是「限定病情敘述」而非「打斷病情敘述」：從言談分析詮釋Beckman and Frankel（1984）並應用於「開放式問診」之教學

當數字告訴你，醫師平均在開始詢問病情的第18秒，「打斷」病人的敘述，而且只有23%的病人有機會講完病情。這些數字有點驚人吧？它們來自一篇被引用率極高的論文（Beckman and Frankel，1984）。更叫人慌的是，原本我們以為「重複病人的話」是鼓勵病人敘述病情的好方法，竟是這「打斷」病人敘述的元兇之一。筆者認為Beckman and Frankel（1984）原文中的措詞「打斷（interruption）」，導致讀者忽略了該文的另一個更具意義的貢獻—醫師哪些回應方式對於病人的病情敘述造成了「限定效應」。本文（1）從言談分析觀點，釐清「打斷」與「限定」；（2）闡述如何將該文的研究成果與啟發應用於「宏觀病情階段」之「開放式問診」技巧訓練：提醒「限定效應」的概念與如何避免「限定式回應」。

關鍵字

開放式問診；收集全面病情資訊；限定病情敘述；打斷病情敘述； Beckman and Frankel（1984）

並列摘要

Two highly-cited statistic numbers from the research by Beckman and Frankel (1984) had alerted both the medical professional and the general public with two surprising statements: doctors 'interrupted' patients' narration of their health problem on an average of '18 seconds' after the patient began to talk and only '23%' of the time were patients provided the opportunity to complete their story at the beginning of the interview. One form of interruption described by Beckman and Frankel was repetition of the patient's last statement. Medical professionals may feel confused as to how repetition of the patient's words gets interpreted as an 'interruption of patient narration' rather than encouragement. In my judgment, the use of the term 'interruption' by Beckman and Frankel might have caused readers to miss a more important message: what types of response tokens by doctors 'redirect' patient narration? In this paper, I will clarify two concepts: 'interruption' vs. 'redirection' and describe how findings from Beckman and Frankel can be applied to the discourse training of open style interviews.

並列關鍵字

Open style interviews ； gathering comprehensive health information ； redirect patient narration ； interrupt patient narration ； Beckman and Frankel (1984)

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