Trust: The Keystone of the Patient-Physician Relationship
Trust: The Keystone of the Patient-Physician Relationship
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DOI：
10.1016/j.jamcollsurg.2016.10.032
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发表时间：
2017-02-01
影响因子：
5.2
通讯作者：
Pellegrini, Carlos A.
中科院分区：
文献类型：
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作者：
Pellegrini, Carlos A.
这个讲座是由一个著名的外科医生，约翰J康利，耳鼻喉科医生谁奉献了他的大部分职业生涯的头部和颈部癌症的治疗。康利博士主要是一名外科医生，而不是哲学家或伦理学家。然而，他认为，为了给癌症患者提供最好的护理，外科医生除了接受传统的外科手术技术方面的培训外，还应该接受其他方面的培训。为此，在20世纪90年代初，他创立了约翰·康利医学伦理和哲学基金会，通过该基金会，他建立了这个讲师职位，在美国外科医生学院内提供一个论坛，讨论外科医生面临的伦理问题。他说：“我认为伦理学和哲学在某种意义上是医学职业的本质。我特别感兴趣的是，作为执业外科医生的前线，保持最高的道德原则。”和康利医生一样，我之所以成为一名外科医生，是因为我对胃肠道的病理生理学很着迷，并将手术视为一种独特的方式，可以用自己的双手改变这些器官的功能。我相信，通过改变病理过程本身，我可以改善病人的生活质量，偶尔治愈一些可怕的疾病，当这不可能时，至少可以减轻人类同胞的痛苦。在我的性格形成时期或早期职业生涯中，我没有以任何正式的方式接受哲学或伦理学的研究。但随着岁月的流逝，我发现治愈的力量，我对病人的影响，以减轻疼痛，痛苦，不适，可以通过我与他们建立的关系来大大增强。随着我在医患关系领域的热情不断增长，以及在我担任外科医生的这些年里，我只使用我的技术专长进行治疗的能力的局限性变得更加明显，我认识到患者和外科医生之间的高质量沟通的影响，这种沟通产生了相互信任，对我的工作成果产生了影响。在我职业生涯的某个阶段，我也意识到我与病人建立良好关系的能力增强了我与自己沟通的能力，让我更好地理解自己的感受，在某种程度上，与自己的灵魂沟通。与此同时，我清楚地意识到，作为外科医生，我们每天都与护士、技术人员、社会工作者、住院医生和其他医疗服务提供者“合作”，他们都代表病人参与工作，当我们通过充分的沟通与我们的团队建立了信任关系时，团队工作得更好，压力更小，我们大家都对出色的工作感到满意和庆祝，我们工作的环境也得到了丰富。本文详细介绍了信任的重要性，通过适当的沟通，在外科医生与病人，手术团队，他或她自己的关系。在这样做的过程中，我广泛借鉴了这些领域的专家，并添加了我自己作为临床医生的解释，将理论构建转化为实际应用，希望它们能直接使患者和护理人员受益。
This lectureship was established by a well-known surgeon, John J Conley, an otolaryngologist who dedicated most of his professional life to the treatment of head and neck cancer. Dr Conley was primarily a surgeon, not a philosopher or an ethicist. Yet, he believed that to provide the best care to patients with cancer, the surgeon should be trained in other areas, in addition to the traditional technical aspects of surgery. To that end, in the early 1990s, he founded the John J Conley Foundation for Ethics and Philosophy in Medicine, through which he established this lectureship to provide a forum within the American College of Surgeons where ethical questions facing surgeons could be discussed. He once said “I consider ethics and philosophy to be in one sense, the essence of the medical profession. I am particularly interested in maintaining the highest ethical principles as a frontline for the practicing surgeon.” 1 Like Dr Conley, I became a surgeon because I was fascinated by the physiopathology of the gastrointestinal tract, and saw surgery as a unique way to make changes with my own hands that affected the functioning of those organs. I believed that by altering the pathologic process itself, I would improve the quality of life for my patients, occasionally cure someone from a dreadful disease, and, when that was not possible, at least alleviate pain and suffering of fellow human beings. I did not embrace the study of philosophy or ethics in any formal way during my formative years or early professional life. But as the years went by, I found that the power of healing, the influence that I have over my patients to alleviate pain, suffering, and discomfort, could be enhanced substantially by the kind of relationship I established with them. As my enthusiasm grew in the area of the patientphysician relationship, and as the limitations of my abilities to heal using only my technical expertise became more obvious during my years as a surgeon, I recognized the impact that quality communication between patients and surgeons, the kind that engenders mutual trust, had on the outcomes of my work. And at some point in my career, I also realized that my ability to establish a good relationship with my patients enhanced my ability to communicate with myself, and allowed me to have a better understanding of my own feelings and, in a way, to communicate with my own soul. At the same time, it became clear to me that, as surgeons, we “team up” every single day with nurses, technicians, social workers, residents, and other healthcare providers, all of whom participate in the work on behalf of the patient and when we have, through adequate communications, established a bond of trust with our team, the team works better, the stress is lower, the satisfaction and celebration of work well done is shared among all of us, and the environment in which we work is enriched. This essay describes in some detail the importance of trust, engendered through appropriate communications, in the relationship of the surgeon with the patient, the surgical team, and him-or herself. In so doing, I have borrowed extensively from experts in those fields and added my own interpretation as a clinician to translate theoretical constructs into practical applications, with the hope that they will directly benefit patients and care providers alike.