Beckman H B, Frankel R M
Ann Intern Med. 1984 Nov;101(5):692-6. doi: 10.7326/0003-4819-101-5-692.
Determining the patient's major reasons for seeking care is of critical importance in a successful medical encounter. To study the physician's role in soliciting and developing the patient's concerns at the outset of a clinical encounter, 74 office visits were recorded. In only 17 (23%) of the visits was the patient provided the opportunity to complete his or her opening statement of concerns. In 51 (69%) of the visits the physician interrupted the patient's statement and directed questions toward a specific concern; in only 1 of these 51 visits was the patient afforded the opportunity to complete the opening statement. In six (8%) return visits, no solicitation whatever was made. Physicians play an active role in regulating the quantity of information elicited at the beginning of the clinical encounter, and use closed-ended questioning to control the discourse. The consequence of this controlled style is the premature interruption of patients, resulting in the potential loss of relevant information.
确定患者寻求治疗的主要原因对于一次成功的医疗问诊至关重要。为了研究医生在临床问诊开始时引导并深入了解患者担忧方面的作用，记录了74次门诊就诊情况。在仅17次（23%）就诊中，患者有机会完整陈述其担忧。在51次（69%）就诊中，医生打断患者陈述并针对特定担忧提问；在这51次就诊中只有1次患者有机会完整陈述开场内容。在6次（8%）复诊中，完全没有引导患者表达。医生在控制临床问诊开始时获取的信息量方面发挥着积极作用，并使用封闭式提问来控制谈话。这种控制性方式的结果是过早打断患者，可能导致相关信息丢失。
