面对癌症：医学何为？Dr.E.L.Trudeau的启示何铁强2010年2月24日Dr. E.L. TrudeauDr. Edward Livingston Trudeauwasdiagnosedwithtuberculosisin1872.Hedecidedtospendthelittletimehebelievedhehadleftinhislifeenjoyingthewilderness.HewenttoLakeSaranacintheAdirondackMountainsofupstateNewYork.Insteadofwastingaway,however,Trudeauimproved!HecreditedhisnewfoundhealthtotheenvironmentatLakeSaranac.EdwardLivingstonTrudeau(1848-1915)Lower Saranac LakeViewedfromtheupperdeck.Little RedTheoriginalcurecottegebuiltin1884.Guiding Principles:Tocuresometimes,torelieveoften,tocomfortalwaysBy Gutzon Borglum, creator of Mt. Rushmore. Relocated from the original sanitarium to the Institutes library courtyard.The Trudeau InstituteAviewfromLowerSaranacLake苏珊桑塔格（SusanSontag,1933-2004)您有过不愉快的经历吗?作为医务人员；作为患者或者作为当医师成为病人时的希望AcadMed81(5):447-453,2006在床边谈，不是在护理站询问我有无问题多一点解释告诉我整个过程有好的非语言沟通也有非医师人员帮忙明确对我谈论“深刻的”问题，不要论断若我未遵循医嘱，不要太严厉多谈些非医疗的事务医患沟通的目标增加患者合作度增进正确性效率支持增加满意度改善病情/预后基本认知CommunicationisabasicclinicalskillCommunicationinmedicineisaseriesoflearnedskillsNotapersonaltraitAnyonecanlearnwhowantstoExperiencecanbeabadteacherKnowledgeofskillsdoesnottranslatedirectlyintoperformance沟通的形式 Shot-putapproach:单方向接受Frisbeeapproach:交互式，给回馈，有共同出发点沟通的层次寒喧谈无关紧要的事理性沟通感性沟通沟通的要诀并非存心说服对方，而是抛开成见、偏见，尊重对方立场与意见，理性地、诚恳地双向沟通原则第一印象胜过一切友善、专注站在患者的角度着想安慰就是良药1.永远先说“我可以”2.倾听、让生气的患者把话讲完.3.礼貌称呼病人4.微笑5.多说请、谢谢、对不起、注意您的声调.6.确认一下是否满足病人的需要.7.做到超过病人所期待的就是最好的安慰应如何说“坏消息”?Why?(决定要告知吗?)When?(何时最恰当?)Who?(告诉谁?)Where?(挑适当场合)How?(如何进行?)What?(针对患者的需要)CORECOMPETENCIESPatient care (compassionate, appropriate, effective)Evaluated through: direct observation, clinical outcomes, patient presentations, bedside rounds, Morning Report presentations.Medical knowledge (biomedical, clinical, cognate sciences, and their application)Evaluated through: annual otolaryngology examination scores, direct observation, direct questioning during clinical care and teaching experiences, journal club and conference discussions (for cognate sciences), patient presentations, scores on Home Study Course self-tests, Morning Report presentations Practice-based learning and improvement (investigation and evaluation, appraisal and assimilation of evidence)Evaluated through: progressive, graded improvement in clinical care and surgical technique, the use of evidence-based medicine and the evaluation of the best-available evidence at the Morning Report meeting and in routine clinical careInterpersonal and communication skills (effective information exchange, teaming with patients and families)Evaluated through: direct observation of communications with other residents, Otolaryngology attending physicians, physicians from other services, non-physician clinical staff, non-physician non-clinical staff, and patients and their families, as well as reviews of pertinent sections of regular quarterly evaluations. Professionalism (carrying out professional responsibilities, ethics, sensitivity)Evaluated through: responsibility in carrying out their professional duties (continuity, responsiveness, availability, and self-sacrifice), following ethical principles, and sensitivity to diverse patient populationsSystems-based practice (awareness and responsiveness to larger context and system of health care, use of system resources)Evaluated through: use of the entire health care system in patient care, and teamwork; direct observation in patient care and at the Morning Report meeting 如何致力于能力建设？我们的回答是什么？