| 英文摘要 |
In 1969, Balint proposed the possibility of patient-centered medicine as a way of medical thinking. After nearly half a century, this concept not only significantly influenced the physician-patient relationship, but also greatly impacted the reform of medical care system and medical education. But, until recently, there is no specifically defined meaning of patient-centeredness that is universally agreed upon. As a consequence, some conflicts existed as to the effect of patient-centeredness on patients’ satisfaction, health behavior, and health status. Furthermore, some medical experts have not accepted the concept as evidence based or appropriate in medical care. In this article, I borrowed some concepts from medical anthropology and the more recently proposed narrative medicine to argue that the patient-centeredness is actually centered on the patient’s meanings of illness; so-called patient-centered medicine could be described more specifically as patient’s meanings of illness-centered medicine. According to Platt’s idea, patient’s meanings of illness can be divided into five components: background, cognitive perception, emotional response, social functional impact, and expectations about management as well as future life. He encouraged physicians to ask appropriate and sophisticatedly worded questions to illuminate details of the patient’s story during patient-centered interview. Then physicians can further interpret, negotiate and co-rewrite the illness narratives with their patients. In conclusion, patient-centered medicine can be described as patient’s “meanings of illness” -centered medicine which is compatible with the essence of newly developed narrative medicine. Physicians should investigate 5 components of their patients’ stories, try to interpret it, negotiate with their patients and help them to fulfill in patients’ real life. This is how we, as physicians, can do to practice patient-centered medicine. |
