[Consultation. Considerations on the practice of medical consultation].
On the theme of Linus Geisler's nine steps for a successful consultation between doctor and patient, the ability for self-criticism, the ability to be able to listen to oneself and the value of the doctor-patient relationship in the context of medical practice will be discussed. Subsequently, the framework of the consultation, the consulting room atmosphere and the complete setting of the consultation will be dealt with. The importance of active listening and the recognition of all messages, both verbal and from body language, will be particularly emphasized. The capability for empathy is presented as the necessary bridge to recognition of the feelings and inner world of the patient. Because one only sees what one is looking for and only recognizes what one knows, the recognition of typical complaints presented by patients in a consultation represents the "something" which must be specifically elucidated. The problems and symptoms which the patient brings to the doctor are surrounded by a ring of fears and apprehensions. For this reason it is decisive to uncover the accompanying cloud of fears and apprehensions with appropriate questions, to correctly assign the unsettling symptoms of the patient and to be able to correctly interpret them. As illustrated by the language of nature - the translation of deoxyribonucleic acid (DNA) triplets into amino acids - the translation of biological, psychological and social aspects of the complaints symptomatic into the level of diagnosis and the translation of the referential, social and affective meaning of the expressions used by the patient, into the level of the significance will be discussed. The role of the doctor here is that of a producer of context and a skilled translator. In the management of functional disorders and chronic diseases the construction of a shared reality is important. The therapeutic function of consultations is due to an introduction of metaphors as bridges - bridges to an improved understanding of the body, the self and the world. The role of the physician here is that of a moderator, motivator an accompanying person. Finally, Jaspers levels of good doctoring (natural science or causal level, nursing level, communicative-existential level) are stressed and the importance of a good patient-physician relationship for a patient-centered medicine is underlined.
Leiss
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O
Gastroenterologische Gemeinschaftspraxis, Mainz. OLeiss@aol.com
D003142:Communication; D003376:Counseling; D003933:Diagnosis; D004645:Empathy; D006801:Humans; D007697:Kinesics; D010817:Physician-Patient Relations; D012649:Self Concept