Leiss O
Gastroenterologische Gemeinschaftspraxis, Mainz.
Anaesthesist. 2007 Jan;56(1):78-91. doi: 10.1007/s00101-006-1070-z.
On the theme of Linus Geisler's nine steps for a successful consultation between doctor and patient, the ability for self-criticism, the ability to be able to listen to oneself and the value of the doctor-patient relationship in the context of medical practice will be discussed. Subsequently, the framework of the consultation, the consulting room atmosphere and the complete setting of the consultation will be dealt with. The importance of active listening and the recognition of all messages, both verbal and from body language, will be particularly emphasized. The capability for empathy is presented as the necessary bridge to recognition of the feelings and inner world of the patient. Because one only sees what one is looking for and only recognizes what one knows, the recognition of typical complaints presented by patients in a consultation represents the "something" which must be specifically elucidated. The problems and symptoms which the patient brings to the doctor are surrounded by a ring of fears and apprehensions. For this reason it is decisive to uncover the accompanying cloud of fears and apprehensions with appropriate questions, to correctly assign the unsettling symptoms of the patient and to be able to correctly interpret them. As illustrated by the language of nature - the translation of deoxyribonucleic acid (DNA) triplets into amino acids - the translation of biological, psychological and social aspects of the complaints symptomatic into the level of diagnosis and the translation of the referential, social and affective meaning of the expressions used by the patient, into the level of the significance will be discussed. The role of the doctor here is that of a producer of context and a skilled translator. In the management of functional disorders and chronic diseases the construction of a shared reality is important. The therapeutic function of consultations is due to an introduction of metaphors as bridges - bridges to an improved understanding of the body, the self and the world. The role of the physician here is that of a moderator, motivator an accompanying person. Finally, Jaspers levels of good doctoring (natural science or causal level, nursing level, communicative-existential level) are stressed and the importance of a good patient-physician relationship for a patient-centered medicine is underlined.
围绕利纳斯·盖斯勒提出的医患成功咨询的九个步骤这一主题,将探讨自我批评能力、倾听自己的能力以及医患关系在医疗实践中的价值。随后,将讨论咨询的框架、咨询室氛围以及咨询的完整设置。将特别强调积极倾听的重要性以及对所有信息(包括言语信息和肢体语言信息)的识别。共情能力被视为认识患者感受和内心世界的必要桥梁。因为人们只看到自己在寻找的东西,只认识自己所知道的东西,所以识别患者在咨询中提出的典型主诉代表了必须具体阐明的“某些东西”。患者带给医生的问题和症状被恐惧和担忧所笼罩。因此,通过适当的问题揭示伴随的恐惧和担忧之云、正确归类患者令人不安的症状并能够正确解读它们是至关重要的。正如自然界的语言——脱氧核糖核酸(DNA)三联体翻译成氨基酸那样,将症状性主诉的生物、心理和社会方面翻译成诊断层面,以及将患者使用的表达的参照、社会和情感意义翻译成意义层面,都将进行讨论。医生在这里的角色是情境创造者和熟练的翻译者。在功能性障碍和慢性病的管理中,构建共同的现实很重要。咨询的治疗功能源于引入隐喻作为桥梁——通向更好地理解身体、自我和世界的桥梁。医生在这里的角色是主持人、激励者和陪伴者。最后,强调了雅斯贝尔斯提出的良好医疗水平(自然科学或因果层面、护理层面、沟通-存在层面),并突出了良好的医患关系对以患者为中心的医疗的重要性。