이야기 접근을 통한 환자중심적 병력청취 대화
Patient-Centered Interviewing: Narrative Approach
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초록
환자중심적 병력청취 대화는 환자가 진정으로 원하고 필요로하는 것, 환자가 선호하는 것을 환자 수준에서 이해해 주고, 적절히 반응해주기 위한 대화이다. 이를 실천하기 위해서는 문진이나 환자교육, 상담을 위한 의료면담에서 의사소통 행위의 변화가 필요하다. 개요, 배경설정, 사건전개, 평가, 종결부의 구조를 가지고 전개되는 이야기는 한 개인의 질병경험과가치관, 삶의 내력과 사회적 환경(직업, 가족관계 등), 감정적영역에 접근할 수 있는 유일하며 핵심적인 통로이다. 이야기는 이야기하는 사람이 과거의 사건을 어떻게 바라보고 표현하는지를 알게 해주며, 화자가 자기 자신과 이야기의 대상 및이야기 상대자(청자)의 정체성을 어떻게 자리매김하는 지를알게 해준다. 환자의 병력 이야기를 들을 수 있는 능력은 이야기 구성 기술, 경청 기법, 공감기법, 효과적인 질문 기법 등의질병 표현단계의 몇몇 의사소통 기술을 요구한다. 환자의 질병경험의 수집은 일개 환자에게만 국한되는 것은 아니며, 유사한 질병을 앓고 있는 환자들의 질병경험을 폭넓게 듣고 체계적으로 정리해 볼 때에 질병경험 데이터베이스가 갖고 있는 유용한 사실적 정보와 질병경험의 이야기가 갖고 있는 치료적 효과에 의하여 많은 이들에게 도움을 줄 수 있을 것이다.
Abstract
Patient-centered interviewing is to understand and respond to patient's needs and prefers at the level of patient. For practicing the patient-centered interview, the way of communication should be changed in history taking, explanation,and patient education. Story telling (illness narrative) which composes of 5 dimensions such as abstract, orientation,development (complication), evaluation, and coda is the unique and key way to approach the area of patient's illness experience, values, history of life, social environment (occupation, family relationship), and emotion. Narrative gives information about how a story teller views and expresses the event that he/she experienced before, and information about how a story teller positions the self, the subjects of story, and listener's identities. Narrative competence to listen to a patient's story requires several kind of interview skills at the moment of patient's expression of disease history, including skill for composing story, skill for listening, skill for empathizing, and skill for effective questioning. Collecting patient's illness story is not refi ned to the individual patient. If we listen to the various patients' illness stories, who have the similar disease, and arrange the stories systematically, the patients' illness database can help many patients by the facts in the database and the therapeutic power of the other patients' illness stories.
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