谈医学生的医患沟通能力培养

以病人为中心,构建和谐的医患关系,避免和减少医患之间的矛盾,为患者提供人性化的医疗保健服务,将成为21世纪医院创新经营的关键。而建立和谐的医患关系,不仅有利于医患双方个体的信任合作及关系融洽,更重要的是它能推动医学发展和社会进步,是一个意义重大而深远的理论与实践问题。因此,传统的医学教育模式亟待调整以适应新的形势发展需要,医学院校不仅要重视对医学生专业知识和操作技能的传授,还应加强对医学生沟通能力的培养和训练。     

医患关系紧张的心理成因探究——以急诊患者家属为例

随着经济社会的发展,医患关系日益成为人们关注的焦点.本文以急诊患者家属为例,从心理方面来探讨医患关系,分析医患关系紧张的原因:利益冲突、心理应激和缺乏沟通等;提出拉近医患关系的见解:医方要注重对患者家属的心理疏导与心理治疗,加强沟通,不断提高自身的能力素质.     

从心理学角度谈医患间的沟通技巧

在临床实践中,医患双方产生矛盾、甚至发生医疗纠纷和医疗事故都是在所难免的.问题的关键在于医务工作者要学会与患者的沟通技巧,从而达到解决问题,消除矛盾的目的.本文启示医务人员要处理好医患纠纷,就必须解决好医患认识上存在的差异,对患者进行疾病的健康教育,了解患者的需求,在沟通过程中做出恰如其分的承诺与保证.     

3例ICU患者放弃治疗医患抉择异议的伦理思考

ICU病房患者放弃治疗一直是医患双方争论的焦点,如何正确地对放弃治疗患者做出抉择显得格外重要。以3例ICU患者放弃治疗的实际案例为例,论述医患双方抉择的异议,进而深入剖析案例引发的伦理思考。从医务人员的角度探讨案例体现的过度医疗和无效医疗问题、终止治疗和放弃治疗问题以及对生命质量及价值的权衡,并提出强化疗效伦理意识、合理取舍放弃治疗时机、树立正确的生命观、增强对放弃治疗患者的临终关怀等解决对策,以期达到对ICU病房中危重患者救治更符合伦理要求的目的,为医患双方对ICU患者放弃治疗抉择提供伦理参考。     

医患关系与医患共同决策关系辨析

密切医患关系和医患共同决策是在当前医疗状况下发展我国医疗事业必不可缺的两个重要条件。同时,密切医患关系和医患共同决策又存在着相互促进、互为因果的关系。密切医患关系可以有效促进医患双方沟通顺畅,促进医患相互信任,为医患共同决策提供前提保证;医患共同决策可以让患者依从性更好,从而让患者得到更优质的医疗服务,因而增加医患双方的相互信任为密切医患关系创造有利条件。两者共同作用,可以为我国医疗卫生事业发展提供有效动力,让患者得到更好的医疗卫生服务,让医疗技术发展得到更广阔的空间。     

试论医疗总值班干预对救治无助急诊患者的体会

"无助急诊患者"是指患者来医院急诊时无家属、亲戚、朋友的陪伴,且当时无能力支付医疗费用的患者[1],主要来源于病倒路旁的流浪汉、乞讨者,另外还有车祸、工伤等意外事故中肇事者、负责人逃逸后留下的无辜受伤者.随着市场经济的迅猛发展及城市流动人口的不断增多,无助急诊患者越来越多,面对这些无助患者的救治与处置,给医院带来了极大的困扰,同时他们也是引发医患冲突的隐性人群之一.我院由医疗总值班的及时干预,积极协调,给此类患者的生命开辟了一条"绿色通道",同时对避免医患纠纷起到了极为重要的作用.     

放弃治疗的法律和伦理学思考

调查放弃治疗后死亡病案629例,主要病因为恶性肿瘤和脑血管病.目前在临床工作中,对疾病晚期和临终期的患者,放弃治疗已成为家属和患者本人重要的选择之一.医患双方应该尊重医学科学,理性对待放弃治疗,履行双方应尽的义务,维护双方合法权力,维护法律的尊严.医院应该加强管理,正确处理放弃治疗的相关问题,更好地服务于患者和社会.     

患者拒绝签署紧急手术知情同意书的处理对策

签署手术知情同意书是医方履行告知义务,保障医患双方合法权益的一种重要手段。当患者病情需要紧急手术但患者或其家属拒绝签署手术知情同意书时,医院面临错失抢救时机和巨大的医疗风险,甚至可能因此成为被告。结合我院临床工作中的成功经验,探讨医院如何在尽可能抢救患者生命的情况下,规避相关法律风险。     

医患双方对医患关系认知情况的调查分析

为了解医患双方对医患关系的认知情况,对江西吉安市五家医院的医生和住院患者采取整群随机抽样法进行随机问卷调查。发现医患双方对医患关系性质、发展趋势及医患冲突的主要诱因、责任主体、主要解决途径的认识状况均存在显著性差异。这种差异直接影响医患关系发展。如何解决医患双方认知的差异是重构和谐医患关系的根本措施。     

加强情商培养 构建急诊和谐的医患关系

急诊科是医院救治急、危、重患者的第一线,也是医患冲突高发的科室,因此善于沟通和交流的高情商成为急诊科医生的必备品质之一;本文从情绪调控、心理学、利益得失、人文素养、语言艺术等角度探讨了急诊科医生情商培养在构建和谐医患关系中的重要作用。     

综合医院开展临床预防服务的可行性

临床预防服务是预防医学的重要组成部分,也是临床医学的重要内容。鉴于慢性非传染性疾病对社会、家庭及个人的负担越来越重,在各级医院尤其综合医院开展临床预防服务,对预防慢性病的发生、发展,降低死亡率、减轻社会、家庭负担,将起到事半功倍的作用,产生深远影响。     

Language and understanding of cardiopulmonary resuscitation amongst an aged inpatient population

Greater patient involvement in health decision-making requires exchange of information between the patient and the healthcare professionals. Decisions regarding healthcare at the end of life include consideration of cardiopulmonary resuscitation (CPR). The stated objectives of this study were to determine how often language around concepts of resuscitation is used in the community by examination of the English language corpora (ELC); to explore the understanding of the same language by a group of older hospital patients; and to determine the patients’ knowledge of the process and success of CPR, as well as the sources of their information. Medical inpatients aged 75 years and older were surveyed to this end in the setting of a tertiary university teaching hospital. Interrogation of the Australian, British and American English Corpora was accomplished by a linguist, and a questionnaire and semi-structured interview were administered to ascertain patient knowledge. We demonstrated that although medical inpatients have some familiarity with terms relating to resuscitation, there is a lack of understanding of the context, process and outcomes of CPR. The predominant sources of information were television and print media. Examination of the ELC revealed a paucity of the use of terms related to resuscitation. This finding indicates that physicians have a duty of care to determine patients’ understanding around resuscitation language, and terms used, in discussions of their preferences before assuming their engagement in shared decision-making. More open public discussion around death and resuscitation would increase the general knowledge of the population and would provide a better foundation for the discussions in times of need.     

脑卒中患者功能独立性与家庭照料者负担感的关系：以社会支持为中介变量和调节变量

研究对203名脑卒中患者的家庭照料者进行了问卷调查,以探讨患者的功能独立性对家庭照料者负担感的作用机制。结果显示,82.3%脑卒中患者的家庭照料者有明显的负担感;患者的功能独立性与家庭照料者的负担感显著负相关;来自患者的社会支持在患者功能独立性与家庭照料者负担感之间起中介作用,而来自患者之外的社会支持则起调节作用。结果表明,在家庭照料负担的干预实践中,应注意区分来源不同的社会支持及其作用机制。     

人文关怀在消除IVF—ET患者心理压力中的作用

近年我国不少生殖医学中心在如何提高体外受精一胚胎移植（IVF—ET）治疗成功率问题上,都将注意力集中在临床用药的研究、控制性超促排卵方案的改进以及实验室条件的改善上,大多忽视IVF—ET患者心理方面的治疗。有研究表明：IVF—ET治疗的成功,不仅与患者自身的病理及生理状况有关,更与患者在治疗过程中产生的心理压力有关。因此,建议医护人员在给不孕症患者实施IVF-ET助孕治疗的全过程中,应给予患者更多人文关怀,这样不仅能够减少IVF—ET患者心理健康问题的发生,而且可以改善患者的身心状态和应对治疗能力,从而提高IVF—ET治疗成功率。     

医院积极处理医疗投诉的意义与实施方法

医疗投诉往往是医疗纠纷的雏形,消极处理可能使矛盾激化,让医院和患者成为对立的双方,由此增加了问题解决的难度和成本。医院积极对待处理医疗投诉具有积极意义,在降低投诉处理难度和成本的同时,也很好的塑造了医院的社会形象。同时阐述了其积极应对的措施。     

EGFR基因突变NSCLC全程管理

表皮生长因子受体（EGFR）基因突变的非小细胞肺癌（non-small cell lungcancer,NSCLC）是一类具有独特病理和临床特征的恶性肿瘤。目前由于针对EGFR基因突变阳性NSCLC治疗中TKIs的应用,患者的生存期已超过三年,所以此类患者从诊断到治疗应进行全程管理。首先要进行分子检测,发现EGFR基因突变NSCLC,以避免失去EGFR—TKIs的治疗机会。研究证明,EGFR基因突变NSCLC任何线接受第一代抑制剂治疗,患者疗效及生存获益且耐受性良好。一代EGFR—TKIs耐药后根据失败模式选择后续局部或全身治疗,或根据耐药失败分子机制给予新的分子靶向治疗。对EGFR基因突变NSCLC应实施科学、有序的全程管理。     

The Future of Psychology in Family Medicine

Psychology has been integral to the field of family medicine since its inception as a medical specialty in the 1960s. Psychologists and other behavioral scientists contribute to family medicine in teaching clinical skills, in defining research questions, in developing research methodology, and in creating integrated physical/mental health care delivery systems. Future developments in the field of psychology in family medicine are likely to emphasize development and evaluation of screening measures which identify mental health problems in primary care, development of early intervention for those mental health problems, and more precise measurement of process and quality of care and health outcomes. Psychologists have an important role to fulfill in educating physicians on alternatives to pharmacologic and medical interventions for common presenting problems in primary care. However, current economic forces shaping the practice of medicine may work against further enhancing the efficacy of the physician in dealing with psychosocial issues. The future role of psychology in family medicine is not yet delineated, and while the move toward parity of reimbursement for mental and physical health care delivery may enhance this collaboration, there is a need to continue to evaluate how the psychological well-being of patients is influenced in the evolution of new models of care delivery.     

Keeping Engaged During Deployment: The Interplay Between Self-Efficacy,Family Support,and Threat Exposure

This study investigated the importance of 2 resilience resources for service members’ ability to deal with threat during deployment. Military self-efficacy and family support were measured before deployment and related to work engagement and burnout levels of service members during deployment. We hypothesized that in high threat situations, low self-efficacy would lead to unfavorable outcomes, whereas in low threat situations, high self-efficacy could have negative consequences. In addition, we hypothesized that family support would compensate for both effects. The results showed these expected 3-way interactions. We found that strong self-efficacy helped service members deal with exposure to threatening situations during deployment, leading to more work engagement and less burnout. However, having strong self-efficacy without being exposed to threat during deployment reduced service members’ work engagement and increased burnout. In addition, we found that the presence of family support compensated for these effects. Service members with low self-efficacy benefitted from family support when threat exposure was high, whereas service members with high self-efficacy benefitted from family support when threat exposure was low. As such, family support seemed to act as a compensatory mechanism for the potential negative effects of self-efficacy. This underlines the importance of studying the interplay between resources that help service members deal with deployment experiences. Practical implications relate to supporting service members’ resilience through enhancing multiple resources.     

Helping patients by involving their families

Patients and their family members may become highly interdependent as patients near the end of life. To best help these patients, healthcare providers can try to become a member of the patient/family team. By becoming a member, careproviders can improve patients' and family members' access to medical information, more effectively offer advice, and assure patients and family members that they can still choose to do what they think is best.     

Maxwell and materialism

In a recent article, Grover Maxwell presents a case for a kind of mind-brain identity theory which he claims precludes materialism. His case is based on some views about meaning which I find plausible. However, I will argue that, by adopting certain assumptions about the nature of sensory experience, and extending some of Maxwell's views about meaning in a plausible way, the issue of a materialistic identity theory is reopened. Ultimately, I will agree that such a theory is not true, but more is needed to show this than Maxwell gives us. But the question of materialism is not thereby closed, because it has become axiomatic these days that materialism does not require an identity theory. So I will go on to consider if all forms of materialism have been ruled out by Maxwell's theory, as extended by me. I will end with a tentative affirmative answer but also with a proposal which, if it can be worked out, would reverse the decision.