Delbanco T L
Department of Medicine, Beth Israel Hospital, Boston, MA 02215.
Ann Intern Med. 1992 Mar 1;116(5):414-8. doi: 10.7326/0003-4819-116-5-414.
Doctors and patients alike are saddened and angered by the distance that increasingly interferes with their interactions. Two complementary strategies may enhance the human quality of clinical care and improve outcomes. First, the doctor and patient can undertake a systematic "patient's review" that addresses seven dimensions of care: 1) respect for patient's values, preferences, and expressed needs; 2) communication and education; 3) coordination and integration of care; 4) physical comfort; 5) emotional support and alleviation of fears and anxieties; 6) involvement of family and friends; and 7) continuity and transition. Incorporating the "review" into the clinical encounter encourages both patient and doctor to confront individual preferences and values and offers patients an explicit framework for participating actively in their care. Second, using survey instruments designed to solicit focused reports from patients that address each dimension of care, doctors can gather aggregate feedback about their practices. Such reports move beyond anecdote and can serve as screening tests that uncover areas in doctors' practices that merit improvement. In addition, patients can join doctors in developing solutions to problems uncovered by patients' reports.
医生和患者都对日益阻碍他们互动的距离感到悲伤和愤怒。两种相辅相成的策略可以提高临床护理的人文质量并改善治疗效果。首先，医生和患者可以进行系统的“患者评估”，该评估涉及护理的七个方面：1）尊重患者的价值观、偏好和表达的需求；2）沟通与教育；3）护理的协调与整合；4）身体舒适度；5）情感支持以及减轻恐惧和焦虑；6）家人和朋友的参与；7）连续性和过渡。将“评估”纳入临床诊疗过程，鼓励患者和医生面对个人偏好和价值观，并为患者提供一个积极参与自身护理的明确框架。其次，医生可以使用旨在征求患者针对护理各方面的重点报告的调查工具，收集有关其诊疗行为的总体反馈。此类报告超越了轶事传闻，可以作为筛查测试，揭示医生诊疗行为中值得改进的领域。此外，患者可以与医生共同制定解决方案，以解决患者报告中发现的问题。
