Obrecht J P
Departement Innere Medizin, Kantonsspital Basel.
Schweiz Rundsch Med Prax. 1991 Apr 23;80(17):450-5.
The motifs of medical practise, in particular by the oncologist and the basic experience of the patient notably the cancer patient are presented. They represent the prerequisite for an individually taylored, solid relationship between physician and patient founding on mutual trust. Medical practise is nowadays founded on a scientific rationale. In contrast to earlier times the ethos of compassion pertains the private sphere. It is the physicians individual choice to proffer the traditional compassion as interest in the fate of an individual patient or not. The fundamental experience of an individual that his destiny lies no longer in his own hands expresses itself in a paradigmatic way by the perception of his illness. The cancer patient experiences--as other patients do--the threats but also his healing as occurrences not caused by him. He therefore does not identify his disease with objective impairments or pathologic findings. On the contrary, he perceives it as a threat to himself, his existence and his personality. The patient experiences his fate, to depend on circumstances and particularly on other individuals, their benevolence, their acceptance, their help. Trust is the basis for relationship between the cancer patient and his physician. Trust is also acceptance of dependence. Dependence is only acceptable if the physician is trustworthy. Trustworthiness cannot be gained by scientific competence alone but requires personal affection by compassion with the patients fate. The physician needs ethical competence to fulfill his task. Information of the patient gains a particular importance in this context. It, as well as the divergent assessment of the disease by patient and physician--the anthropologic difference--and the "equilibrating systems" are exposed.
本文介绍了医疗实践的主题，尤其是肿瘤学家的实践以及患者，特别是癌症患者的基本经历。它们是建立在相互信任基础上，医生与患者之间建立个性化、稳固关系的前提。如今的医疗实践基于科学原理。与早期不同，同情的精神属于私人领域。医生是否提供传统的同情，即对个体患者命运的关注，是其个人选择。个体认为自己的命运不再掌握在自己手中的基本体验，通过对疾病的感知以一种典型的方式表现出来。癌症患者和其他患者一样，体验到威胁，但也将康复视为并非由自己导致的事情。因此，他不会将自己的疾病等同于客观损伤或病理发现。相反，他将其视为对自己、自己的存在和个性的威胁。患者体验到自己的命运取决于各种情况，特别是取决于其他人、他们的善意、接纳和帮助。信任是癌症患者与其医生之间关系的基础。信任也是对依赖的接受。只有当医生值得信赖时，依赖才是可接受的。值得信赖不能仅靠科学能力获得，还需要对患者命运的同情所带来的个人情感。医生需要具备道德能力来完成其任务。在这种情况下，向患者提供信息具有特别重要的意义。文中揭示了这一点，以及患者和医生对疾病的不同评估——人类学差异——和“平衡系统”。
