精神科初診的醫病相遇：醫師會說些什麼？

The Physician-Patient First Encounter： What Would Psychiatrists Talk About?

當突破精神疾患迷思的的民眾來到門診時，精神科醫師會如何與其互動呢？又是否會明確告知診斷呢？透過訪談5位精神科醫師，請其回顧初診經驗，結果發現：即便是首次到精神科門診者，卻常久受臨床症狀所苦。有經驗的醫師會由其生活事件是否符合常理、敘述能力、及陪診家屬補充資訊進行研判，雖以病患問診為主，但需顧及家屬參與，且居中運用醫師權威扛起對病友的要求，以腦病理歸因、用藥控制症狀、慢性病心態調整等回應常見提問。即便初診時已確定其診斷，但受訪者都強調以舒緩其症狀為由開藥、並以腦部病理解釋症狀成因，且未建立信任前迴避明講病名；認為初診時應以病人為主體、同理來建立信任關係，但也需注意消弭病友與陪診家屬間的緊張；不講太多預後資訊、但要引發希望、並提出誘因讓病友回診。文末討論研究發現對精神醫療社工的意涵，嘗試將精神社工倡導角色具象化，兼具資源統籌及讓案主發聲，並對醫療教育訓練及轉介服務提出相關建議。

Given the public insensitivity and wrong perceptions of mental health in Taiwan, people easily miss the best timing for early detections of mental illness. Once they did become the psychiatric outpatients, what was the psychiatrist-patient interaction like? Would they be informed of the diagnosis? Through in-depth interviewing five psychiatrists at a medical center in the northern Taiwan, the following findings emerged: most new clients actually had been suffered with symptoms for a while. Based on the patients' capability to deal with life events, to describe their own circumstances, and information provided by the accompanying family members, the experienced psychiatrists came up with the symptom assessment. Mainly addressing consultations to the patients without neglecting their family members in the process, the psychiatrist required patients' compliance and shifted the responsibility from the family members. As to some common questions asked, such as “Why these symptoms? How to fix it? How long to recover?”, the psychiatrists attributed the patients' symptoms to some brain etiology, and then prescribed for symptom control. And chronic illness was given as an example to long-term treatment. No diagnostic disclosure without trusting relationship, the psychiatrists dealt with the patients' symptoms first. At the first encounter of the patients, according to the interviewed psychiatrists, attentions should be given to the following aspects: respecting the subjectivity of the patient, building trusting relationship with empathy, mediating the tension between the patient and their family members, no need to release too much information about prognosis, but hope-inspiring, providing incentives for the patients' follow-up visits. The interviewed psychiatrists have no comments to the traditional Chinese medicine, as long as the patients still followed their prescriptions. It was concluded with the implication for psychiatric social work and recommendations for psychiatrists' training needs and referral services.