用沟通建立信任，病人关系的沟通技巧-医院文化-医院绩效咨询,医院绩效管理,医院管理咨询 -九鼎医院管理顾问

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用沟通建立信任，病人关系的沟通技巧

提交者：九鼎医管发表时间：2020-1-3点击次数：3603来源:

医院文化建设

现今医师的执业环境并不友好，其原因来自很多方面。近年来，医患纠纷事件频发，医师与病人的关系时常被悬在高处，吹弹可破。随着现代医学的不断迭代，病人对于医疗服务质量的要求越来越高，医疗服务不再局限于看病治病，搞好病人关系，对于建立病人与机构之间稳固的信任关系至关重要。

医患沟通是医疗诊断的需要，医患沟通是减少纠纷的需要，医患沟通是具备治疗功能的。在医疗服务中，除了不断提升的医疗技术水平外，与病人的沟通技巧也应同步发展。在病人关系处理上，原港大深圳医院病人关系科创始经理赖光强医生认为，与患者进行双向的沟通，充分尊病人的知情权、选择权，让病人积极配合治疗，这能减少不必要的医患纠纷。

下面，我先和大家分享的一个有关病人关系的沟通技巧的案例。这个案例希望能传达：沟通就是 “感病人所感，想病人所想，见病人所见”。无须听也无须说，就是直视对方内心，所谓坦诚相待，用心感受，你得了解他们，你要知道他们要的。

下面我从九个方面也是九个研究来与大家分享。

1 我们低估了病人参与的愿望▷ 2 你知道病人来诊的目的吗▷ 3 你会多长时间打断你的病人▷ 4 你与你的病人谈了多久▷ 5 病人要的和你给的一致吗▷ 6 你的病人会听你说的吗▷ 7 你有告诉你的病人如何用药▷ 8 病人最不满意的三大问题▷ 9 为什么我的病人还会告我呢

1、我们低估了病人知情和参与的愿望

下图这个研究对我们有很多的启发，某医院确认的1012名乳腺癌患者，仅有34%的人将治疗癌症方法的选择决定权交给医生，而66%人都要知情和参与，其中44%的希望和医生一起决定治疗癌症方法的选择，还有22%的人说我要自己决定癌症的治疗方法。

治疗的选择权当然是病人的，可是我们医生是不是已经想当然的认为病人是求医问药，医生的选择就是帮你选择？很多年前牛津大学出版社出版了一本《聪明的病人》，书中说家长式的病人关系已经不适合现在了，病人都想问为什么，而医生还停留在“听我的，这个病要这样治。” 目前国际流行的是，SHARE DECISION共同决定，让病人知情和参与，显然会让病人更开心、更满意。

2、病人来诊的目的是什么

我们看病人的时候，建立病人关系的时候最重要的能力就是识别病人的需求，如果病人要什么都不知道，那么注定要谈崩。五年前，我接待的一个投诉令我印象深刻，投诉的病人说，赖医生你们医院那个医生我实在谈不下去。我一进门，那个医生就说：“你看什么病”，一听我就火了，我知道什么病还来看什么医生？然后我跟他说，我有头痛，胆囊炎，还有肾结石，结果那个医生说，你看哪个先？对呀，看病的第一需求就是知道病人为什么来看病。

其实很多时候医生是不知道病人为什么来看病的。你看病人带几个问题来看病呢？显然不是只有一个问题。那有多少问题被发现，只有50%，为什么，因为很多医生认为病人提出的第一个问题就是病人来看病的主要问题，其实不然。

3、你多长时间打断病人

有个病人去看医生，医生，我头痛。结果医生立即打断他说，头的那个部位痛，痛多久啦，吃过什么药？家里人有高血压吗？这个病人被问蒙了。谁说我们的医生冷漠，多么热情啊，结果病人还不领情？

病人说，我不是看头痛的，我只是头疼，头疼我的香港脚又患了。下面是一个有关打断病人的研究结果，我们平均18秒的时间会打断病人，越早打断病人，则越少机会能听到全部主诉，就会越迟发现病人反映的问题，以致错过重要的问题；在被打断陈述的患者中，只有1/51的患者能在后来完成他们的陈诉；94%的打断是以医生获得话语权而结束；越晚打断病人，则越有可能发现病人的问题。允许病人完成陈述可以明显低后续才发现问题的概率。

在这个研究中，51个受访者中有34个病人在提出首要问题后被打断，很明显医生认为病人提出的第一个问题就是病人要反映的最重要的问题，所以医生选择打断病人并发问；如果病人没被打断，病人发言的时间也不会超过60秒，即使医生鼓励他们继续陈述，病人也不会超过150秒。后面，有人继续这个研究，在1999年重复了这个测试，结果医生平均在病人陈述23秒的时候打断，已经延长了5秒，实在是了不起的进步。我们要继续鼓励医生不要打断病人，因为打断病人可能不仅仅是病人不满意，还可能会导致误诊。

4、你与病人谈了多久

打断病人还可能会导致误诊，是真的吗？在这个有关看病时长的研究的很值得深思的。

经常有病人投诉说，医生看病时2分钟就把我打发了，可医生也很委屈，医生说，我看了他10几分钟。在这个研究里，在20分钟的看诊过程中，只有1分钟给病人提供信息而不是大多数医生高估的以为长达9分钟。这里到底发生了什么，到底谁在说谎？

5、病人要的和你给的一致吗

我们医生很委屈，你怎么可以说我二分钟就打发了，明明是5分钟，看皮肤的问题，看一个小时也是一样，我有经验，一秒钟我就准确诊断了，不知道没见过的皮肤病，我就看一小时也看不出来。问题在那里，因为病人要的和我们给的不一样，也就是我们连病人要什么都可能理解错了。病人和医生在告知不同类型医疗信息的重要性上有不同意见，病人主要关注病情的预后、诊断和病因，医生往往高估了病人对治疗和药物疗法的信息需求。

6、你的病人会听你说的吗

当然即使口灿莲花，病人也未必会听你。我们可以看到在这个研究里，有10—90%的病人完全不服用药物或错误地服用药物，50%的长期用药病人和72%节食的病人不遵从医嘱，30%-40%用药预防疾病的病人不遵从医嘱，而且20%-30%用药物治疗急性病的病人也不遵从医嘱。

7、你有告诉你的病人如何用药

为什么病人不听医生的话，不听医生的话吃药？因为医生压根就没说。这是我从医那么多年最荒唐的研究。我们总是被灌输病人依从性好不好，病人有没有遵守医嘱？现在问题来了，原来完全不是病人的问题，是我们医生的问题，那就是医生在开药时，20%的病人没有得到有关药物的任何信息，30%的病人没有被告知药名和用药的原因，80%的病人没有被告知用药的频率，可能告知的也就是在处方上写着的BID，TID， QD 等，或者药房工作人员会告诉你。

药房以为医生已经讲了，就说按医生说的吃就好了，问题是医生没说，或者没讲病人听得懂的。最要命的是，90%的病人没被告知用药时长。比如HP感染的病人，四联用药，要用15天，阿莫西林，克拉霉素，奥美拉唑，胶体果胶铋，这么多药要病人坚持服，必须花些时间详细讲，而不是药房会告诉你的。

8、病人最不满意的三大问题

我们与病人沟通中的问题，病人不满意或不听医生的话有三个原因：一是缺乏热情和友善。二是使用术语，没有考虑病人的担忧和期望，反正讲了你也不懂，恶性循环，干脆就不讲了，这又变成了医生冷漠。三是缺少对诊断和病因的清晰解释，才会导致病人到处问医生到处DOCTOR SHOPPING，我这个病是不是真这个病，用这个药没错吗，好象是信任的问题，实质是沟通问题。有这个三个问题，从而导致病人满意度下降依从性下降。

9、为什么我的病人还会告我呢

沟通不好，不仅仅满意度下降，依从性下降，也会导致病人甚至发起投诉。有四方面的沟通问题会在医疗诉讼中出现：忽视病人\忽略病人的想法\很少传递信息\不能理解病人的观点。

在70%的医疗诉讼案件中，律师把医生的沟通和态度作为病人起诉医疗侵权案件的首要原因。病人和医生之间的谈话破裂——是造成医疗侵权诉讼的重要因。谈话破裂，简称把天聊死了，结果就法庭见。我们不能让这个情况再次发生了。

有关病人关系的沟通问题，医患关系的沟通问题由来已久，有人诉诸人文教育不够，有人诉诸系社会信任问题，还有人说是体制的问题。我认为沟通就是个案，不能放大，我们每个人都做好沟通，就没有那么多社会问题了。

下面我谈谈我的研究，在过去七年中，我一直从事与病人的沟通工作，我试图去发现些真实的情况。如果说沟通还有什么诀窍的话，我想说，见人说人话，见鬼说鬼话，是个真理。

医院的不同科室，不同病人，是有不同的需求的，得采取不同讲话方式。骨科全科的病人满意度高，不仅仅是病程长，可能医务人员接触的时间长，所以关键是陪伴；儿科急诊科的病人投诉程度高，因为都很着急，儿科是父母急，急诊科是心情急，不管是和尚急还是太监急，但绝对不能和尚不急太监急。

儿科的病人父母急，我们要表现出急，表现出同理心来。你不急，病人父母就觉得你医德就不好，有些病人是会动不动给你盖帽子的。我们再看看内科有什么不同，神经内科的病人经常和精神科病人相混淆，所以感谢的话也不要太以为真，但消化内科和内分泌科就不一样，投诉是真的，因为病人太需要讲话太需要安慰了，这两个科病人出现抑郁和心理问题概率大，也容易投诉，同理心要表现得更到位，更愿意听他们讲话才好。

当然心内科和呼吸内科的投诉和感谢一样多可以理解，因为心内科病人要么心跳要么心不跳了，呼吸科病人，要么有气要么没气，所以投诉和感谢都在一闪念一瞬间。在外科看来，神经外科仍然是高居感谢榜榜首，因为和神经内科一样，都尽说胡话，当然是感谢了。胃肠外科小儿外科以及肝胆耳鼻喉科，投诉高，这么些科室病人我们更耐心些，他们需要关心需要聊天，需要聊痛快了，你想想后门不畅那多痛苦。而乳腺外科泌尿外科都是不通，用了药，要么通了，要么不通，所以投诉和感谢一样多，关键是讲清楚，通了是缘份，不通是命不好。我的研究并不是开玩笑，是希望大家多些开心。

我们小结一下，病人关系的沟通技巧只要用心感受就好。我尝试用一句经典的话来总结，那就是沟通宝典：有时去道歉，常常去示弱，总是去承担。

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PHP Authors
Contribution	Authors
Zend Scripting Language Engine	Andi Gutmans, Zeev Suraski, Stanislav Malyshev, Marcus Boerger, Dmitry Stogov, Xinchen Hui, Nikita Popov
Extension Module API	Andi Gutmans, Zeev Suraski, Andrei Zmievski
UNIX Build and Modularization	Stig Bakken, Sascha Schumann, Jani Taskinen
Windows Port	Shane Caraveo, Zeev Suraski, Wez Furlong, Pierre-Alain Joye, Anatol Belski
Server API (SAPI) Abstraction Layer	Andi Gutmans, Shane Caraveo, Zeev Suraski
Streams Abstraction Layer	Wez Furlong, Sara Golemon
PHP Data Objects Layer	Wez Furlong, Marcus Boerger, Sterling Hughes, George Schlossnagle, Ilia Alshanetsky
Output Handler	Zeev Suraski, Thies C. Arntzen, Marcus Boerger, Michael Wallner

SAPI Modules
Contribution	Authors
AOLserver	Sascha Schumann
Apache 1.3 (apache_hooks)	Rasmus Lerdorf, Zeev Suraski, Stig Bakken, David Sklar, George Schlossnagle, Lukas Schroeder
Apache 1.3	Rasmus Lerdorf, Zeev Suraski, Stig Bakken, David Sklar
Apache 2.0 Filter	Sascha Schumann, Aaron Bannert
Apache 2.0 Handler	Ian Holsman, Justin Erenkrantz (based on Apache 2.0 Filter code)
Caudium / Roxen	David Hedbor
CGI / FastCGI	Rasmus Lerdorf, Stig Bakken, Shane Caraveo, Dmitry Stogov
CLI	Edin Kadribasic, Marcus Boerger, Johannes Schlueter, Moriyoshi Koizumi, Xinchen Hui
Continuity	Alex Leigh (based on nsapi code)
Embed	Edin Kadribasic
FastCGI Process Manager	Andrei Nigmatulin, dreamcat4, Antony Dovgal, Jerome Loyet
ISAPI	Andi Gutmans, Zeev Suraski
litespeed	George Wang
NSAPI	Jayakumar Muthukumarasamy, Uwe Schindler
phpdbg	Felipe Pena, Joe Watkins, Bob Weinand
phttpd	Thies C. Arntzen
pi3web	Holger Zimmermann
Sendmail Milter	Harald Radi
thttpd	Sascha Schumann
tux	Sascha Schumann
WebJames	Alex Waugh

Module Authors
Module	Authors
BC Math	Andi Gutmans
Bzip2	Sterling Hughes
Calendar	Shane Caraveo, Colin Viebrock, Hartmut Holzgraefe, Wez Furlong
COM and .Net	Wez Furlong
ctype	Hartmut Holzgraefe
cURL	Sterling Hughes
Date/Time Support	Derick Rethans
DB-LIB (MS SQL, Sybase)	Wez Furlong, Frank M. Kromann
DBA	Sascha Schumann, Marcus Boerger
DOM	Christian Stocker, Rob Richards, Marcus Boerger
enchant	Pierre-Alain Joye, Ilia Alshanetsky
ereg	Rasmus Lerdorf, Jim Winstead, Jaakko Hyvätti
EXIF	Rasmus Lerdorf, Marcus Boerger
fileinfo	Ilia Alshanetsky, Pierre Alain Joye, Scott MacVicar, Derick Rethans
Firebird driver for PDO	Ard Biesheuvel
FTP	Stefan Esser, Andrew Skalski
GD imaging	Rasmus Lerdorf, Stig Bakken, Jim Winstead, Jouni Ahto, Ilia Alshanetsky, Pierre-Alain Joye, Marcus Boerger
GetText	Alex Plotnick
GNU GMP support	Stanislav Malyshev
Iconv	Rui Hirokawa, Stig Bakken, Moriyoshi Koizumi
IMAP	Rex Logan, Mark Musone, Brian Wang, Kaj-Michael Lang, Antoni Pamies Olive, Rasmus Lerdorf, Andrew Skalski, Chuck Hagenbuch, Daniel R Kalowsky
Input Filter	Rasmus Lerdorf, Derick Rethans, Pierre-Alain Joye, Ilia Alshanetsky
InterBase	Jouni Ahto, Andrew Avdeev, Ard Biesheuvel
Internationalization	Ed Batutis, Vladimir Iordanov, Dmitry Lakhtyuk, Stanislav Malyshev, Vadim Savchuk, Kirti Velankar
JSON	Omar Kilani, Scott MacVicar
LDAP	Amitay Isaacs, Eric Warnke, Rasmus Lerdorf, Gerrit Thomson, Stig Venaas
LIBXML	Christian Stocker, Rob Richards, Marcus Boerger, Wez Furlong, Shane Caraveo
mcrypt	Sascha Schumann, Derick Rethans
MS SQL	Frank M. Kromann
Multibyte String Functions	Tsukada Takuya, Rui Hirokawa
MySQL driver for PDO	George Schlossnagle, Wez Furlong, Ilia Alshanetsky, Johannes Schlueter
MySQL	Zeev Suraski, Zak Greant, Georg Richter, Andrey Hristov
MySQLi	Zak Greant, Georg Richter, Andrey Hristov, Ulf Wendel
MySQLnd	Andrey Hristov, Ulf Wendel, Georg Richter, Johannes Schlüter
OCI8	Stig Bakken, Thies C. Arntzen, Andy Sautins, David Benson, Maxim Maletsky, Harald Radi, Antony Dovgal, Andi Gutmans, Wez Furlong, Christopher Jones, Oracle Corporation
ODBC driver for PDO	Wez Furlong
ODBC	Stig Bakken, Andreas Karajannis, Frank M. Kromann, Daniel R. Kalowsky
OpenSSL	Stig Venaas, Wez Furlong, Sascha Kettler, Scott MacVicar
Oracle (OCI) driver for PDO	Wez Furlong
pcntl	Jason Greene, Arnaud Le Blanc
Perl Compatible Regexps	Andrei Zmievski
PHP Archive	Gregory Beaver, Marcus Boerger
PHP Data Objects	Wez Furlong, Marcus Boerger, Sterling Hughes, George Schlossnagle, Ilia Alshanetsky
PHP hash	Sara Golemon, Rasmus Lerdorf, Stefan Esser, Michael Wallner, Scott MacVicar
Posix	Kristian Koehntopp
PostgreSQL driver for PDO	Edin Kadribasic, Ilia Alshanetsky
PostgreSQL	Jouni Ahto, Zeev Suraski, Yasuo Ohgaki, Chris Kings-Lynne
Pspell	Vlad Krupin
Readline	Thies C. Arntzen
Recode	Kristian Koehntopp
Reflection	Marcus Boerger, Timm Friebe, George Schlossnagle, Andrei Zmievski, Johannes Schlueter
Sessions	Sascha Schumann, Andrei Zmievski
Shared Memory Operations	Slava Poliakov, Ilia Alshanetsky
SimpleXML	Sterling Hughes, Marcus Boerger, Rob Richards
SNMP	Rasmus Lerdorf, Harrie Hazewinkel, Mike Jackson, Steven Lawrance, Johann Hanne, Boris Lytochkin
SOAP	Brad Lafountain, Shane Caraveo, Dmitry Stogov
Sockets	Chris Vandomelen, Sterling Hughes, Daniel Beulshausen, Jason Greene
SPL	Marcus Boerger, Etienne Kneuss
SQLite 3.x driver for PDO	Wez Furlong
SQLite3	Scott MacVicar, Ilia Alshanetsky, Brad Dewar
Sybase-CT	Zeev Suraski, Tom May, Timm Friebe
System V Message based IPC	Wez Furlong
System V Semaphores	Tom May
System V Shared Memory	Christian Cartus
tidy	John Coggeshall, Ilia Alshanetsky
tokenizer	Andrei Zmievski, Johannes Schlueter
WDDX	Andrei Zmievski
XML	Stig Bakken, Thies C. Arntzen, Sterling Hughes
XMLReader	Rob Richards
xmlrpc	Dan Libby
XMLWriter	Rob Richards, Pierre-Alain Joye
XSL	Christian Stocker, Rob Richards
Zip	Pierre-Alain Joye, Remi Collet
Zlib	Rasmus Lerdorf, Stefan Roehrich, Zeev Suraski, Jade Nicoletti, Michael Wallner

PHP Documentation
Authors	Mehdi Achour, Friedhelm Betz, Antony Dovgal, Nuno Lopes, Hannes Magnusson, Georg Richter, Damien Seguy, Jakub Vrana, Adam Harvey, Peter Cowburn
Editor	Philip Olson
User Note Maintainers	Daniel P. Brown, Thiago Henrique Pojda
Other Contributors	Previously active authors, editors and other contributors are listed in the manual.

Websites and Infrastructure team
PHP Websites Team	Rasmus Lerdorf, Hannes Magnusson, Philip Olson, Lukas Kahwe Smith, Pierre-Alain Joye, Kalle Sommer Nielsen, Peter Cowburn, Adam Harvey, Ferenc Kovacs, Levi Morrison
Event Maintainers	Damien Seguy, Daniel P. Brown
Network Infrastructure	Daniel P. Brown
Windows Infrastructure	Alex Schoenmaker