Norfolk Tim, Birdi Kamal, Walsh Deirdre
Department of Psychology, City University, London, UK.
Med Educ. 2007 Jul;41(7):690-7. doi: 10.1111/j.1365-2923.2007.02789.x.
Considerable research has been conducted recently into the notion of patient-centred consulting. The primary goal of this approach is to establish a clear understanding of the patient's perspective on his or her problem, and to allow this understanding to inform both the explanation and planning stages of the consultation. The quality of this understanding is largely determined by the empathic accuracy achieved by the doctor; the primary benefit is a therapeutic rapport between doctor and patient.
To highlight the role of empathy and communication skills in establishing rapport, we initially developed a model which seeks to draw the various motivational and skill elements identified in separate research papers into a comprehensive model of the journey towards shared understanding between doctor and patient. We then conducted an initial validation of the model via qualitative analysis involving general practitioners (GPs) and clinical psychologists.
The validation offered encouraging support for the principal elements of the model. Specific suggestions for clarification and extension were then incorporated in a revised model.
The model appears to capture the dynamic process of establishing a therapeutic relationship (rapport) between doctor and patient, defined by the quality of the doctor's understanding of the patient's perspective on his or her problem. Arguably, the most important contribution of the model is to highlight the fact that 'empathy' and consequent 'rapport' are not mystical or exclusive concepts but, rather, involve the use of specific skills accessible at some level by all.
最近对以患者为中心的诊疗咨询理念进行了大量研究。这种方法的主要目标是明确了解患者对自身问题的看法，并使这种理解贯穿于诊疗咨询的解释和规划阶段。这种理解的质量在很大程度上取决于医生所达到的共情准确性；主要益处是医生与患者之间建立起治疗性的融洽关系。
为了突出共情和沟通技巧在建立融洽关系中的作用，我们最初开发了一个模型，该模型旨在将在不同研究论文中确定的各种动机和技能要素整合到一个全面的模型中，以展现医生与患者达成共同理解的过程。然后，我们通过涉及全科医生（GPs）和临床心理学家的定性分析对该模型进行了初步验证。
验证为该模型的主要要素提供了令人鼓舞的支持。随后，针对模型的澄清和扩展提出的具体建议被纳入了修订后的模型中。
该模型似乎捕捉到了医生与患者之间建立治疗关系（融洽关系）的动态过程，这一过程由医生对患者对自身问题看法的理解质量所定义。可以说，该模型最重要的贡献在于强调了“共情”以及随之而来的“融洽关系”并非神秘或排他的概念，而是涉及到所有人在某种程度上都可掌握的特定技能的运用。
