Langewitz W
Division of Psychosomatic Medicine/Internal Medicine, University Hospital Basel, Hebelstr. 2, CH-4031 Basel, Switzerland.
Patient Educ Couns. 2007 Aug;67(3):319-23. doi: 10.1016/j.pec.2007.04.009. Epub 2007 May 30.
Basic research and careful observation of clinical practice have yielded a vast amount of empirical data on communication in health care. This research has been guided by the assumption that good communication will be better understood and easier to teach when its single constituents are identified. This paper points to the limitation of this approach.
Based upon the terminology of phenomenological thinking grounded in neo-phenomenology (Hermann Schmitz) contradictory findings from the literature on patient-centred communication in Internal Medicine and Oncology are used as a starting point to elucidate different paradigms in conducting research in clinical communication.
The phenomenological approach of the German philosopher Hermann Schmitz (*1928) is briefly presented. It is based upon experiences that 'on the average everybody can vividly access or retrieve from his memory'. Empirical research does not provide unequivocal advice how to communicate with an individual patient. Likewise, researchers note unexpected reactions from real patients-they do not behave as the expert would assume. The inclusion of the phenomenon of a certain atmosphere is proposed referring to the impression of 'something in the air' that sometimes can be identified during communication or upon entering a room. Even though it can be sensed with high evidence, it cannot be deduced from particular observations. Instead, the atmosphere is part of a situation in which meaning is dissolved in chaotic manifoldness. Sensing an atmosphere is a function of the lived body (Leib) as opposed to phenomena that are mediated by the senses.
Current research and teaching models cover only part of the phenomenology of professional communication. How research and education might profit from the addition of Schmitz' philosophical approach will be outlined in this article.
Including perceptions of the lived body (Leib) should improve research in clinical communication and teaching courses.
基础研究以及对临床实践的仔细观察已产生了大量关于医疗保健中沟通的实证数据。该研究一直基于这样一种假设，即当确定良好沟通的单个组成部分时，它将更容易被理解且更易于传授。本文指出了这种方法的局限性。
基于新现象学（赫尔曼·施密茨）中现象学思维的术语，以内科和肿瘤学中以患者为中心的沟通的文献中的矛盾发现为出发点，以阐明临床沟通研究中的不同范式。
简要介绍了德国哲学家赫尔曼·施密茨（生于1928年）的现象学方法。它基于“一般来说每个人都能生动地回忆起或从记忆中检索到”的经验。实证研究并未提供明确的建议说明如何与个体患者进行沟通。同样，研究人员注意到真实患者的意外反应——他们的行为与专家的设想不同。建议纳入某种氛围现象，这是指在沟通期间或进入房间时有时能察觉到的“空气中有某种东西”的印象。尽管它能被高度明确地感知到，但无法从特定观察中推导出来。相反，氛围是意义在混乱的多样性中消解的情境的一部分。感知氛围是身体（Leib）的一种功能，这与由感官介导的现象相反。
当前的研究和教学模式仅涵盖了专业沟通现象学的一部分。本文将概述如何通过增加施密茨的哲学方法使研究和教育受益。
纳入对身体（Leib）的感知应能改进临床沟通研究和教学课程。
