Модели общения врача и пациента

В частной медицине пациент, если ему не понравился врач, просто переходит в другую частную клинику. Как построить коммуникацию между врачом и пациентом, чтобы разочарований было меньше?

Существует несколько традиционных моделей поведения врачей, каждая из которых подразумевает разную стратегию поведения врача по отношению к пациенту. Чтобы сделать общение врача с пациентом более комфортным, лечение более эффективным и избежать негативных отзывов, полезно понимать специфику этих моделей:

  • Инженерная модель
  • Патерналистская модель
  • Коллегиальная модель
  • Контрактная модель

Прочитайте интервьюДмитрия Андреевича Красножона, одного из лидеров нашего рейтинга хирургов-онкологов о том, как правильно общаться с пациентами.


Инженерная модель

При инженерной модели врач воспринимает пациента безлично, как сломавшийся механизм, нуждающийся в ремонте. Часто такой подход выбирают хирурги, у которых недостаточно времени для личного общения с больным. Инженерная модель не допускает обсуждения процесса лечения.

Плюсы: скорость приёма, и, по мнению некоторых медиков, при такой модели вероятность врачебной ошибки ниже.

Минусы: такой подход малоприменим к частной медицине. Многим пациентам важна вовлеченность врача в процесс лечения, многие привыкли обсуждать с врачом свое состояние и получать живую обратную связь.
Такой пациент, столкнувшись с инженерным подходом, чувствует безразличие и отношение “на потоке”. Вполне вероятно, что пациент не станет принимать назначенную терапию, решив, что врач назначает всем общие стандартные схемы.

Конечно, инженерный подход вовсе не означает безразличие или пренебрежение к пациенту, она лишь свидетельствует об определенном подходе врача к выполнению своих обязанностей — только не все пациенты могут это правильно считать.

Патерналистская модель

Патерналистская модель подразумевает стиль общения, сходный с отношениями родителя и ребенка. Врач относится к пациенту с заботой и вниманием, но вместе с тем, может проявлять настойчивость и в определенном смысле диктовать своему подопечному правила лечения.

На сегодняшний день такая модель является очень распространенной, особенно в государственной медицине. Она может не устроить пациентов, имеющих свои взгляды на лечение, а также тех, кто не любит подчиняться указаниям специалиста без подробных разъяснений.

Плюсы: более легкая коммуникация с точки зрения врача.

Минусы: Врачам может мешать инициатива пациентов, если они не умеют с ней работать и строить диалог так, чтобы не обесценить мнение пациента. Знание пациента мешает, тем более что чаще всего это знание не совпадает с их точкой зрения. Обычно, когда пациент рассказывает: «Я вот прочитал то-то», — врач думает: «Лечитесь сами, если читали».

Коллегиальная модель

При коллегиальной модели между врачом и пациентом преобладает принцип равноправия. Доктор обязуется предоставить максимально полную, правдивую информацию о вашем состоянии и всех возможных методах диагностики и лечения, а вы участвуете в обсуждении этой информации и высказываете свои идеи по поводу оптимизации лечебного процесса.

Плюсы: С образованным пациентом гораздо легче работать, он твой партнер, он берет на себя часть ответственности — это уже коллегиальная модель общения.

Минусы: много противоречивой медицинской информации в интернете — часто пациенты не знают, где можно прочитать достоверный материал о заболевании.

Возникновение коллегиальной модели связано, в первую очередь с интернетом — пациенты получили простой и быстрый доступ к информации о болезнях, симптомах и лечении через поиск.
Зачастую люди не говорят, что предварительно прочитали статьи в интернете, и если слышат от врача что-то другое, не знают, где правда, но в принципе начинают гораздо критичнее относиться к медикам.

Не всегда врачи умеют завоевать доверие. Врачи, которые начинали практику ещё в доперестроечные времена, уверены, что доверие вызывают дипломы на стене, звание кандидата или доктора наук, обилие сложных медицинских терминов в речи. Но в реальности дипломы не влияют на доверие, а неспособность врача простыми словами объяснить, что происходит, доверие даже уменьшает.

Доверие вызывает диалог, выслушивание пациента, объяснение тех или иных симптомов, снятие тревоги за здоровье, в случаях, где это необходимо. Позвольте пациенту озвучить свои опасения, чтобы тот почувствовал, что вы заинтересованы тоже. Сейчас врач в значительной степени становится консультантом, который предлагает решения пациенту.

Контрактная модель

В настоящее время все большую распространенность приобретает контрактная модель, подразумевающая отношения клиента и исполнителя. В соответствии с этим подходом, врач, как поставщик услуг, старается максимально удовлетворить запросы клиента, чтобы тот в будущем снова обратился в данное лечебное учреждение.

А пациент придирчиво оценивает качество работы доктора, исходя из своего понимания целесообразности тех или иных назначений. Несмотря на господствующее положение позиции больного, многим людям не нравится чрезмерная услужливость со стороны врача, и они избегают контрактной модели общения.

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