Goldberg D P, Jenkins L, Millar T, Faragher E B
Mental Illness Research Unit, University of Manchester.
Psychol Med. 1993 Feb;23(1):185-93. doi: 10.1017/s0033291700038976.
It is argued that a general practitioner's ability to make accurate ratings of psychological distress is partly determined by the rate at which patients emit cues that are indicative of such distress. This study addresses the behaviours of doctors which influence the rates at which patients emit such cues. Consultations were videotaped involving six General Practice Vocational Trainees, three of them poor, and three of them able identifiers of emotional illness. Consultations were selected so that each trainee was rated interviewing 4 patients with low GHQ scores, and 4 patients with high scores. Behaviours are described which lead to increased cue emission and which are also practised more frequently by able identifiers, while other behaviours reduce cue emission and are practised less frequently by them. Another set of behaviours is no more frequent among the able identifiers, but when practised by able identifiers is associated with increased cue emission by the patients, and when practised by poor identifiers with unaltered or decreased cue emission. Interviews that are 'patient-led' are associated with increased rates of cue emission, while those that are 'doctor-led' are associated with lower rates. The implications of these findings for training doctors working in general medical settings are discussed.
有人认为，全科医生对心理困扰进行准确评估的能力部分取决于患者发出此类困扰迹象的频率。本研究探讨了影响患者发出此类迹象频率的医生行为。对六名全科医生职业培训学员的会诊进行了录像，其中三名评估能力较差，另外三名是识别情绪疾病的能力较强者。选择会诊案例时，确保每位学员都要对4名GHQ得分较低的患者和4名得分较高的患者进行问诊。文中描述了那些会导致更多迹象发出的行为，能力较强的识别者也更频繁地采用这些行为，而其他行为则会减少迹象发出，能力较强的识别者较少采用。还有一组行为在能力较强的识别者中出现的频率并不更高，但当被能力较强的识别者采用时，会使患者发出更多迹象，而被能力较差的识别者采用时，患者发出的迹象不变或减少。“以患者为主导”的问诊与更高的迹象发出率相关联，而“以医生为主导”的问诊则与更低的迹象发出率相关联。文中讨论了这些发现对在普通医疗环境中工作医生培训的启示。
