A biopsychosocial approach to finding common ground in the clinical encounter.
A biopsychosocial approach to finding common ground in the clinical encounter.
复制标题
在临床遭遇中寻找共同点的生物心理社会方法。
DOI：
10.1097/00001888-200006000-00017
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发表时间：
2000
期刊：
影响因子：
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通讯作者：
Maskarinec,G
中科院分区：
文献类型：
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作者：
Yamada,S;Greene,G;Bauman,K;Maskarinec,G
目的临床医生如何在与患者的冲突中找到共同点，或者教育工作者如何教实习医生做到这一点，我们知之甚少。作者着手为寻找共同点的过程建立一个概念模型。方法三年家庭实习助理的学生写下他们在医患关系中遇到的冲突的案例。作者分析了这些案例，先是独立的，然后是集体的。经过几次迭代，他们得到了一个基于案例材料的模型。结果作者认为，对恩格尔首先提出的、后来由McWhinney更新的生物-心理-社会模型进行修改是一种合适的、实用的冲突来源分类方案。该系统包括五个层次：(1)患者个体，(2)医患关系，(3)患者家庭，(4)患者和家庭的民族信仰系统，(5)政治经济。结论这种分层的、多层次的生物心理社会方法使临床医生能够识别系统中发生冲突的级别。这明确了解决的策略，使患者和医生更容易找到共同点。这也可能是向实习医生传授此类技能的一个有用的启发式模式。
PurposeLittle is known about how clinicians find common ground in conflicts with their patients or how educators can teach physicians-in-training to do so. The authors set out to create a conceptual model for the process of finding common ground.MethodStudents in a third-year family practice clerkship wrote up cases they had encountered in which conflicts arose in the patient-doctor relationship. The authors analyzed these cases, first independently and then collectively. After several iterations, they arrived at a model grounded in the case material.ResultsThe authors suggest that a modification of the biopsychosocial model first proposed by Engel and later updated by McWhinney is an appropriate and practical schema for classifying sources of conflict. This hierarchical system consists of five levels:(1) individual patient,(2) relationship between patient and physician,(3) patient's family,(4) ethnic belief systems of patient and family, and (5) political economy.ConclusionThis hierarchical, multilevel biopsychosocial approach allows the clinician to identify the level in the system at which a conflict has arisen. This clarifies the strategies for resolution, making it easier for patient and doctor to find common ground. This may also be a useful heuristic model for teaching such skills to physicians-in-training.