真话的局限：转换障碍患者的神经科医生沟通。
Limits to truth-telling: neurologists' communication in conversion disorder.
机构信息
King's College London, Department of Psychological Medicine, Institute of Psychiatry, London, UK.
出版信息
Patient Educ Couns. 2009 Nov;77(2):296-301. doi: 10.1016/j.pec.2009.05.021. Epub 2009 Jun 27.
OBJECTIVE
Neurologists face a dilemma when communicating with their conversion disorder patients - whether to be frank, and risk losing the patient's trust, or to disclose less, in the hope of building a therapeutic relationship. This study reports how neurologists in the UK described dealing with this dilemma in their practice.
METHODS
Practicing consultant neurologists from an NHS region were recruited by snowball sampling. Twenty-two of 35 consultants in the region were interviewed in depth, and the interviews qualitatively analysed.
RESULTS
The neurologists were reluctant to disclose conversion disorder as a differential diagnosis until they were certain. They were guided by the receptivity of their patients as to how psychological to make their eventual explanations, but they did not discuss their suspicions about feigning. They described their communications as much easier now than they had seen in training.
CONCLUSION
Neurologists adapt their disclosure to their patients, which facilitates communication, but imposes some limits on truth-telling. In particular, it may sometimes result in a changed diagnosis.
PRACTICE IMPLICATIONS
An optimum strategy for communicating diagnoses will need to balance ethical considerations with demonstrated therapeutic benefit.
目的
当与转换障碍患者沟通时，神经科医生面临两难境地——是坦诚相待，冒着失去患者信任的风险，还是少透露一些，希望建立治疗关系。本研究报告了英国的神经科医生如何在实践中处理这一困境。
方法
通过雪球抽样招募来自 NHS 地区的执业顾问神经科医生。对该地区的 35 名顾问中的 22 名进行了深入访谈，并对访谈进行了定性分析。
结果
神经科医生不愿意透露转换障碍作为鉴别诊断，直到他们确定。他们根据患者的接受程度来决定最终解释的心理程度，但他们没有讨论对佯装的怀疑。他们表示，与过去相比，现在的沟通要容易得多。
结论
神经科医生根据患者的情况调整自己的披露方式，这有助于沟通，但对说实话施加了一些限制。特别是，这可能会导致诊断的改变。
实践意义
沟通诊断的最佳策略需要平衡伦理考虑和已证明的治疗益处。
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