Hardee James T, Platt Frederic W, Kasper Ilene K
Department of Internal Medicine, Kaiser Permanente, Denver, CO, USA.
J Gen Intern Med. 2005 Jul;20(7):666-9. doi: 10.1111/j.1525-1497.2005.0125.x.
Escalating health care costs are affecting patients across the country. As employers and insurance companies face higher expenses, they may move to a cost-sharing strategy, which potentially increases financial burdens on patients. In this situation, physicians may find themselves serving as both medical and financial advisors for their patients. Clinical encounters in which patients experience financial hardship can be awkward and frustrating for both parties. Physicians must learn to discuss issues of affordability in a manner that builds, rather than detracts, from a therapeutic alliance. This article describes our experiences using several communication skills that can help in the discussion of health care costs with patients. The primary skill, empathic communication, which includes "we" statements and "I wish ..." statements, serves to create a platform for shared decision-making, negotiation, and a search for alternatives. In addition, it is helpful if physician offices have resource materials available and strategies identified to assist patients facing financial hardship.
不断攀升的医疗保健成本正在影响全国各地的患者。随着雇主和保险公司面临更高的费用，他们可能会转向成本分摊策略，这可能会增加患者的经济负担。在这种情况下，医生可能会发现自己既要为患者提供医疗建议，也要提供财务建议。患者经历经济困难的临床会诊对医患双方来说都可能尴尬且令人沮丧。医生必须学会以一种有助于建立而非破坏治疗联盟的方式来讨论可承受性问题。本文介绍了我们运用多种沟通技巧与患者讨论医疗保健成本的经验。主要技巧是共情沟通，包括使用“我们”表述和“我希望……”表述，有助于创建一个共同决策、协商及寻找替代方案的平台。此外，如果医生办公室备有资源材料并确定了帮助面临经济困难患者的策略，那将很有帮助。
