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2013年11月25日 (月)

香山リカのココロの万華鏡:ムダな「前置き」大切に /東京

November 24, 2013(Mainichi Japan)
Kaleidoscope of the Heart: The importance of doctors using soft words
香山リカのココロの万華鏡:ムダな「前置き」大切に /東京

I recently went to a hospital for a checkup after some health problems, taking the role of patient, rather than my usual role of doctor. Called into the consultation room, I sat in front of the doctor. On a computer monitor on a desk, I could see what were probably my CT scans, and I began to get nervous.

The doctor looked over the data, faced me, and said with a soft smile, "Relax, there are no serious problems. I'll explain."

Thanks to that simple reassurance of "relax," I was able to pull my emotions together and listen attentively to the doctor's explanation. After leaving, I thought to myself, "Those first words when talking to patients are important."

There is no shortage of doctors who are good at the medical side of their job but poor conversationalists, and there are seminars on how to talk to patients that are held for people like that. A textbook that is used for these seminars says, "Words are needed that will allow the patient to psychologically prepare themselves."

For example, when giving bad news, rather than saying it right out, the doctor should remember to soften the blow with words like, "This is something I'd rather not say..." or "I've found something that needs to be treated, so I'm going to explain about it, OK?" The presence of these softening words lets the patient prepare themselves, and makes them feel that the doctor is sincerely dealing with their problem.

I thought back on myself, and how I handle this issue. As a psychiatrist, I do not have to worry about suddenly giving a diagnosis after something like a blood check. However, do I not sometimes, after looking at a patient's filled-out symptom form, say "Let's see ... You can't sleep? Since when?" without so much as a hello? Do I not sometimes, after a diagnosis is over, say without warning, "It's manic-depressive disorder, based on what you've told me."
 私は診察室でどうだろう、と我が身を振り返った。精神科の場合血液検査などでいきなり病名を告げることはないのだが、初めての患者さんに対して記入してもらった問診票を見ながら、あいさつなどもなしに「えーと、眠れないんですか? いつから?」などと切り出してはいないか。また、一通りの診察後に「そううつ病ですね、お話からすると」といきなり診断名を伝えてはいないだろうか。

"You were worried, weren't you?" "It's all right," "There's a problem but we can get over it together." These and other blow-cushioning phrases are sometimes omitted as a waste of time, not only at doctor's offices but at other jobs and in life in general. Some people seem to think that exchanges of only the necessary information are best because they are efficient.

However, people are not made strong enough to withstand getting nothing but cold, hard facts, or nothing but the doctor's conclusion. I myself should be more careful to use soft, cushioning words in my own office.

(By Rika Kayama, psychiatrist)
毎日新聞 2013年11月19日 地方版


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