Abramovitch H, Schwartz E
Dept. of Behavioral Science, Sackler School of Medicine, Tel Aviv University, Ramat Aviv, Israel.
Theor Med. 1996 Jun;17(2):175-87. doi: 10.1007/BF00539739.
The negative consequences of physicians' failure to establish and maintain personal relationships with patients are at the heart of the "humanistic crisis" in medicine. To resolve this crisis, a new model of doctor-patient interaction is proposed, based on the ideas of Martin Buber's philosophy of dialogue. This model shows how the physician may successfully combine the personal (I-Thou) and impersonal (I-It) aspects of medicine in three stages. These "Three Stages of Medical Dialogue" include: 1. An Initial Personal Meeting stage, which initiates the doctor-patient relationship and involves mutual confirmation; 2. An Examination stage, which requires a shift from a personal to an impersonal style of interaction; 3. An Integration Through Dialogue or "Healing Through Meeting" Stage, which involves the integration of the impersonal medical data into the ongoing dialogue between doctor and patient, as a basis for shared decision-making. The use of the model, as well as common failures of doctor-patient dialogue are discussed.
医生未能与患者建立并维持人际关系所带来的负面后果，是医学领域“人文危机”的核心所在。为解决这一危机，基于马丁·布伯对话哲学的理念，提出了一种新型医患互动模式。该模式展示了医生如何在三个阶段成功地将医学的个人（我-你）和非个人（我-它）层面结合起来。这“医学对话的三个阶段”包括：1. 初次见面阶段，开启医患关系并涉及相互确认；2. 检查阶段，需要从个人互动风格转变为非个人互动风格；3. 通过对话整合或“通过会面治愈”阶段，即将非个人的医学数据整合到医患之间正在进行的对话中，作为共同决策的基础。文中还讨论了该模式的应用以及医患对话中常见的失误。
