叙事医学在医患沟通中的应用与发展

Application and Development of Narrative Medicine in Doctor-Patient Communication

摘要: 医患沟通指医患间通过言语和非言语交流来分享信息、意义和感受的过程。医患沟通对患者及医务人员均有着重要意义。医患沟通模式涉及大量的叙事议题。医生的疾病叙事与患者的疾痛叙事的差异使得医生和患者在面对同一病症时产生了视域偏差。视域偏差是造成医患沟通障碍的主因之一。医患视域偏差可以尝试用叙事医学的理论和方法加以解决。包括：医生的医学话语与患者的生活话语互通；实行平行病历促进疾病叙事与疾痛叙事融合；实行医患共同决策；培养临床叙事思维，提升医患叙事能力。叙事医学在和谐医患沟通方面的进展体现在：第三方视角的叙事医学实践，全员参与的发展叙事医学实践，完善叙事–循证医学模式等方向。

Abstract: Doctor-patient communication (DPC) refers to the process of sharing information, meaning and feelings between doctors and patients through verbal and nonverbal communication. DPC is of great significance to both patients and medical staff. The DPC model involves a large number of narrative topics. The difference between the doctor’s disease narrative and the patient’s illness narrative make the doctor and the patient have a vision deviation when facing the same disease. The vision deviation is one of the main causes of communication obstacles between doctors and patients. The vision deviation can be solved by the theory and method of narrative medicine. Including: the communication between doctors’ medical discourse and patients’ life discourse; Implementing parallel medical records to promote the integration of disease narrative and illness narrative; Implementing joint decision-making between doctors and patients; Cultivate clinical narrative thinking and improve the narrative ability of doctors and patients. The progress of narrative medicine in harmonious DPC is reflected in the following directions: narrative medicine practice involving the third party, developing narrative medicine practice with full participation, and perfecting narrative-evidence-based medicine model.