Ong L M, de Haes J C, Hoos A M, Lammes F B
Department of Medical Psychology, Academic Medical Hospital, Amsterdam, The Netherlands.
Soc Sci Med. 1995 Apr;40(7):903-18. doi: 10.1016/0277-9536(94)00155-m.
Communication can be seen as the main ingredient in medical care. In reviewing doctor-patient communication, the following topics are addressed: (1) different purposes of medical communication; (2) analysis of doctor-patient communication; (3) specific communicative behaviors; (4) the influence of communicative behaviors on patient outcomes; and (5) concluding remarks. Three different purposes of communication are identified, namely: (a) creating a good inter-personal relationship; (b) exchanging information; and (c) making treatment-related decisions. Communication during medical encounters can be analyzed by using different interaction analysis systems (IAS). These systems differ with regard to their clinical relevance, observational strategy, reliability/validity and channels of communicative behavior. Several communicative behaviors that occur in consultations are discussed: instrumental (cure oriented) vs affective (care oriented) behavior, verbal vs non-verbal behavior, privacy behavior, high vs low controlling behavior, and medical vs everyday language vocabularies. Consequences of specific physician behaviors on certain patient outcomes, namely: satisfaction, compliance/adherence to treatment, recall and understanding of information, and health status/psychiatric morbidity are described. Finally, a framework relating background, process and outcome variables is presented.
沟通可被视为医疗护理的主要要素。在回顾医患沟通时，将探讨以下主题：（1）医疗沟通的不同目的；（2）医患沟通分析；（3）具体的沟通行为；（4）沟通行为对患者治疗结果的影响；以及（5）总结。确定了三种不同的沟通目的，即：（a）建立良好的人际关系；（b）交换信息；以及（c）做出与治疗相关的决策。医疗问诊期间的沟通可以通过使用不同的互动分析系统（IAS）进行分析。这些系统在临床相关性、观察策略、信度/效度以及沟通行为渠道方面存在差异。讨论了问诊中出现的几种沟通行为：工具性（以治愈为导向）与情感性（以关怀为导向）行为、言语与非言语行为、隐私行为、高控制与低控制行为，以及医学与日常语言词汇。描述了特定医生行为对某些患者治疗结果的影响，即：满意度、对治疗的依从性/坚持性、对信息的回忆和理解，以及健康状况/精神疾病发病率。最后，提出了一个将背景、过程和结果变量联系起来的框架。
