Suchman A L, Markakis K, Beckman H B, Frankel R
Primary Care Institute, Highland Hospital, Rochester, NY 14620, USA.
JAMA. 1997 Feb 26;277(8):678-82.
To formulate an empirically derived model of empathic communication in medical interviews by describing the specific behaviors and patterns of interaction associated with verbal expressions of emotion.
A descriptive, qualitative study of verbal exchanges using 11 transcripts and 12 videotapes of primary care office visits to a total of 21 physicians.
An urban health maintenence organization (HMO), an urban university-based general medicine clinic, and an urban community hospital general medicine clinic. ANALYTIC METHOD: Individual review of transcripts by each research team member to identify instances of expressed or implied emotional themes and to observe the physicians' responses. Individual ratings were compared in group discussions to achieve consensus about the classifications. Similar consensus-based classification was used for review of videotapes.
We observed that patients seldom verbalize their emotions directly and spontaneously, tending to offer clues instead. If invited to elaborate, patients may then express the emotional concern directly, and the physician may respond with an accurate and explicit acknowledgment. In most of the interviews, the physicians allowed both clues and direct expressions of affect to pass without acknowledgment, returning instead to the preceding topic, usually the diagnostic exploration of symptoms. With emotional expression so terminated, some patients attempted to raise the topic again, sometimes repeatedly and with escalating intensity. We noted a parallel dynamic for encounters in which patients sought praise. We summarized the full interactional sequence in a simple descriptive model.
This empirically derived model of empathic communication has practical implications for clinicians and students who want to improve their communication and relationship skills. Based on our observations, the basic empathic skills seem to be recognizing when emotions may be present but not directly expressed, inviting exploration of these unexpressed feelings, and effectively acknowledging these feelings so the patient feels understood. The frequent lack of acknowledgment by physicians of both direct and indirect expressions of affect poses a threat to the patient-physician relationship and warrants further study.
通过描述与情感言语表达相关的具体行为和互动模式，构建一个基于实证的医学访谈中移情沟通模型。
一项描述性定性研究，使用11份转录文本和12份录像带，内容为21位医生的基层医疗门诊就诊情况。
一家城市健康维护组织（HMO）、一家城市大学附属综合诊所和一家城市社区医院综合诊所。分析方法：每个研究团队成员对转录文本进行单独审查，以识别表达或隐含的情感主题实例，并观察医生的反应。在小组讨论中比较个人评分，以就分类达成共识。对录像带的审查也采用类似的基于共识的分类方法。
我们观察到，患者很少直接自发地表达自己的情绪，而是倾向于给出线索。如果被邀请详细说明，患者可能会直接表达情感关切，医生可能会做出准确明确的回应。在大多数访谈中，医生对情感线索和直接表达都不予回应，而是回到之前的话题，通常是对症状的诊断探索。情感表达如此结束后，一些患者会试图再次提起这个话题，有时会反复提起，而且强度不断增加。我们注意到在患者寻求赞扬的互动中也存在类似的动态。我们用一个简单的描述模型总结了完整的互动序列。
这个基于实证的移情沟通模型对希望提高沟通和关系技巧的临床医生和学生具有实际意义。根据我们的观察，基本的移情技巧似乎是识别何时可能存在未直接表达的情绪，邀请患者探索这些未表达的感受，并有效地确认这些感受，以便患者感到被理解。医生经常对情感的直接和间接表达缺乏确认，这对医患关系构成了威胁，值得进一步研究。
