In order to improve the quality of medical services and build a harmonious doctor-patient relationship, respect, understanding and humanistic care for patients are reflected in the entire process of medical services from admission to discharge, and further guarantee the informed consent of patients rights, establish a new doctor-patient relationship of mutual respect, understanding, and trust with patients, safeguard patients' vital interests, enhance medical staff's awareness of responsibility and legal awareness, improve the quality of medical services, and ensure medical safety. Each hospital must establish a sound doctor-patient communication system , strengthen doctor-patient communication.

1. The meaning of doctor-patient communication

Doctor-patient communication is a two-way interaction between doctors and patients. It is a kind of communication and a tacit understanding. The doctor-patient communication system refers to a relatively systematic system summarized in order to improve the quality of medical services, realize active cooperation between medical staff, patients and their families in medical services, and build a new doctor-patient relationship of mutual respect, understanding, trust, and equality. Doctor-patient communication methods are established and implemented in the hospital.

Communication is unlimited and can be done in any time or format. It depends on the patient's cultural background, knowledge level, age structure, psychological characteristics, personality, temperament, disease status, etc. The exploration of the connotation of communication will never end, and we must continue to improve and perfect it.

2. Time for communication between doctors and patients

1. Outpatient reception communication

When outpatient doctors receive patients, they should based on the patient’s past medical history and current situation. A preliminary diagnosis of the disease will be made based on medical history, physical examination, and auxiliary examinations, and outpatient treatment will be arranged. Those who meet the indications for admission may be admitted to the hospital for treatment. During this period, outpatient physicians should communicate with patients, solicit their opinions, and strive for their understanding of various medical treatments. When necessary, the communication content should be recorded in the outpatient medical records and outpatient medical records to achieve mutual recognition of signatures.

2. Communication upon admission

When admitting a new patient, the ward medical staff should first introduce themselves to the patient. After completing the medical history collection and admission physical examination, they should follow the hospital's " Medical Instructions" content and requirements require necessary communication with patients or their relatives, and appropriate health education.

After making a preliminary diagnosis and formulating a treatment plan, the attending (supervising) doctor should inform the patient of the patient’s current condition, the proposed treatment plan, the medical community’s current understanding of the disease, the current status of diagnosis and treatment, and the current status of diagnosis and treatment in our hospital. The level of diagnosis and treatment of this disease should be explained and fully informed to the patient or his relatives in detail, and recorded in the first course of the disease. For patients in critical condition, notification and signature procedures should be completed.

3. Communication during hospitalization

During the diagnosis and treatment process, medical staff should explain to the patient or his relatives the various diagnosis and treatment measures taken and their corresponding risks and side effects. ; When the patient's condition changes or the treatment plan is changed, the patient should be fully informed of the relevant reasons and reasons. Those whose condition worsens to a serious or critical condition should be notified in writing and signed; for those who want to undergo surgery, anesthesia, blood transfusion, chemotherapy, radiotherapy, implantation For high-risk diagnostic and treatment activities such as medical equipment, invasive diagnostic examinations, experimental examinations and treatments, examinations and treatments that will cause a large financial burden, the patient (in principle, the patient himself, and in special circumstances his relatives or authorized agents) (person) agrees and performs the signature procedures; if the diagnosis and treatment measures are changed under special circumstances (such as changing the surgical method during the operation), and the patient refuses or abandons the diagnosis and treatment, the reasons and possible consequences must be informed, the patient's signature must be obtained, and records must be kept. .

4. Communication when discharged

When the patient is discharged from the hospital, medical staff should explain the patient's overall treatment situation and disease recovery and cure status during the hospital to the patient or relatives, and explain the discharge in detail Medical advice and precautions after discharge.

The following types of patients must be fully informed of the relevant circumstances and complete the signature procedures when they are discharged from hospital:

(1) For various reasons, clinical treatment is still in progress. Patients who voluntarily request to be discharged;

(2) Patients who have undergone various medical device implantation surgeries during this hospitalization;

(3) Patients must be discharged from hospital Those who need follow-up treatment or regular monitoring and review, otherwise serious consequences may occur;

(4) Those who need to carry out activities and functional exercises in strict accordance with the standard requirements after discharge.

5. Discharge visit communication

For patients who have been discharged, medical staff should conduct follow-up communication by telephone or door-to-door visits, and provide information on the patient's condition recovery, medication, and daily life after discharge. Provide detailed understanding of the situation and other aspects and provide rehabilitation guidance, and make necessary registrations in the discharged patient register.

3. Contents of doctor-patient communication

1. Communication of diagnosis and treatment plans

(1) Past history, current medical history; (2) Physical examination; (3) Auxiliary examination;

(4) Preliminary diagnosis and confirmed diagnosis; (5) Diagnostic basis; (6) Differential diagnosis;

(7) Planned treatment plan, which can Provide more than 2 treatment options and explain the pros and cons for selection; (8) Early prognosis judgment, etc.

2. Communication in the diagnosis and treatment process

Medical staff should introduce the patient’s disease diagnosis, main treatment measures, purpose and results of important examinations, patient’s condition and prognosis to the patient or family , possible serious consequences of certain treatments, adverse drug reactions, surgical methods, surgical complications and preventive measures, medical drug expenses, etc., and listen to the opinions and suggestions of patients or family members, answer questions raised by patients or family members, and enhance patient awareness. and family members’ confidence in disease treatment. Medical staff should strengthen their understanding of the limitations and risks of current medical technology, and introduce them to patients or family members in a targeted manner so that patients and family members know what they are doing, so as to gain their understanding, support and cooperation and ensure the smooth progress of clinical medical work. During the patient's hospitalization, the responsible physician must understand the patient's diagnosis, main treatment methods, important examination purposes and results, possible serious consequences of certain treatments, adverse drug reactions, surgical methods, surgical complications and preventive and treatment measures, medical expenses, etc. Carry out regular communication and record the communication content in the disease course record and nursing record sheet.

When the patient is admitted, the nurse should introduce the hospital and department overview and hospitalization instructions to the patient, comfort the patient, and record the communication content on the nursing record sheet.

3. Hierarchical communication

When communicating, pay attention to the hierarchy of communication content. Medical staff at different levels should communicate according to the severity, complexity and prognosis of the patient's condition. At the same time, different communication methods should be adopted according to the different educational levels and requirements of patients or family members. If a dispute has already occurred or there are signs of a dispute, communication must be focused and reported to the competent department and hospital leaders in a timely manner.

For patients with ordinary diseases, the responsible physician should communicate with the patient or family members about the patient’s condition, prognosis, treatment plan and other details during ward rounds; The medical team (chief or deputy chief physician, chief physician, resident physician and responsible nurse) will communicate formally with the family members together; for patients with greater medical risks, poor treatment effects, and poor prognosis, the department director should preside over Convene a general consultation. The department director and the physician in charge will communicate with the patient, explain the consultation opinions and next treatment plan to the patient or family, obtain the consent of the patient or family, and ask the patient or family to sign for confirmation if necessary. When necessary, the patient's condition can be reported to the medical department, which will organize relevant personnel to communicate with the patient or family members. For malignant tumors and diseases involving personal privacy, attention should be paid to the combination and unification of the protective medical system and the obligation to disclose when communicating.

4. Discharge visit communication

For patients who have been discharged, medical staff should keep records in the discharge patient registration book, and record the patient's recovery status after discharge and the medication after discharge. , rest, etc. are written on the discharge certificate. Extended caring services are conducive to enhancing emotional communication between patients and medical staff, and are also conducive to cultivating loyal customers of the hospital.

IV. Methods of doctor-patient communication

1. Communication methods

(1) Prevention-oriented communication: During medical activities, if possible Patients with signs of problems should immediately make them the focus of communication and carry out targeted communication. Possible problematic patients and events discovered during the shift should also be considered as important content when handing over in the morning and evening, so that the next shift of medical staff can be well aware of and communicate in a targeted manner.

(2) Exchange of communicators: If the responsible doctor has difficulty or obstacles in communicating with the patient or family member, another medical staff or superior doctor or department director should be used to communicate with him.

(3) Written communication: For patients who have lost language ability or need to undergo certain special examinations, treatments, or major surgeries, patients or family members who do not cooperate or understand the medical behavior, or some special patients, Communication should be in writing.

(4) Collective communication: When lower-level doctors are not sure about the explanation of a certain disease, they should first ask the superior physician for instructions or communicate collectively with the superior physician.

(5) Communication after coordination and unification: When the diagnosis is unclear or the disease condition worsens, before communication, doctors and doctors, doctors and nurses, and nurses and nurses should discuss with each other and have a unified understanding. The superior doctor will then explain the situation to the family members to avoid causing distrust and doubt in the patient or family members.

2. Communication skills

When communicating with patients or family members, you should respect each other, listen patiently to each other, sympathize with the patient's condition, be willing to dedicate love to the patient, and be patient Based on the principle of integrity, adhere to the following points:

(1) One tip: listen to the patient or family members to say a few words, try to let the patients and family members vent and talk, and make the best possible response to the patient's condition. Explain accurately.

(2) Two masters: master the condition, examination results and treatment status; master the patient’s medical expenses and the social and psychological status of the patient and his family members.

(3) Three things to note: pay attention to the education level, emotional state and feelings of the communication partner; pay attention to the communication partner’s awareness and expectations of the disease; pay attention to your own emotional reactions and learn to control yourself .

(4) Four avoidances: avoid using tone, tone, and sentences that stimulate the other party’s emotions; avoid suppressing the other party’s emotions and deliberately changing the other party’s point of view; avoid using too many professional words that are difficult for the other party to understand; avoid Force the other party to accept the doctor's opinions and facts immediately.

5. Communication records and requirements

Each communication should have a detailed communication record in the medical record. The communication record should be used as a ward round record or a disease course record and should include the actual content. and communicate results.

VI. Evaluation

1. Doctor-patient communication is a routine item in disease course records and included in the hospital's medical quality assessment system.

2. Due to failure to conduct doctor-patient communication as required, or improper doctor-patient communication causing medical disputes, severe penalties will be imposed in accordance with or with reference to the regulations on rewards and punishments for medical quality.

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