模块三：病史采集PPT.pdf

Information Gathering模块三：病史采集模块三：病史采集2Learning Objectives学习目标：学习目标：By the end of this workshop participants will be able to use these skills to build relationships这部分课程结束后，学员将能够使用下列技巧建立关系：?Greeting:wordless问候：无声的（非语言性的）?Greeting:verbal问候：语言性的?Asking about the reason for the visit询问就诊原因?Eliciting complete agenda问明患者的全部意向?Eliciting the patients story问清病史?Facilitating辅助病人讲述?Checking核对?Partnership伙伴关系22录像观摩录像观摩32活动一：个人经验活动一：个人经验经历练习经历练习43Why gather information?为什么要采集病史？为什么要采集病史？The two purposes of information gathering病史采集的两个目的:1.To understand the disease了解病情2.To understand the patient了解患者54Understanding Disease目的一：了解病情：目的一：了解病情：Disease is understood by entering the world of science.通过进入医生的专业领域了解病情Gathering information to采集病史以便：?Test hypotheses检验假设?Make diagnoses作出诊断65Understanding Patients目的二：了解患者目的二：了解患者Patients are understood by entering the world of the patient.通过进入患者的世界了解患者Gathering information to understand病史采集以便了解患者：?Reaction to disease对疾病的反应?Visit expectations来看病的期望76Keys to Expertise专业知识是关键专业知识是关键The keys to entering each world进入每个世界的钥匙:?Sciencemedical expertise科学医学专业知识?Patientcommunications expertise患者交流技巧87Potential Consequences可能出现的结果可能出现的结果Consequences of not entering the patients world未进入患者的世界可能造成的后果:1.Poor outcomes治疗结果差2.Poor satisfaction不满意3.Poor compliance依从性不良98Ultimately,Lack of harmony in the doctor-patient-family relationship最终导致医生患者家属关系不和谐109Module Goals本章目标本章目标The goals of this module are to这一模块的目标是:?Learn how to gather information学习如何采集病史?Using the perspectives of 2 worlds运用两个世界的概念1110Patient Obstacles患者的障碍患者的障碍Patients withholding information from fear of患者隐瞒病情是因为害怕:1.Judgment评价2.Physician power医生的地位3.Disease(denial)疾病（否认）1211Doctor Obstacles医生的障碍医生的障碍Doctors medical thinking structure医生的医学思维结构:?Disease focused关注疾病1312Doctor Obstacles(cont.)医生的障碍（续）医生的障碍（续）Doctors time limitations医生的时间限制:?Is it possible to get out of the patients world in 15 minutes?在15分钟内走出患者的世界可能吗？1412Listening聆听聆听?聆听的目的：给患者表达自己意见的机会，创造良好的气氛，使患者感到与你的沟通愉快且获得尊重?聆听的形式：?反应式聆听?感觉式聆听（设身处地的聆听）1512聆听的五个层次聆听的五个层次1.设身处地的聆听2.专注的听3.选择的听4.虚应的听5.听而不闻1.设身处地的聆听2.专注的听3.选择的听4.虚应的听5.听而不闻1612反应式聆听反应式聆听以表情或声音做出反应鼓励对方继续发表意见连接词：?是的?对?是这样.?唔?嗯1712感觉式聆听感觉式聆听（设身处地的聆听）（设身处地的聆听）转述对方意见，引起共鸣，加深对方对你想听到的支持意见的印象：连接词：?您的意思是?换句话说?您是说.?让我试试能不能这样理解您的意思1813The CMDA“3 Phase”ChecklistCMDA三阶段检测表三阶段检测表3 phases三个阶段1.Early:Greeting,Reason for Visit,Agenda早期：问候，就诊原因，意向2.Middle:Patients story,Facilitating,Checking中期：让病人陈述问题，辅助病人讲述，核对3.Late:Partnership后期：伙伴关系3 PhaseInformation GatheringCMDA Checklist CMDA病史采集检查表1914Early Phase早期：Greeting 1-2.问候问候Non-verbal1.非语言性的非语言性的?Tone of voice语调?Eye contact眼神交流?Hand shake握手Verbal2.语言性的语言性的?Use words of greeting使用问候语?Use formal address使用正式的称呼“Nice to see you,Mr.Chu很高兴见到你，楚先生。”3 PhaseInformation GatheringCMDA Checklist CMDA病史采集检查表2015Early Phase早期：Discovering the Reason(s)for the Visit3.问明患者就诊原因问明患者就诊原因?Use Open-Ended Questions进行一般询问?Dont interrupt不要打断患者?Rememberreasons for visit may not be medical记住就诊原因可能是非医学的3 PhaseInformation GatheringCMDA Checklist CMDA病史采集检查表2116Early Phase早期：Eliciting the Patients Complete Agenda4.问明患者的全部意向？问明患者的全部意向？“Is there anything else?还有吗？”Saves the doctor time!节省医生的时间！3 PhaseInformation GatheringCMDA Checklist CMDA病史采集检查表2217Middle Phase中期：Eliciting the Patients Story 5.问清病史问清病史?Open-ended questions开放性询问“请说得详细些”，“然后呢？”?Open-closed cone先开放，然后再缩小范围“讲讲你的胸痛”“从什么时候开始痛？”“疼痛有多剧烈？”3 PhaseInformation GatheringCMDA Checklist CMDA病史采集检查表2318Middle Phase中期：Clarifying the Patients Story 6.澄清患者主述澄清患者主述“Tell me what you mean by你的意思是”“头晕目眩，你是指”3 PhaseInformation GatheringCMDA Checklist CMDA病史采集检查表2419Middle Phase中期：Facilitating 7.辅助患者讲述辅助患者讲述Non Verbal非语言性的?Head nods点头Verbal语言性的?Saying things like“uh-huh”“嗯嗯”?Repeating the patients last words重复患者最后的话?Paraphrasing what the patient said理解病人的话3 PhaseInformation GatheringCMDA Checklist CMDA病史采集检查表2520Middle Phase中期：Checking 8.核对核对A summary statement to confirm understanding概括性的陈述以确认理解无误“Tell me if I understand what you have said请告诉我，对于你所说的，我的理解是否正确无误”3 PhaseInformation GatheringCMDA Checklist CMDA病史采集检查表2621Late Phase晚期：Partnership 9.伙伴关系伙伴关系?Cement relationship with a“we”statement谈话用“我们”以加强关系?Transition to the physical exam向体格检查过渡“接下来我们要作体格检查，之后我们可以坐下来讨论导致你的症状的可能原因。”3 PhaseInformation GatheringCMDA Checklist CMDA病史采集检查表272角色扮演练习角色扮演练习62425282角色扮演练习角色扮演练习?不要过分纠缠案例本身的文化与社会背景?本案例可能有不同的解决方法?要集中于“病史采集技能”的应用?以学习的心态去练习掌握Information GatheringCMDA Checklist CMDA病史采集检查表2292Learning Objectives学习目标：学习目标：By the end of this workshop participants will be able to use these skills to build relationships这部分课程结束后，学员将能够使用下列技巧建立关系：?Greeting:wordless问候：无声的（非语言性的）?Greeting:verbal问候：语言性的?Asking about the reason for the visit询问就诊原因?Eliciting complete agenda问明患者的全部意向?Eliciting the patients story问清病史?Facilitating辅助病人讲述?Checking核对?Partnership伙伴关系30Thank You!谢谢谢谢