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[心身医学医生在姑息治疗中的作用——两例病例报告]

[The role of psychosomatic medicine doctors in palliative care medicine--two case reports].

作者信息

Matsuoka Hiromichi, Otsuka Masatomo, Koyama Atsuko, Hatabe Shigeru, Funai Sadao, Tanaka Akira

机构信息

Dept. of Psychosomatic Medicine, Sakai Hospital, Kinki University School of Medicine.

出版信息

Gan To Kagaku Ryoho. 2010 Feb;37(2):359-62.

Abstract

Palliative care medicine deals with the issue of death by listening to the story of patient's lives. There are several problems such as stress overload or burnout due to the difficulty in responding to all demands from patients and the shortness of time. These problems sometimes make doctors specializing in palliative care have less interest in patients, negative feelings or an indifferent attitude to them. In this report, two cases in which a psychosomatic medical doctor intervened were analyzed. The satisfaction of patients and the stress overload of doctors engaged in palliative care were examined retrospectively by investigation of patients' charts. Both factors were improved by such interventions, thus underscoring the possible contributions by these doctors in cancer medicine. Psychosomatic medicine is based on a biopsychosocial model and related to both physical and psychosocial factors. There are many similar viewpoints between psychosomatic medicine and palliative care medicine. Psychosomatic medical doctors have an advantage in that they can contribute to palliative care without stress overload or burnout because of their special training in communication skills to deal with patients from the standpoints of both mind and body. However, these doctors have not received psychiatric training so as to be able to diagnose precisely and treat psychiatric problems such as adjustment disorders, depression and delirium. Therefore, their further training in psychiatry for several months or years is an issue to be addressed in future.

摘要

姑息治疗医学通过倾听患者的人生故事来处理死亡问题。由于难以应对患者的所有需求以及时间紧迫,存在诸如压力过载或职业倦怠等若干问题。这些问题有时会使姑息治疗专科医生对患者的兴趣降低、产生负面情绪或对他们持冷漠态度。在本报告中,分析了两例心身医学医生进行干预的案例。通过查阅患者病历,对姑息治疗患者的满意度和医生的压力过载情况进行了回顾性调查。通过此类干预,这两个因素均得到改善,从而凸显了这些医生在癌症医学中可能做出的贡献。心身医学基于生物心理社会模型,与身体和心理社会因素均相关。心身医学和姑息治疗医学之间有许多相似观点。心身医学医生具有优势,因为他们在沟通技巧方面接受过特殊培训,能够从身心两个角度与患者打交道,所以能够在不出现压力过载或职业倦怠的情况下为姑息治疗做出贡献。然而,这些医生尚未接受过精神病学培训,以便能够准确诊断和治疗诸如适应障碍、抑郁症和谵妄等精神问题。因此,他们在精神病学方面进行数月或数年的进一步培训是未来需要解决的一个问题。

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