关怀人际关系
肯尼思·施瓦茨(Kenneth Schwartz)——波士顿的一位成功律师,在40岁的时候被诊断出肺癌。在手术前一天,他来到了医院的术前接待区等候术前咨询,护士们业务繁忙,工作时都是疾步小跑。
等了好久之后护士终于叫到了他的名字,于是他走进办公室。一开始,那位进行术前咨询的护士态度十分简慢,施瓦茨感觉自己就是另外一个没有任何识别标志的病人。不过,当施瓦茨告诉她自己得的是肺癌的时候,她的表情柔和起来。她还握住他的手,问他感觉如何。
突然间,他们的关系不再是护士与病人,施瓦茨给她讲自己两岁的儿子本的故事。她告诉施瓦茨自己的侄子也叫本。当谈话快要结束的时候,她已经开始擦眼泪了。尽管她的职责并不要求她去手术区,但是她还是说她会来看他。
第二天当他坐在轮椅中等着被推进手术室的时候,她来了。她眼泪汪汪地抓住他的手,祝他好运。
施瓦茨在医院中还经历过许多这样的关怀。就像他所说的那样,这样的善意关怀“使许多原本难以忍受的过程变得不那么痛苦了”。[14]
在几个月后,也就是他去世前不久,施瓦兹做出了一项捐赠,希望通过自己的努力能够使更多的病人得到这种仁慈的关爱。他在马萨诸塞州综合医院成立了肯尼思·施瓦茨中心,来“支持和推动人性化医疗护理”。
他希望这种人性化医疗护理能够为病人带来希望,并且为医务工作者提供支持,这些都有助于病人的康复。[15]
施瓦茨中心每年都会颁发年度人性化护理奖来表彰那些在护理病人过程中表现出极大爱心、堪称典范的医务工作者。该中心另外一项颇有成效的举措就是改革了医院研讨会。传统的医院研讨会一般都是为医务工作者介绍本领域的一些最新成果,而“施瓦茨中心研讨会”却为医院员工提供了一个可以畅谈自己忧虑和担心的机会。这样做的初衷在于让医务工作者能够通过对自身情感的反思来改善自己与病人间的交流。[16]
马萨诸塞州剑桥市奥本山医院的贝思·劳恩(Beth Lown)博士曾经说:“第一次在施瓦兹中心开研讨会的时候,我们以为大约六七十人能来参加就不错了。但是出乎我们意料的是,到场的医务工作者大约有160名。这些研讨会的成功证明我们的确需要坦诚地交流彼此对于工作的看法与情感。”
作为美国医师与病人学会的官员,劳恩博士看待问题有着自己独特的视角:“与病人进行良好的沟通本是许多人进入医学界的初衷,但是它逐渐被以生物学和医学为导向、以科学技术为驱动力、以尽快接收并治疗病人为目的的医院文化所取代。我们现在应该考虑的问题并不是医学院学生是否能够通过学习获得同理心的能力,而是我们现行体制中究竟哪些因素使他们丧失了这一基本能力。”
现行的医学资格考试中就包含了对于人际能力的评估,这也证明了医生营造和谐人际关系能力的重要性。医生在他们的职业生涯中的平均问诊次数大约为20万次,问诊是他们与病人建立和谐关系的最佳时机。
分析能力越来越强的医学头脑将问诊分成7个部分,包括开始时的询问和交流病人情况到最后治疗方案的制订。它所强调的不是医学操作的规范(当然是考虑到这一点的),而是人性化的服务。
比如,医生应该鼓励病人多谈一下自己的情况,而不要从一开始就占据着对话的主导权。医生们需要与病人进行良好的沟通,这样他们才能了解病人对于疾病和治疗的态度。换句话说,他们需要调动同理心并与病人建立和谐的关系。
劳恩博士认为,这些技巧“是可以通过学习获得的,但是它们也像其他临床技能一样,需要在实践中锻炼和培养”。而且,她还认为,这样不仅会提高医生的效率,使病人更好地坚持治疗,而且还会提高病人对于医疗服务的满意度。
肯尼思·施瓦茨去世前几个月的话语更加直白,他写道:“人性化关怀的疗效是大量的放射疗法和化学疗法都无法比拟的,它们燃起了我痊愈的希望。尽管我并不认为仅仅依靠希望和从容的心态就能够战胜癌症,但是它们的确改变了我”。
- On rates of burnout, see Sameer Chopra et al., “Physician Burnout,” Student JAMA 291 (2004), p.633.
- On the heart surgeon turned patient, see Peter Frost, “Why Compassion Counts!” Journal ofManagement Inquiry 8 (1999), pp. 127–33. The saga of the heart surgeon as told by Frost is looselybased on the story of Fitzhugh Mullan, a physician who wrote about his own shift from doctor-in-charge to helpless patient suffering from cancer in Vital Signs: A Young Doctor’s Struggle with Cancer(New York: Farrar, Straus and Giroux, 1982). I, in turn, have slightly modified and shortened Frost’sversion.
- David Kuhl, What Dying People Want (Garden City, N.Y.: Doubleday, 2002).
- On rapport and lawsuits, see W. Levinson et al., “Physician-Patient Communication: TheRelationship with Malpractice Claims Among Primary Care Physicians and Surgeons,” Journal of theAmerican Medical Association 277 (1997), pp. 553–59.
- Fabio Sala et al., “Satisfaction and the Use of Humor by Physicians and Patients,” Psychology andHealth 17 (2002), pp. 269–80.
- On patient satisfaction, see Debra Roter, “Patient-centered Communication,” British MedicalJournal 328 (2004), pp. 303–4.
- Doctors, it turns out, are not the best judges of how well their patients understand them. Whenpatients being treated for myocardial infarction or pneumonia were surveyed about their posthospitaltreatment plans, just 57 percent said they comprehended the plans. But when the very physicians whomade up those plans and had explained them to their patients were asked the same question, they said89 percent understood. That gap showed up again when just 58 percent of patients knew when theycould resume their normal activities, while their physicians assured the researchers that 95 percentknew. See Carolyn Rogers, “Communications 101,” American Academy of Orthopedic Surgeons’Bulletin 147 (1999), p. 5.
- On exit interviews, see ibid.
- On the second-year medical students, see Nancy Abernathy, “Empathy in Action,” MedicalEncounter (Winter 2005), p. 6.
- On security and compassion, see Omri Gillath et al., “An Attachment-Theoretical Approach toCompassion and Altruism,” in P. Gilbert, ed., Compassion: Conceptualizations, Research, and Use inPsychotherapy (London: Routledge and Kegan Paul, 2004).
- For the flow chart for caregiving, see William Kahn, “Caring for the Caregivers: Patterns ofOrganizational Caregiving,” Administrative Science Quarterly 38 (1993), pp. 539–63.
- Lyndall Strazdins, “Emotional Work and Emotional Contagion,” in Neal Ashkanasy et al., eds.,Managing Emotions in the Workplace (Armonk, N.Y.: M.E. Sharpe, 2002).
- For a detailed study of leadership excellence in the medical sector and service professionsgenerally, see Lyle Spencer and Signe Spencer, Competence at Work: Models for SuperiorPerformance (New York: John Wiley, 1993).
- On making the unbearable bearable, see Kenneth B. Schwartz, “A Patient’s Story,” Boston GlobeMagazine, July 16, 1995.
- The Kenneth B. Schwartz Center has a website at www.theschwartzcenter.org
- These rounds might be on any topic pertinent to the personal aspects of patient care, ranging fromhandling a difficult or hostile patient or family, to coping with the emotional price of caring forseriously ill patients. They are regularly scheduled at Mass General (as Harvard Medical School’s mostrenowned hospital is known) and have been adopted by more than seventy other hospitals. TheSchwartz Center offers help to other hospitals interested in starting such rounds.
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