從同情到同理－失去視域融合的醫病溝通如何可能？

From Sympathy to Empathy-Is It Possible to Have a Good Physician-Patient Communication without ＂Fusion of Horizons＂?

黃苓嵐(Ling-Lang HUANG)

《哲學與文化》 45卷8期 (2018/08) Pp. 163-179

摘要

背景：同理心（Empathy）乃是醫學人文教育中首重培養之人文精神。但何謂同理心？我們訴求醫療人員必須具備同理心，以增進醫病溝通的效果，但在醫病關係日趨緊繃的醫療現場，「缺乏同理心」常常如同一頂高帽壓迫在每個醫療人員頭上，甚至常常會演變成所謂的同情疲勞（compassion fatigue）現象。目的：同理與同情（Sympathy）並不相同，單純的同情並無法解決醫療場域醫病關係緊張的現象，本文希望透過同理心的三個步驟思考我們是否可以改善醫病溝通的成效。方式：本文將透過以下三個面向來探討我們如何透過同理心的輔助來達到良好的醫病溝通。一、同情與同理的區別。二、同理的三個步驟為何。三、同理心與醫病溝通的關係。討論與結論：醫病之間的鴻溝存在已久，從早期的醫師中心說（Physician-centered）所強調的醫師專業決策，到近期的病人中心說（Patient-centered）所強調的醫病共享決策（Shared Decision Making, SDM），都無法妥善的使醫病關係更加緊密，我們的醫療糾紛案例仍舊節節上升。推究其原因常與彼此之間的差異性無法被完整意識與接納有關。醫師與病人分屬不同角色，在各自不同的視域（horizon）下，他們卻常常必須一起進行醫療決定，也因此很容易產生對方無法理解自己、缺乏同理心之感。藉由同理心的三個步驟，增強醫病間的視域融合（Fusion of Horizons）將可以拉近醫病之間的理解與認同。

關鍵字

同情 ； 同理 ； 視域融合 ； 同情疲勞 ； 醫病溝通

並列摘要

Background: Empathy is the core of medical humanities education. However, while we over-emphasize that medical professionals should express their empathy towards patients to enhance physician-patient communication, it may sometimes conversely make the patient-physician relationship even tenser because of ＂compassion fatigue＂. Purpose: ＂Empathy＂ is different from ＂sympathy＂ which on its own is actually not very helpful to reduce the tense physician-patient relationship in real world clinical arenas. The current work is to define ＂empathy triad＂ which may give us a good stand to improve genuine physician-patient communication. Methods: This work is to elaborate and discuss following three important aspects, through which we are able to express our empathy in an appropriate way, and thus enhance genuine communication between patients and physicians. First, the distinction between sympathy and empathy. Second, the ＂empathy triad＂. Third, the relationship between empathy and physician-patient communication. Discussion and Conclusion: The gap between physician and patient has been existing for a long time. From ＂physician-centered＂ to ＂patient-centered＂, the gap remains and genuine shared decision making has never appeared. As a result, the number of medical disputes is still increasing. The main underlying reason is that physicians and patients have very distinct backgrounds and view horizons, but have to make one common final medical decision. If they just stand on their own horizons, there would be no appropriate empathy towards each other. Reaching ＂fusion of horizons＂ through the ＂empathy triad＂ is a critical step to enhance genuine physician-patient communication, which may be the real ＂antidote＂ for the tense relationship between patients and physicians.

並列關鍵字

Sympathy ； Empathy ； Fusion of Horizons ； Compassion Fatigue ； Physician-Patient Communication

參考文獻

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