Center for Health Services and Society, Department of Psychiatry and Biobehavioural Sciences, University of California Los Angeles, Los Angeles, California 90024, USA.
Med Educ. 2013 May;47(5):443-52. doi: 10.1111/medu.12104.
Good social relationships are crucial to well-being and to health in particular. The perception of having supportive social relationships has effects on reducing morbidity and mortality comparable with those of a good diet, regular exercise and cessation of moderate smoking. This suggests that supportive, trusting relationships with doctors could have a substantial direct biomedical effect on patients' health.
A critical review of the patient-doctor relationship (PDR) literature is presented, along with a review of relevant interactional studies that examine doctor-patient interactions from the perspective of conversation analysis (CA). This literature shows how patients respond to doctors' verbal and non-verbal behaviours in systematic ways that affect how they disclose and how they relate to doctors.
Findings from the CA literature suggest that clinicians might consider several important interactional features to improve the PDR and perhaps also patient health outcomes: (i) the use of open-ended questions (e.g. 'What brought you in today?') and positive polarity items (e.g. 'Is there something else you wanted to talk about today?') elicits patient concerns and addresses unmet concerns more effectively than the use of closed questions and negative polarity items, respectively; (ii) eye gaze suggests availability and an attending recipient, and patients indicate that doctor attentiveness at crucial parts of their problem presentation is important, and (iii) verbal dysfluencies are one practice speakers employ to gain the attention of a non-attending recipient. Doctors may want to pay attention to patients' dysfluencies to better understand when their attention is valued.
Constructing supportive relationships with patients often does not require a great investment of time, but it does require commitment to 'being there for patients'. This review suggests that when doctors attune to language and social practices during medical consultations, the relationships they develop with patients may substantially improve patients' health and be intrinsically rewarding for both doctors and patients.
良好的社会关系对幸福感，尤其是健康至关重要。人们认为拥有支持性的社会关系可以降低发病率和死亡率，其效果与良好的饮食、有规律的运动和适量戒烟相当。这表明，与医生建立支持性、信任性的关系可能会对患者的健康产生实质性的直接生物医学影响。
本文对医患关系（PDR）文献进行了批判性回顾，并对相关的交互研究进行了回顾，这些研究从会话分析（CA）的角度考察了医患互动。该文献表明，患者会以系统的方式对医生的言语和非言语行为做出反应，从而影响他们的披露方式以及与医生的关系。
来自 CA 文献的研究结果表明，临床医生可能会考虑几个重要的交互特征，以改善 PDR，也许还能改善患者的健康结果：（i）使用开放式问题（例如，“今天是什么让你来看病？”）和正电级项目（例如，“今天你还有什么其他想谈的吗？”）比使用封闭式问题和负电级项目更有效地引出患者的关注并解决未满足的关注；（ii）眼神交流表明医生的可用性和专注的接受者，患者表示，在他们陈述问题的关键部分，医生的关注是很重要的；（iii）言语不流畅是说话者用来引起非关注接收者注意的一种做法。医生可能需要关注患者的言语不流畅，以更好地了解何时他们的关注是有价值的。
与患者建立支持性关系通常不需要大量的时间投入，但需要承诺“陪伴在患者身边”。这篇综述表明，当医生在医疗咨询中关注语言和社会实践时，他们与患者建立的关系可能会极大地改善患者的健康，并为医生和患者带来内在的回报。
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