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WHOLE PERSON CARE in FAMILY MEDICINE 家庭医学中的全人照顾 Jessica Watters, MD Loma Linda University Family and Preventive Medicine Residency

What is “Whole Person Care”? 什么是“全人照顾”？ Whole person care is caring for the patient’s body,mind andspirit. 全人照顾是关心照顾病人的身体、心理和心灵。

It also means understanding how the patient’s family and social situation affect their health needs. 这也意味着了解病人的家庭和社会环境是如何影响他们的健康需求。

Whole Person Care is also called BIOPSYCHOSOCIOSPIRITUAL care 全人照顾也叫生物-心理-社会-心灵照顾 BIO = biological BIO =生物的 PSYCHO = psychological PSYCHO=心理的 SOCIO = social SOCIO=社会的 SPIRITUAL 精神的

Whole Person Care is also called BIOPSYCHOSOCIALSPIRITUAL care 全人照顾也叫生物-心理-社会-心灵照顾 Bio (biological): caring for the whole body, treating illness & protecting health BIO（生物的)：　　照顾全身,治疗疾病和保护健康

TREATING the DISEASE 治疗疾病 TREATING the WHOLE PATIENT 治疗整个病人 Treating the patient’s symptoms 治疗病人的症状 Understanding how a disease affects the whole body 了解一个疾病是如何影响整个身体的 Diagnosing & treating disease 诊断和治疗疾病 Helping the patient be as healthy as possible 帮助病人尽可能的健康

Whole Person Care is also called BIOPSYCHOSOCIALSPIRITUAL care 全人照顾也叫生物-心理-社会-心灵照顾 Psycho (psychological): Psycho(心理的)： caring for the mind & understanding how the mind affects the body 照顾心理和了解心理是如何影响身体的

TREATING the DISEASE 治疗疾病 TREATING the WHOLE PATIENT 治疗整个病人 Understanding the disease 了解这种疾病 Understanding the patient’s experience of the disease 了解病人得这种疾病的体会 Curing illness 医治疾病 Helping the patient find healing 帮助病人得到康复 Telling the patient what to do 告诉病人去做什么 Involving the patient in decision making & respecting their choice 让病人参与做决定并且尊重他们的选择

Whole Person Care is also called BIOPSYCHOSOCIALSPIRITUAL care 全人照顾也叫生物-心理-社会-心灵照顾 Social:社会的 caring for the patient with understanding of the patient’s family & social situation 通过了解病人的家庭和社会环境照顾病人

TREATING the DISEASE 治疗疾病 TREATING the WHOLE PATIENT 治疗整个病人 Only treat the patient 只治疗病人 Involve the patient’s family as much as possible 尽可能多的包括病人的家人 Give the same medical care to every patient 给每个病人同样的医疗照顾 Adjust the treatment according to the patient’s individual situation 根据病人的个人情况调整出适合的治疗

Whole Person Care is also called BIOPSYCHOSOCIALSPIRITUAL care 全人照顾也叫生物-心理-社会-心灵照顾 Spiritual:心灵的 Caring for the patient with an understanding of their attitudes and beliefs 用一个理解的态度和信念来照顾病人

TREATING the DISEASE 治疗疾病 TREATING the WHOLE PATIENT 治疗整个病人 Don’t ask about the patient’s attitudes & beliefs 不询问病人的态度和信念 Take a spiritual history to find out about a patient’s attitudes & beliefs 采集一个精神方面的病史从而了解病人的态度和信念 Don’t understand the patient’s spiritual beliefs or spiritual needs 不了解病人的信仰和心灵需求 Adjust the treatment according to the patient’s beliefs, assist patients in finding help for spiritual needs 根据病人的信仰调整治疗，帮助病人寻找到在心灵上的需求

OVERALL RESULT全部结果 Positive and Trusting Relationship 积极和信任的关系 Positive and Trusting Relationship 积极和信任的关系 Higher Patient Satisfaction and Better Communication 患者满意度更高和更好的沟通 Higher Patient Satisfaction and Better Communication 患者满意度较高和更好的沟通 Plan agreed on by both physician and patient 治疗计划得到病人和医生双方同意 Plan agreed on by both physician and patient 治疗计划得到病人和医生双方同意 Patient more likely to follow plan 病人更容易遵循治疗计划 Patient more likely to follow plan 病人更容易遵循治疗计划 Better Health for Patient 病人更加健康 Better Health for Patient 病人更加健康

Bio-Caring for the WHOLE BODY 全人照顾中的生物照顾 Family Medicine is the only specialty that cares for the WHOLE BODY at ANY AGE 家庭医学是唯一擅长照顾任何年龄人群整个身体的专业

Caring for the WHOLE BODY 照顾全身 A young woman comes to see the doctor for nausea. She could be pregnant, she could have a viral gastroenteritis, or she could have a brain tumor. A family doctor will think of all possibilities, and help her get the care she needs no matter what the cause of her symptoms are. This is caring for the whole body. 一个年轻的女性由于恶心来看病。她可能怀孕了,可能有病毒性肠胃炎、或者她可能有脑瘤。一个家庭医生会考虑到所有的可能性,并帮助她得到她需要的照顾不论什么原因导致这种症状。这是照顾全身。

Caring for the WHOLE BODY 照顾全身 Another patient comes with chest pain and difficulty breathing. He could have pneumonia, asthma, a heart attack, heart failure, or anxiety. A family doctor can check the blood pressure and heart rate, examine the heart and lungs, ask about anxiety, and order a chest x-ray or an ECG. If the patient has heart failure and pneumonia at the same time, the family doctor can treat both problems. This is caring for the whole body. 　另一个病人由于胸痛和呼吸困难来诊。他可能得了肺炎、哮喘、心脏病,心脏衰竭,或焦虑。一个家庭医生可以检查血压和心率,听心肺,询问是否有焦虑，做胸部x射线或心电图检查。如果病人同时有心脏衰竭和肺炎,家庭医生可以同时治疗这两个问题。这是照顾病人的全身。

Caring for the WHOLE BODY 照顾全身 A 3 year old child comes in with a cough and a fever. He may have a viral or a bacterial infection. The family physician can examine the patient and determine the type of infection. If it is a viral infection, the physician will not give antibiotics, because he knows they will not help the infection and he is concerned about the side effects the antibiotics could cause. This is caring for the whole body. 一个3岁的孩子因咳嗽和发烧来诊。他可能是细菌或病毒感染。家庭医生可以检查病人并确定感染的类型。如果它是一个病毒感染,医生将不会给抗生素,因为他知道抗生素不会对这种感染有帮助并且会考虑到抗生素可能导致的副作用。这是照顾全身。

Caring for the WHOLE BODY 照顾全身 A 70 year old man cannot walk because of a stroke. The family physician can help find the cause of his stroke, treat his high blood pressure, and decide if he needs a blood thinner. He can also evaluate his speech, check his ability to swallow, and ask how well he can care for himself. He will also remember to check the patient’s skin to look for any ulcers that can result from the patient lying in bed all day. This is caring for the whole body. 一个70岁的男性由于中风不能走路。家庭医生可以帮助他找到中风的原因,治疗他的高血压,并且决定他是否需要用一种血液稀释剂。他还可以评估他的语言,检查他的吞咽能力,并询问他对自己照顾的如何。他还会记得查看病人的皮肤是否有由于长期卧床而导致的溃疡。这是照顾病人的全身。

Psycho - Caring for the mind Psycho-照顾心理 The health of the body is closely connected to the health of the mind, including: 健康的身体与健康的心灵密切相关,包括: - emotions‐情绪 - past experiences‐过去的经历 - behavior choices‐行为的选择 - knowledge‐知识 - how patient’s cope with difficulties‐患者如何应付困难

Caring for the mind 照顾心理 The special role of the family physician 家庭医生的特殊角色 A family physician has a special ability to care for the mind/spirit because the physician has a relationship with the patient that continues for many visits, giving the physician an opportunity to know the patient well. 家庭医生有一种特殊的能力去照顾病人的心灵/心理,因为医患间有一种关系是医生有很多持续的访问病人的机会，这给医生提供了更多了解病人的机会。

Caring for the mind 照顾心理 A physician does not need to be a psychiatrist to care for the mind/spirit. The physician just needs to remember to ask a few questions and be able to listen to patients’ stories. 一个内科医生并不需要像一个精神科医生那样去照顾病人的心灵/精神。内科医生只需要记住要问的一些问题,并且能够倾听病人的故事。

Caring for the mind 照顾心灵 A physician does not need to have an hour to spend with a patient to care for the patient’s mind/spirit. Just a few minutes to listen and show that the physician cares can make a big impact in a patient’s health outcome. 一个内科医生不需要花一小时去照顾病人的心灵/精神。就用几分钟的时间倾听来表达医生的关心会对病人的健康状况有很大的影响。

Caring for the mind 照顾心理 Some questions a physician can ask to understand the health needs of a patient’s mind: 医生可以通过问一些问题了解病人心灵方面的健康需求： • What is your greatest concern at this time? • 　什么是你这段时间最担心的? • When was the last time you felt really well? • 　你上次感觉很好是什么时候? • Tell me about the stress in your life right now. • 　告诉我关于你现在生活里的压力。 • Are there any relationships (with your spouse, parents, child, boss, etc) that are causing you stress or anxiety? • 　是否有任何人际关系(与你的配偶、父母、孩子、老板、等等) 给你造成压力和焦虑? • What do you enjoy doing the most? What helps you relax? 你最喜欢做什么?什么能帮助你放松?

Caring for the mind 照顾心理 Over time, as the patient grows to trust the physician, the physician will learn about the patient’s experiences, beliefs, knowledge, and emotions. This will help the physician know how to help the patient understand his/her medical problems. It will also help the physician understand the patient’s behaviors, and give the physician the ability to help the patient choose healthy behaviors. 随时间过去,当病人变得信任医生,医生将会了解病人的经历、信仰、知识、情感。这将有助于医生知道如何帮助病人了解他/她的医疗问题。它还能帮助医生理解病人的行为,并给医生能力去帮助病人选择健康的行为。

Caring for the mind 照顾心理 A man comes in with a cough and difficulty breathing. He has been smoking for 40 years. He does not want to stop smoking. His family physician finds that he has COPD, and gives him medication. He also asks what he likes about smoking, and the patient says it helps him relax. At each visit, the physician talks to the patient about other ways to relax, and keeps encouraging him to slowly reduce the amount he smokes and use other ways to relax instead. One year later, the patient has stopped smoking. This is caring for the mind. 一个男性由于咳嗽和呼吸困难来诊。他已经抽了40年的烟。他不愿意戒烟。他的家庭医师发现他有慢性阻塞性肺病(COPD),并给他用药物治疗。他还问病人为什么喜欢吸烟,病人说这有助于他放松。每次来访,医生都和病人讨论可以用其它方法来放松心情,并一直鼓励他慢慢减少吸烟量,用其他方式放松。一年以后,这个病人已经戒烟了。这是照顾病人的心灵。

Caring for the mind 照顾心理 A child is brought in by his mother because he has stomach pain every morning before school. The family physician examines him and finds no problems. Before ordering expensive tests, the physician asks the child if he likes school. The child says there are older children who are mean to him at school and he is afraid to go to school. The physician explains that the stomach pains are likely due to the child’s fear, and discusses with the mother how to improve the situation at school so the child does not feel afraid. This is caring for the mind. 一个孩子因为他每天早晨上学前胃痛被母亲带来看病。他的家庭医师查体并没有发现任何问题。在做很贵的化验检查前，医生问孩子是否喜欢学校。这个孩子说,年长的孩子们在学校对他很刻薄,他害怕去上学。医生解释,胃部疼痛可能是由于孩子的恐惧,并与母亲探讨如何改善孩子在学校的情况使孩子不再感到害怕。这是照顾心灵。

Caring for the mind照顾心理 A 20 year old woman is in a motor vehicle accident. She is badly injured. After she leaves the hospital, she sees her family physician. Her physician notices that her recovery is slow, and her pain is very severe. The physician asks more questions, and realizes she is very anxious and depressed and afraid she will have another accident. As she tells the physician about her fears, she begins to cry, and the physician listens and shows kindness and understanding, and assures her that many people feel fear after an accident. The physician suggests she go to counseling. As her fears become less, her pain improves, and she is able to recover. This is caring for the mind. 　　一个20岁的女性遇到了机动车事故。她受了重伤。出院以后,她看了她的家庭医生。她的医生发现她康复的较慢,而且她痛得很厉害。医生问了更多的问题,意识到她很焦虑和抑郁,并害怕自己再发生意外。当她告诉医生自己的恐惧时,她开始哭泣,医生听着并表示友好和理解,让她相信许多人在发生意外事故后都会感到恐惧。医生建议她去心理咨询。随着她的害怕变少,她的疼痛改善了，并且康复了。这是照顾心灵。

Social –Understanding the Patient’s Family & Social Situation 社会的-了解病人的家庭和社会环境 • Understanding a patient’s family and social situationallows a physician to: • 了解病人的家庭和社会环境使医生能： • -make a more accurate diagnosis • 得出一个更精确的诊断 • give the patient more useful advice and education • 给病人提供更有用的建议和教育 • adjust treatment to the patient’s situation (financial situation, time needs, support from family and friends, etc) • 根据病人的情况调整治疗(财务状况、时间的需求,从家人和朋友处得到的支持,等等)。

Understanding the Situation了解情况 Some questions a physician can ask to understand the patient’s family and social situation: 医生可以问一些问题来了解病人的家庭和社会环境。 • What kind of work do you do? • 你是做什么类型的工作的? • How is this illness affecting your usual lifestyle? Is there anything you need help doing that you usually do not need help with? 这种疾病影响你平常生活方式的程度如何?你有什么需要帮忙做的事而通常不需要帮助的? • Who lives at home with you? Who could help you if you were too ill to care for yourself? 谁和你在家住？如果你太过虚弱不能照顾你自己谁能帮助你? • How far away do you live from the hospital/clinic? • 你住的地方离医院或诊所多远？

Understanding the Situation了解情况 A 2 year old boy is diagnosed with strep throat. The infection is mild. There is a choice of an antibiotic that is taken twice a day or an antibiotic that is taken four times a day. The child goes to daycare all day and the mother says it will be difficult to give the medication frequently. Because the physician understands the situation, he prescribes the antibiotic that is only needed twice a day. 一个2岁男孩被诊断患有链球菌性喉炎。感染是轻度的。可以选择一种抗生素是一天服两次的，或另一种抗生素是一天服四次的。这个孩子去的是全日制托儿所,妈妈说频繁给药会有困难。因为医生了解这种情况,开了一天只需要两次的抗生素。

Understanding the Situation了解情况 A man with diabetes is seen for a foot ulcer. The physician knows his daughter who is a nurse and shows her how to bandage the ulcer and how to watch for infection. 一个糖尿病病人来看足部溃疡。医生知道他的女儿是一个护士,告诉她如何包扎溃疡和如何预防感染。

Understanding the Situation了解情况 Another man with diabetes is seen for a foot ulcer. His wife is in the hospital with cancer and his children are very busy caring for her, working, and caring for their own child who is studying for exams. There is no one to help him change the bandages. The physician arranges for him to come to clinic three days a week for a nurse to change his bandages and check for infection. 另一名男子有糖尿病足部溃疡。他的妻子正在住院治疗癌症，孩子们都忙著照顾她妻子、工作、照顾自己准备考试的孩子。没有人帮他换绷带。医生安排他一个星期来诊所3天,让护士给他换绷带并检查是否有感染。

Understanding the Situation了解情况 A 30 year old woman sees her family physician after breaking her arm. She says she fell down the stairs. The last time she saw her family physician the physician noticed she had bruises on her arms. He tells her that anytime he sees a patient with an injury, he asks if anyone has hit the patient or hurt the patient in any way. He tells her that no one should ever be hurt by another person, and that anytime someone is hurt he wants to help them find a way to be safe. Even though she says at first that she fell, eventually she tells him that her husband is beating her. They discuss ways she could safely leave her husband, and the physician keeps careful records of her injuries so if she decides to report to the police she will have evidence. This is understanding the patient’s situation. 一个30岁的女性手臂受伤后来看她的家庭医师。她说她从楼梯上摔下来了。上次她来看家庭医生时医生注意到她胳膊有淤青。医生告诉她,每当他看一个受伤的病人,他都会问是否有人打病人或用任何方法伤害病人。并告诉她,任何人都不应该被其他人伤害,有人受伤了他会随时帮助他们找到一种保证安全的方法。尽管起初她说是她跌倒了,最后她告诉医生,她的丈夫殴打她。他们讨论了可以安全地离开她丈夫的方法 ,医生详细的记录了她的伤势，如果她决定报警,她将有证据。这是了解病人的情况。

Spiritual – understanding the patient’s attitudes and beliefs 心灵的——了解病人的态度和信念 A patient’s beliefs and attitudes have a big impact on their every day life decisions. Understanding what gives a patient’s life meaning will help the physician understand the patient’s behaviors and attitudes. Helping the patient find peace and hope in life will improve the patient’s health. 一个病人的信仰和态度会对他们日常的人生决策产生很大的影响。理解是什么给了病人生活的意义将帮助医生了解病人的行为和态度。协助病人在生活中找到和平和希望将改善病人的健康状态。

Spiritual – understanding the patient’s attitudes and beliefs 心灵的——了解病人的态度和信念 Even physicians with no religious beliefs can understand and support patients’ spiritual needs, and help patients find resources for spiritual care and help. 即使医生没有宗教信仰还是能理解和支持病人的精神需求,帮助病人找到精神上的关怀和帮助。 Taking a SPIRITUAL HISTORY is an easy way to understand a patient’s attitudes and beliefs. 采集精神上的病史是了解病人态度和信念的一种简单的方法。

Caring for the spirit 照顾心灵 Some questions a physician can ask to understand a a patient’s attitudes and beliefs: 　医生可以问一些问题来了解病人的态度和信念。 • What keeps you going when you are facing difficulties? • 当你面临的困难时是什么让你坚持下去? • What gives your life the most meaning? 什带给你生活最多的意义？ • What do you believe the purpose of your life is? • 你认为你生命的目的是什么? • Do you have any religious beliefs? 你有什么宗教信仰? • Do you have any beliefs that I should understand in order to provide better care for you? 你有什么信仰我可以理解从而提供给你更好的照顾？

Caring for the spirit 照顾心灵 A 35 year old woman comes to clinic with high blood pressure. The family physician asks the patient about her stress level. The patient tells the physician she is having problems in her marriage that are causing her a lot of stress. She starts to cry, and the physician listens, and asks her about her spiritual beliefs. The physician offers to pray for the patient and she agrees. Afterwards, she is much calmer and says she feels more peace. When the physician checks the blood pressure again, even though no medication was given, it is normal. This is caring for the spirit. 一个35岁的女性由于高血压来到诊所。家庭医生问病人关于她的压力水平。她告诉医生现在她的婚姻出现问题使她有了很大的压力。她开始哭了起来,医生听着,并问她关于她的宗教信仰。医生想为病人祈祷,她答应了。后来,她平静了很多并说她感觉更加平安了。当医生再次检查血压时,即使没用药物,血压也正常了。这是照顾心灵。

Caring for the spirit 照顾心灵 A 60 year old woman comes to clinic for a health check. This is her first time to clinic, so the physician wants to know her medical history, family history and social history. The physician also asks about her spiritual history, including her religious beliefs and what helps her in hard times. He also asks if there is anything he should know about her beliefs in order to give her better care. The patient is surprised because no doctor has asked these questions before. She feels the doctor must really care about her to ask her these questions, and she wants to keep coming to this doctor for all her medical problems.　　一个60岁的女性来门诊做健康体检。这是她第一次去诊所,所以医生想知道她的病史、家族史、社会史。医生还问了关于她的精神的病史,包括她的宗教信仰,在遇到困难时是什么在帮助她。为了给她提供更好的照料，他还问是否有什么是他可以知道的有关于她信仰的事情。病人感到惊讶,因为以前没有医生问过这些问题。她觉得医生一定是真的在乎她才问她这些问题的,她想一直让这个医生为她解决所有的医疗问题。

Caring for the spirit 照顾心灵 An 50 year old man is dying from cirrhosis. He has a history of using drugs and heavy alcohol use for many years. He has no family with him at the hospital. The physician notices that he seems very afraid of dying. The physician has little experience in helping patients find peace in dying, so he asks the man if he would like to talk to someone from the local church. The man agrees, and the physician calls the church and asks them to send a volunteer to spend time with this man and talk to him about his fears. This is caring for the spirit. 一个50岁的人得了肝硬化快要死了。他有很多年的吸毒史及酗酒史。在医院里没有家人陪他。医生发现他似乎很怕死。这个医生没有太多的经验帮助病人在垂死时找到平安,因此他问病人是否愿意跟当地教会来的人谈谈。这个人同意了,医生给教会打了电话，让他们派一个志愿者与该男子花时间谈谈关于他的恐惧。这是照顾心灵。

Final thoughts 最后的想法 • Whole person (biopsychosociospiritual) care takes practice but is easy to learn if we remember that every patient has a story. If we are always interested in our patients’ life experiences, feelings and beliefs, we will get better and better at providing whole person care. • 全人(生物心理社会心灵)照顾需要练习，但如果我们记住每个病人都有故事，这很容易学会。如果我们总是关心病人的经历，感受，信仰,我们会做的更好并更好的提供全人关怀。

Final thoughts 最后的想法 • The easiest way to practice is to pick one or two questions to ask every patient. Then, pick another question. Soon, the questions will be a normal part of your history. • 最简单的练习方法是挑一个或两个问题去问每个病人。然后,再挑另一个问题。很快,这些问题将会成为你采集病史的一个正常部分。

Final thoughts 最后的想法 Whole person care happens in little steps over time. Each time we see the patient we can get to know them a little more and with time we will show them we care about them as a whole person. When patients know we care, they will ask more questions, be more likely to follow our advice, and even ask our opinions on the recommendations made by specialists. 　全人照顾随着时间在小步进行着。每当我们看到病人时,我们可以了解他们多一点,随着时间的推移,我们就能向他们展示我们在用全人照顾的方式关怀着他们。当病人知道我们关心,他们会问更多的问题,更愿意接受我们的建议,甚至对专家给出的建议会问我们的观点。

Final thoughts 最后的想法 • Whole person care matters! More and more research is showing that caring for the whole person results in higher patient satisfaction, higher physician satisfaction with their jobs, and better clinical outcomes, for both acute and chronic diseases. • 全人照顾很重要!越来越多的研究显示, 照顾整个人会使病人满意度更高,使医生对自己工作的满意度更高, 对急性和慢性疾病的治疗得到更好的临床效果。

Final thoughts 最后的想法 • Family medicine physicians can be the world-wide leaders in whole person care. We can demonstrate to other physicians that caring for a patient’s body, mind, social/family situation and spirit results in better medical care. • 家庭医师可以在全人照顾方面成为病人可及医疗资源的领导人。我们可以向其他医生证明,照顾病人的身体、心理、社会和家庭环境和心灵会带来更好的医疗服务。

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