医生如何向患者解释检查结果


NeuroTimes | Dec. 8, 2015


Credits: bmj.com


国内的医患关系日趋紧张。虽然从情感上讲,我大多数时候是站在医生这边的,因为我的很多同学、朋友是医生,在科研期间也或多或少待过门诊和病房,知道医生的紧张和辛苦,和有些患者的胡搅蛮缠。但说实话,有时候医生在特别疲劳和繁忙的情况下,实在难以注意到一个病人的心情。也许很多时候,条理清晰地多说一两句话,就能让患者更了解自己的病情,对检查结果更放心,也更理解要做一个检查的目的。

知乎上有过一个提问:为什么去医院看感冒要做心电图。很多医生的回答写的很清楚,让大家都明白了做心电图的目的,毫无疑问医生是对的。但在实际的门诊中,估计很少有人真的能用简洁的语言去解释清楚心电图的目的,这就让很多不懂医学的人一头雾水。因为在大多数人印象中,感冒和心电图确实是八杆子打不着的关系,你不能用一个至少5年医学生的经验去要求一个外行人。

BMJ上的这篇文章,体现了一名医生真正的“情怀”,医生不但需要看好病,还需要让患者理解这些检查结果代表什么意思,有什么意义。看一个病人的时间很紧张,但在体制没有大变化的前提下,如何短时间内简洁地向患者说明情况,是值得思考和尝试的。

BMJ文章针对指标检查的目的,如诊断、监测、风险分级、筛查等等,举了5个例子(就不翻译了):

Box 1: “My sodium level is slightly low at around 131 mmol/L: is there something wrong?”
Although most healthy people have a sodium value between 133 mmol/L and 146 mmol/L, one in every 40 healthy people will have a reading just below this range. Because you are otherwise well and the level has not changed, it is unlikely to be important.

 

Box 2: “My coeliac disease blood test result is negative: does this mean I have nothing to worry about?”
The negative test result makes coeliac disease unlikely but does not completely rule it out. However because of your symptoms, I would like to discuss with the gastroenterology specialist whether further investigation for coeliac disease is needed.

 

Box 3: My cholesterol was 5.7 mmol/L. I improved my diet but now it has gone up to 6.1 mmol/L: why?’
Cholesterol levels vary from day to day depending on such factors as body rhythms, fluid intake, and season of the year. A small change in cholesterol like this is probably due to this natural variation rather than a true rise in value.

 

Box 4: “My cholesterol is high so why am I not being offered treatment?”
Only people at higher risk of heart disease benefit from cholesterol lowering tablets. Although your cholesterol level is increased, we calculated that your risk of heart disease over the next 10 years is low because you are otherwise healthy, don’t smoke, and have normal blood pressure. The benefit from a cholesterol lowering tablet at this stage is likely to be low and such tablets may also have side effects.

 

Box 5: “Can I get some cancer blood tests done as part of my health check?”
You have no features that make me worried about cancer. Cancer blood tests are not useful here as they are not very good at picking up cancer; they also give a lot of false positive readings that need further complex tests to sort out and can sometimes lead to unnecessary treatment and anxiety. They are mainly used for following up patients with known cancer. A better approach for picking up cancer is to come back to see me promptly if you have any worrying symptoms.




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