Robins L S, Wolf F M
Department of Postgraduate Medicine and Health Professions Education, University of Michigan, Ann Arbor 48109-0201.
Soc Sci Med. 1988;27(3):217-21. doi: 10.1016/0277-9536(88)90124-4.
The therapeutic success of physician-patient interactions depends in large part on how physicians interpret and respond to patients' implicit and explicit messages. Using a hypothetical vignette, in which a patient refuses to comply with a recommended therapeutic regimen, we found that first-year medical students with no classroom training in medical interviewing implicitly recognized that the situation called for face preserving or polite linguistic behavior. Ninety percent of them used culturally sanctioned politeness forms to repair the conversational breakdown depicted in the vignette. They responded to this clinical scenario, however, with linguistic behaviors borrowed from their everyday interactions, some of which were culturally appropriate, but not necessarily therapeutic. We suggest that students can learn to adapt their culturally appropriate behaviors and engage in therapeutic communication as physicians if they are given the necessary conceptual tools. We discuss how Brown and Levinson's theories of politeness and strategic language usage can (1) provide a framework for interpreting communication in general and physician-patient interaction in particular, (2) illuminate some of the problems inherent in doctor-patient encounters, and (3) be used prescriptively for teaching students and health professionals how to avoid some communication difficulties.
医患互动的治疗成功在很大程度上取决于医生如何解读和回应患者隐含与明确的信息。通过一个假设的小插曲，即患者拒绝遵守推荐的治疗方案，我们发现没有接受过医学面谈课堂培训的一年级医学生暗中意识到这种情况需要面子保全或礼貌的语言行为。他们中有90%使用了文化上认可的礼貌形式来修复小插曲中描述的对话破裂。然而，他们对这种临床情景的回应采用的是从日常互动中借用的语言行为，其中一些在文化上是合适的，但不一定具有治疗性。我们认为，如果给学生提供必要的概念工具，他们能够学会调整其在文化上合适的行为，并作为医生进行治疗性沟通。我们讨论了布朗和列文森的礼貌理论以及策略性语言使用如何能够：（1）提供一个总体上解读沟通、特别是医患互动的框架；（2）阐明医患会面中固有的一些问题；（3）被规范性地用于教导学生和健康专业人员如何避免一些沟通困难。
