Doctor-patient empathy makes diagnosis and treatment more intimate (Big Health Observation·Focus on Narrative Medicine③)

  Narrative medicine has been in China for more than ten years. The Department of Neurosurgery of Beijing Xuanwu Hospital was the first to implement this concept, and achieved good results. It has accumulated more than 3,000 parallel medical records.

This is due to the strong advocacy of Professor Ling Feng, the head of the department at that time.

Is it necessary for Chinese hospitals to introduce this concept?

What kind of change can it bring about?

A few days ago, our reporter interviewed Professor Ling Feng.

  Let doctors think from the perspective of patients

  Reporter: How did you come into contact with the idea of ​​narrative medicine?

Why would you accept it?

  Ling Feng: At the end of 2011, under the convening of Academician Han Qide, then director of Peking University School of Medicine, Peking University Institute of Medical Humanities held a symposium on "Narrative Medicine".

At that time, I was also invited to participate, and I felt that this concept was very important.

  Medicine is a science as well as a study of human beings. If no one studies it, this science will be very cold.

Especially when some doctor-patient disputes occurred at that time, I felt that society was changing, people's thinking was changing, and humanistic feelings were also changing.

Under such circumstances, if we as doctors are unable to turn the tide and return the humanistic spirit to science, science will become colder and colder, and ordinary people will become more and more confused.

So I resonated very quickly.

  Reporter: Did you accept it right away?

  Ling Feng: Yes, I not only accept it, but also think that this matter can be well implemented.

So, I implemented it when I was the director of neurosurgery at our hospital.

  We recruit a lot of resident doctors and fellow doctors every year, and we mainly implement it among them. Specifically, we ask them to write a parallel medical record every month.

  The first parallel medical record was written by the director of our hospital. He is my student. He accepted my ideas very much and wrote one soon, playing a very good leading role.

  At the beginning, everyone didn't know how to write this thing.

I told them, just write what you think, write the stories of the patients you met, those things that can promote the sublimation of the soul, and those things that can touch the softest part of your heart, just write it out .

  Reporter: Why did you write it out?

  Ling Feng: Writing it out itself is a process of rethinking and reprocessing, and then re-touching one's "rumination". Otherwise, when encountering such things in normal times, it will be a flash of thought and pass away.

However, if you write it now, you will recall it, sort it out, sort it out, sublimate it, and let this experience communicate with yourself more.

After a long time, I will be more able to understand the patient and put myself in the patient's shoes.

  This is actually the most important point. Let the doctor think from the perspective of the patient. If this patient is your brother or sister, how would you deal with it?

Empathy is very important, and it is actually the essence of a great doctor’s sincerity.

You have exchanged and empathized, and you take the patient's life as your own. As much as your life is, so is the patient's life.

  Sometimes complete treatment may not be the best way

  Reporter: According to data, the Department of Neurosurgery of Beijing Xuanwu Hospital has been implementing the concept of narrative medicine for more than 10 years, and has accumulated more than 3,000 parallel medical records.

how did you do that?

Will it continue to be implemented?

  Ling Feng: It will continue to be implemented, because we have made the writing of parallel medical records a medical humanistic assessment standard for resident training, which is a one-vote veto.

In other words, if you don't write parallel medical records, no matter how good the other exams are, it will be useless.

  Reporter: Will it be too strict?

  Ling Feng: What's the use of a cold doctor?

How is it different from a robot?

Robots are even more accurate.

Since you are a living person, you should have temperature, be a thoughtful doctor, a doctor with temperature.

  Reporter: You said just now that we are promoting this system among residents, so other doctors and nurses don’t need to do this?

  Ling Feng: No, because residency training is the initial stage of training for doctors.

Writing parallel medical records is to let them cultivate humanistic feelings at the beginning of practicing medicine.

The superior doctor should instruct them.

  For the senior doctors of residents, we will organize regular seminars to let them talk more about what they have experienced, not only about medical problems, but also about their own thinking.

  Through discussion, I found that each of them has a part of the most painful part in their hearts, that is to say, many successful cases are not remembered, but one thing they did wrong will be remembered deeply.

  A doctor told a story of a girl who had been treated as a paraplegic.

He missed her very much, and later went to visit her at the patient's home in Tangshan.

After going there, the patient said to the doctor, Uncle, let me show you something.

She took out two disability certificates, one belonged to her brother, who was mentally handicapped since childhood, and the other belonged to herself.

Seeing this scene, the doctor cried at the time, and he still choked up and lost his voice when he recalled it.

He felt guilty that the patient did not recover but became disabled under his treatment.

Later, he tried to encourage her, helped her go to college, helped her find a job, and did a lot of things in this regard.

  Such discussions can be very useful for doctors treating patients, motivating them to improve their techniques, and reminding them to look for loopholes.

This doctor is now a successful academic leader, but he still studies medical skills, takes every operation seriously, and cares for every patient enthusiastically.

  Reporter: After such discussions and reflections, doctors will be more attentive in their diagnosis and treatment in the future.

  Ling Feng: Yes, and I will put myself in the patient's shoes and consider whether I should do more or less, and to what extent.

How to grasp this degree is actually not entirely a scientific thing.

The clinical choice cannot be determined by rules and regulations. For example, when flying an airplane, follow the operating procedures, because airplanes are dead, but people are different, and each person’s internal environment is different. It is necessary to enter into each patient’s make choices in the world.

  For example, acoustic neuromas are often next to the facial nerve, and acoustic neuroma removal will affect the facial nerve and cause facial paralysis.

Some patients are very concerned about the face.

If we cut the tumor cleanly, it will certainly be able to effectively prevent recurrence and prolong life, but the result may be facial paralysis. For this patient, life is worse than death, which greatly affects the quality of life.

They would rather have another operation than facial paralysis.

So in this case, we may need to be more conservative about some tumors that stick to the facial nerve, keep it on the nerve, and use other methods to deal with it later.

  Everyone's needs are different. It cannot be said that thorough treatment is the best way, not necessarily.

Different needs, different plans, the comparison and selection of different plans will promote greater improvement of medical skills.

In other words, when humanistic feelings are injected into diagnosis and treatment, the technology will be better promoted and improved, not to say that the more humanistic the more conservative.

Now our facial nerve preservation rate has reached 98% during acoustic neuroma resection.

  Doctor's "Second Happiness"

  Reporter: In addition to parallel medical records, where is the application of narrative medicine?

  Ling Feng: Treating any patient is risky, but the difference is whether the risk is large or small.

We have to balance the risks.

For example, if you ask the patient to sign a consent form for surgery, if you only say that there is a risk of death or paralysis... the patient's legs are weak at that time, and he thinks that the operation will not be solved. choice.

  We don’t talk like this with patients. We all say that your operation is risky, but the proportion is so small; after the operation, how much is the improvement benefit.

Seeing the risk-benefit ratio, patients or family members will clearly realize that this risk is worth taking, even if there is a risk, I will accept it, because I want to pursue greater benefits.

  Reporter: After more than 10 years of implementing the concept of narrative medicine, what kind of changes has it brought to the department?

  Ling Feng: Changes are subtle. The biggest manifestation is that the overall appearance of the people in our department is different from other departments, which is mainly reflected in the way of talking and the reactions of patients.

  Many patients who come to our department for medical treatment are "traveling around the world". They will come to us after seeing a doctor in many places.

Through comparison, they will say that your doctor is very amiable and willing to explain more, and what he explained is exactly what they want to ask.

  Some patients are very nervous to see an expert, and they can't ask questions.

But our doctors will patiently inform and explain, and will follow up the patients after the operation.

Patients are most helpless when they are ill, because they do not know medicine, and they will have infinite fear and anxiety.

In this case, caring for him and caring for him is like catching a piece of wood in the vast ocean, so they will feel that our doctors are different.

  Reporter: Does narrative medicine need to be popularized in China?

  Ling Feng: It must be popularized, and every doctor must become a warm doctor, so that ordinary people can benefit.

Doctors can't just focus on improving technology, who is improving technology for?

For patients, patients are human beings with seven emotions and six desires.

When treating a disease, the technical level only accounts for 1/3, and the 2/3 is human psychology, emotion, spirit, and emotion.

If your 1/3 cannot be integrated with that 2/3, your work is only 1/3, and the effect on a patient is only 1/3.

If it can be well integrated, it will be of great help to life.

  All the improvement of the doctor is for others, all the improvement is for others, and the happiness is based on the health of others.

So actually doctors have a "second pleasure".

Many people only have one kind of happiness, such as making money and being happy.

When a doctor performs a successful operation, he is very happy.

The patients get health, the family gets happiness, and the happiness of giving back is the second kind of happiness for doctors.

  This happiness is very pure.

  Xiong Jian