性病护理机构、家庭护理机构和临终关怀机构，在这些地方学生可以与患者建立持续的关系。
