Williams G C, Quill T E, Deci E L, Ryan R M
University of Rochester, New York.
Ann Intern Med. 1991 Jul 1;115(1):59-63. doi: 10.7326/0003-4819-115-1-59.
The behavior of health care practitioners toward their patients can greatly affect the patients' motivation for change. Mark Twain's story, "The Facts Concerning the Recent Carnival of Crime in Connecticut," is used to illustrate how traditional strategies for motivating patients to change can have the paradoxic effect of inhibiting change and growth. We use a theory of human motivation, referred to as self-determination theory, to explain this effect and suggest alternative strategies for facilitating patient motivation. Empirical tests of the theory have shown that people will accept more responsibility for behavior change when motivated internally rather than externally. In the doctor-patient relationship, this internal motivation for change can be facilitated when doctors allow choice, provide relevant information, and acknowledge the patient's perspective. We propose a simple, three-question model, consistent with self-determination theory, for physicians to use with patients who smoke and are not yet ready to try quitting.
医护人员对待患者的行为会极大地影响患者改变的动力。马克·吐温的故事《康涅狄格最近的犯罪狂欢节的真相》被用来说明传统的激励患者改变的策略如何会产生抑制改变和成长的悖论效应。我们运用一种被称为自我决定理论的人类动机理论来解释这种效应，并提出促进患者动机的替代策略。该理论的实证测试表明，当受到内在而非外在激励时，人们会对行为改变承担更多责任。在医患关系中，当医生允许患者选择、提供相关信息并认可患者的观点时，这种内在的改变动机就能得到促进。我们提出一个与自我决定理论一致的简单的三问题模型，供医生用于那些吸烟但尚未准备好尝试戒烟的患者。
