Bartlett E E
Pediatrics. 1984 Nov;74(5 Pt 2):920-3.
Pediatricians spend 35% to 41% of their direct patient care time on patient education and counselling. However, studies indicate that teaching alone generally is ineffective. It is logical that the patient or parent must have an understanding of the basics of the regimen in order to follow the pediatrician's advice. However, teaching, even when supplemented by pamphlets or audiovisual programs, generally is not sufficient to bring about behavior change. A "stepped approach" to patient education is recommended. This approach consists of three steps: (1) using interpersonal skills to establish rapport and provide reassurance; (2) teaching about the illness, regimen, and other health matters; and (3) identifying and overcoming obstacles to behavior change. Step 3 is not necessary if steps 1 and 2 have been successful in achieving patient adherence to physician recommendations. By questioning the patient or parent at the follow-up visit, the pediatrician can identify the obstacles that are interfering with acceptance of his or her advice--this process is the "behavioral diagnosis." Once the cause of the problem has been determined, selection of the appropriate solution is usually straight-forward. This three-step approach to patient education can be more effective and less time-consuming than traditional approaches.
儿科医生将35%至41%的直接诊疗时间用于患者教育和咨询。然而，研究表明，单纯的教导通常是无效的。患者或家长必须了解治疗方案的基础知识，才能遵循儿科医生的建议，这是合乎逻辑的。然而，即使辅以宣传册或视听节目，教导通常也不足以带来行为改变。建议采用“循序渐进法”进行患者教育。这种方法包括三个步骤：（1）运用人际沟通技巧建立融洽关系并给予安慰；（2）讲解疾病、治疗方案及其他健康问题；（3）识别并克服行为改变的障碍。如果步骤1和2成功促使患者遵循医生的建议，那么步骤3就没有必要。通过在随访时询问患者或家长，儿科医生可以识别出妨碍接受其建议的障碍——这个过程就是“行为诊断”。一旦确定了问题的原因，选择合适的解决方案通常就很简单了。这种三步式患者教育方法可能比传统方法更有效且更省时。
