{"id":1123,"date":"2019-01-07T23:58:43","date_gmt":"2019-01-07T23:58:43","guid":{"rendered":"http:\/\/ehps.easyall.org\/php\/?p=1123"},"modified":"2025-11-04T14:33:59","modified_gmt":"2025-11-04T14:33:59","slug":"patient-talk-what-the-doctor-clearly-says-and-the-patient-clearly-does-not-understand","status":"publish","type":"post","link":"https:\/\/practicalhealthpsychology.com\/sk\/2019\/01\/patient-talk-what-the-doctor-clearly-says-and-the-patient-clearly-does-not-understand\/","title":{"rendered":"Rozhovor s pacientom: \u010co lek\u00e1r hovor\u00ed a \u010domu pacient zjavne nerozumie"},"content":{"rendered":"<p><strong>Anne Marie Plass, Univerzitn\u00e9 Medic\u00ednske Centrum v G\u00f6ttingene, Nemecko<\/strong><\/p>\n<p><em>Pred nejak\u00fdm \u010dasom sa zn\u00e1ma dermatologi\u010dka, ktor\u00e1 pracuje ako \u0161pecialistka na psori\u00e1zu (chronick\u00e9 ko\u017en\u00e9 ochorenie) v\u00a0univerzitnej nemocnici, s\u0165a\u017eovala na mnoh\u00fdch pacientov, ktor\u00ed nedodr\u017eiavaj\u00fa lie\u010dbu napriek tomu, \u017ee mali stanoven\u00fd spolo\u010dn\u00fd cie\u013e na z\u00e1klade zdie\u013ean\u00e9ho spolo\u010dn\u00e9ho rozhodovania s \u0148ou ako s ich lek\u00e1rkou.<\/em><\/p>\n<p><!--more--><\/p>\n<p>Zdie\u013ean\u00e9 \u00a0\u010di spolo\u010dn\u00e9 rozhodovanie je definovan\u00e9 ako &#8220;pr\u00edstup, kedy lek\u00e1ri a pacienti spolo\u010dne zdie\u013eaj\u00fa najlep\u0161ie dostupn\u00e9 inform\u00e1cie v momente, kedy \u010delia \u00falohe rozhodovania sa&#8221;, zvy\u010dajne ke\u010f s\u00fa k dispoz\u00edcii dve alebo viac mo\u017enost\u00ed lie\u010dby alebo je do procesu lie\u010dby zapojen\u00e1 viac ako jedna osoba. Pacienti aj lek\u00e1ri prispievaj\u00fa k rozhodovaciemu procesu v oblasti medic\u00edny a pacienti s\u00fa podporovan\u00ed, aby zv\u00e1\u017eili mo\u017enosti dosiahnutia informovan\u00fdch preferenci\u00ed a po\u017eadovan\u00fdch v\u00fdsledkov. Rozhodnutia o zdie\u013ean\u00ed sa st\u00e1vaj\u00fa \u010doraz d\u00f4le\u017eitej\u0161\u00edmi v politike zdravotnej starostlivosti, pri\u010dom mnoh\u00ed profesion\u00e1lni poskytovatelia zdravotnej starostlivosti sa sna\u017eia by\u0165 \u010do najviac na pacienta-orientovan\u00ed ako sa len d\u00e1. Najm\u00e4 preto, \u017ee tento sp\u00f4sob komunik\u00e1cie s pacientom m\u00f4\u017ee zlep\u0161i\u0165 adherenciu a d\u00f4veru v procese lie\u010dby.<\/p>\n<p>V svojej podstate je spolo\u010dn\u00e9 rozhodovanie zalo\u017een\u00e9 na vz\u00e1jomnom porozumen\u00ed a re\u0161pekte. Lek\u00e1r a pacient s\u00fa v tomto procese rovnocenn\u00fdmi partnermi, ktor\u00ed prispievaj\u00fa k rozhodnutiu t\u00fdm, \u017ee do rozhovoru prin\u00e1\u0161aj\u00fa vlastn\u00e9 odborn\u00e9 znalosti a sk\u00fasenosti. Takto poskytovate\u013e starostlivosti prispieva prostredn\u00edctvom lek\u00e1rskych vedomost\u00ed a odborn\u00fdch znalost\u00ed a pacient prid\u00e1va vedomosti a odborn\u00e9 znalosti o svojom osobnom \u017eivote. To v\u0161etko sa v\u0161ak \u013eah\u0161ie povie ako urob\u00ed. Zatia\u013e \u010do mnoh\u00ed zdravotn\u00edcki pracovn\u00edci tvrdia, \u017ee &#8220;to u\u017e robia&#8221;, \u00fadaje z prieskumov o sk\u00fasenostiach s pacientmi nazna\u010duj\u00fa, \u017ee tomu tak vo v\u0161eobecnosti nie je.<\/p>\n<p><em>Dermatologi\u010dka, s ktorou som hovorila, zvykla spolo\u010dne s pacientmi rozhodn\u00fa\u0165, ak\u00e1 terapia by im najviac vyhovovala miesto toho, aby rozhodovala v ich mene. Preto v\u00f4bec nerozumela, pre\u010do jej pacienti e\u0161te st\u00e1le neboli motivovan\u00ed u\u017e\u00edva\u0165 lieky pod\u013ea predp\u00edsan\u00e9ho predpisu, a to ani po tom, ako stanovila lie\u010dbu na z\u00e1klade osobn\u00fdch preferenci\u00ed pacienta. Pri opise sp\u00f4sobu, ak\u00fdm implementovala spolo\u010dn\u00fd rozhodovac\u00ed proces do ka\u017edodennej klinickej praxe, povedala, \u017ee akon\u00e1hle pacient pri\u0161iel do jej ambulancie, informovala ho, \u017ee po\u010das tejto konzult\u00e1cie spolo\u010dne rozhodn\u00fa o lie\u010dbe a bud\u00fa spolo\u010dne diskutova\u0165 o r\u00f4znych terapeutick\u00fdch mo\u017enostiach. <\/em><\/p>\n<p>Niekedy m\u00f4\u017eu pacienti potrebova\u0165 \u010das na \u0161t\u00fadium nov\u00fdch inform\u00e1ci\u00ed a zv\u00e1\u017eenie svojich osobn\u00fdch preferenci\u00ed sk\u00f4r, ako sa zavia\u017eu k nov\u00fdm rozhodnutiam. Je to predov\u0161etk\u00fdm vtedy, ke\u010f nie je jasn\u00e9 bud\u00face smerovanie ich zdravotn\u00e9ho stavu a z\u00e1rove\u0148 sa od nich vy\u017eaduje, aby o t\u00fdchto bud\u00facich eventualit\u00e1ch uva\u017eovali, hoci ich nikdy predt\u00fdm neza\u017eili. Ke\u010f je im v takomto momente pon\u00faknut\u00e1 \u00faloha pri spolo\u010dnom rozhodovan\u00ed, niektor\u00ed pacienti sa m\u00f4\u017eu c\u00edti\u0165 prekvapen\u00ed alebo rozru\u0161en\u00ed ponukou mo\u017enost\u00ed a neistotou v tom, \u010do by mohlo by\u0165 pre nich najlep\u0161ie. V\u010dasn\u00e9 informovanie pacientov o r\u00f4znych mo\u017enostiach lie\u010dby a ich \u00fa\u010dasti na spolo\u010dnom rozhodovan\u00ed m\u00f4\u017ee zlep\u0161i\u0165 \u00fa\u010dinnos\u0165 spolo\u010dn\u00e9ho rozhodovania.<\/p>\n<p><em>S cie\u013eom pom\u00f4c\u0165 jej pacientom pri rozhodovan\u00ed o lie\u010dbe, ktor\u00e1 by najlep\u0161ie vyhovovala ich osobn\u00fdm preferenci\u00e1m, navrhla t\u00e1to dermatologi\u010dka svojim pacientom percent\u00e1, napr\u00edklad 10%tn\u00e9 alebo 20%tn\u00e9 zlep\u0161enie, ako mo\u017en\u00e9 ciele lie\u010dby. Ke\u010f si pacient vybral percento, o ktorom si myslel, \u017ee mu najviac vyhovuje, dermatologi\u010dka mu vysvetlila, ak\u00e1 lie\u010dba bude potrebn\u00e1 na dosiahnutie tohto cie\u013ea, \u010d\u00edm akt\u00edvne zapojila pacienta do rozhodovacieho procesu. Napriek tomu sa jej pacienti st\u00e1le nedr\u017eali stanovenej lie\u010dby, aj ke\u010f si sami vybrali mo\u017enos\u0165, ktor\u00e1 sa im \u00fadajne najlep\u0161ie hodila. Sp\u00fdtala som sa jej, \u010di si mysl\u00ed, \u017ee jej pacienti rozumej\u00fa zmyslu 20%tn\u00e9ho \u010di 30%tn\u00e9ho zlep\u0161enia, a \u010di by sa vyjadrili podobne, keby mali stanovi\u0165 \u017eelan\u00fa mieru \u00fa\u013eavu od existuj\u00facich sympt\u00f3mov aj niekomu in\u00e9mu vlastn\u00fdmi slovami.<\/em><\/p>\n<p>\u010cas\u0165 probl\u00e9mu spo\u010d\u00edva v prirodzenej tendencii profesion\u00e1lov v oblasti zdravotnej starostlivosti pou\u017e\u00edva\u0165 jazyk, ktor\u00fd je pre in\u00fdch odborn\u00edkov preva\u017ene transparentn\u00fd av\u0161ak pre pacientov pr\u00edli\u0161 zlo\u017eit\u00fd. Jazyk v medic\u00edne m\u00f4\u017ee by\u0165 komplikovan\u00fd a d\u00f4kazy nazna\u010duj\u00fa, \u017ee takmer polovica pacientov m\u00e1 probl\u00e9m porozumie\u0165 mu. \u017darg\u00f3n a abstraktn\u00e9 pojmy maj\u00fa tendenciu vyvola\u0165 \u0161irok\u00fa \u0161k\u00e1lu interpret\u00e1ci\u00ed, ktor\u00e9 sa m\u00f4\u017eu v\u00fdrazne odchy\u013eova\u0165 od t\u00fdch, ktor\u00e9 mal poskytovate\u013e starostlivosti na mysli. Navy\u0161e ve\u013ek\u00e9 mno\u017estvo d\u00f4kazov nazna\u010duje, \u017ee aj hodnoty posudzovania m\u00f4\u017eu by\u0165 predmetom nespr\u00e1vneho v\u00fdkladu. \u013dudia m\u00f4\u017eu v dotazn\u00edku uvies\u0165, \u017ee nie s\u00fa schopn\u00ed kr\u00e1\u010da\u0165 500 metrov, aj ke\u010f v n\u00e1slednom rozhovore potvrdia, \u017ee \u010dasto chodia dlh\u0161ie ako hodinu v n\u00e1kupnom stredisku.<\/p>\n<p><em>Odpovedala som \u0161pecialistke, \u017ee ak by som bola pacientom, bolo by pre m\u0148a cie\u013eom lie\u010dby by\u0165 schopn\u00e1 poda\u0165 \u013eu\u010fom ruku alebo nosi\u0165 tri\u010dko s kr\u00e1tkym ruk\u00e1vom. Pozrela na m\u0148a a za\u010dala sa smia\u0165 hovoriac, \u017ee m\u00e1m pravdu, a \u017ee jej by to nikdy nenapadlo. Navy\u0161e si neuvedomila, \u017ee informovanie pacienta o\u00a0jeho \u00fa\u010dasti na rozhodovacom procese vopred m\u00f4\u017ee by\u0165 efekt\u00edvnej\u0161ie.<\/em><\/p>\n<p>Preto je mimoriadne d\u00f4le\u017eit\u00e9, aby zdravotn\u00edcki pracovn\u00edci na svojich pacientov pam\u00e4tali pri ka\u017edom rozhodnut\u00ed a pok\u00fasili sa im porozumie\u0165. A net\u00fdka sa to len \u013eud\u00ed s obmedzenou (zdravotnou) gramotnos\u0165ou. V\u0161etci pacienti by benefitovali z jasn\u00fdch a stru\u010dn\u00fdch inform\u00e1ci\u00ed ako aj z minimalizovania odborn\u00e9ho \u017earg\u00f3nu. Okrem toho je pre lek\u00e1rov mimoriadne d\u00f4le\u017eit\u00e9, aby komunikovali v jazyku, na ktor\u00fd s\u00fa pacienti zvyknut\u00ed, vyjadruj\u00fac sa slovami, ktor\u00e9 pou\u017e\u00edvaj\u00fa.<\/p>\n<p>Praktick\u00e9 odpor\u00fa\u010dania:<\/p>\n<ul>\n<li>Zv\u00fd\u0161en\u00e9 zapojenie pacienta do rozhodovac\u00edch procesov m\u00f4\u017ee zlep\u0161i\u0165 dodr\u017eiavanie terapeutick\u00fdch re\u017eimov a v\u00fdsledkov lie\u010dby.<\/li>\n<li>V\u017edy sa sna\u017ete vyjadrova\u0165 slovami, ktor\u00e9 pacienti pou\u017e\u00edvaj\u00fa (t. j. vyhn\u00fa\u0165 sa zdravotn\u00edckemu odborn\u00e9mu \u017earg\u00f3nu)<\/li>\n<li>Majte na pam\u00e4ti, \u017ee hoci to, \u010do hovor\u00edte, v\u00e1m m\u00f4\u017ee by\u0165 \u00faplne jasn\u00e9, m\u00f4\u017ee d\u00f4js\u0165 k v\u00fdrazn\u00fdm nedorozumeniam. Preto sa v\u017edy uistite, \u017ee v\u00e1m pacient porozumel.<\/li>\n<li>Pon\u00faknite pacientom \u010das a u\u017eito\u010dn\u00e9, \u013eahko zrozumite\u013en\u00e9 inform\u00e1cie. Uistite sa, \u017ee ste dobre pripraven\u00ed na d\u00f4le\u017eit\u00e9 konzult\u00e1cie.<\/li>\n<li>Nechajte pacientov vopred vedie\u0165, \u010do sa od nich o\u010dak\u00e1va pri spolo\u010dnom rozhodovan\u00ed.<\/li>\n<\/ul>\n<p><em>Prelo\u017eila Zuzana Dankulincov\u00e1<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>By Anne Marie Plass, University Medical Center of G\u00f6ttingen, Germany Sometime ago a dermatologist who works as a psoriasis (a chronic skin disorder) -specialist in a university hospital, complained to me about many patients who do not adhere to the [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":1190,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_et_pb_use_builder":"","_et_pb_old_content":"","_et_gb_content_width":"","_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"_uf_show_specific_survey":0,"_uf_disable_surveys":false,"footnotes":""},"categories":[28],"tags":[],"class_list":["post-1123","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-communication"],"translation":{"provider":"WPGlobus","version":"3.0.2","language":"sk","enabled_languages":["en","id","my","bg","zh","hr","cz","da","de","es","fr","gr","he","it","ja","kr","lv","lt","hu","nl","no","pl","pt","ro","ru","sk","fi","sv","tr","uk"],"languages":{"en":{"title":true,"content":true,"excerpt":false},"id":{"title":true,"content":true,"excerpt":false},"my":{"title":true,"content":true,"excerpt":false},"bg":{"title":true,"content":true,"excerpt":false},"zh":{"title":true,"content":true,"excerpt":false},"hr":{"title":false,"content":false,"excerpt":false},"cz":{"title":true,"content":true,"excerpt":false},"da":{"title":true,"content":true,"excerpt":false},"de":{"title":true,"content":true,"excerpt":false},"es":{"title":true,"content":true,"excerpt":false},"fr":{"title":true,"content":true,"excerpt":false},"gr":{"title":true,"content":true,"excerpt":false},"he":{"title":true,"content":true,"excerpt":false},"it":{"title":true,"content":true,"excerpt":false},"ja":{"title":false,"content":false,"excerpt":false},"kr":{"title":false,"content":false,"excerpt":false},"lv":{"title":true,"content":true,"excerpt":false},"lt":{"title":true,"content":true,"excerpt":false},"hu":{"title":false,"content":false,"excerpt":false},"nl":{"title":true,"content":true,"excerpt":false},"no":{"title":false,"content":false,"excerpt":false},"pl":{"title":true,"content":true,"excerpt":false},"pt":{"title":true,"content":true,"excerpt":false},"ro":{"title":true,"content":true,"excerpt":false},"ru":{"title":true,"content":true,"excerpt":false},"sk":{"title":true,"content":true,"excerpt":false},"fi":{"title":true,"content":true,"excerpt":false},"sv":{"title":false,"content":false,"excerpt":false},"tr":{"title":false,"content":false,"excerpt":false},"uk":{"title":true,"content":true,"excerpt":false}}},"aioseo_notices":[],"_links":{"self":[{"href":"https:\/\/practicalhealthpsychology.com\/sk\/wp-json\/wp\/v2\/posts\/1123","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/practicalhealthpsychology.com\/sk\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/practicalhealthpsychology.com\/sk\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/practicalhealthpsychology.com\/sk\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/practicalhealthpsychology.com\/sk\/wp-json\/wp\/v2\/comments?post=1123"}],"version-history":[{"count":30,"href":"https:\/\/practicalhealthpsychology.com\/sk\/wp-json\/wp\/v2\/posts\/1123\/revisions"}],"predecessor-version":[{"id":4620,"href":"https:\/\/practicalhealthpsychology.com\/sk\/wp-json\/wp\/v2\/posts\/1123\/revisions\/4620"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/practicalhealthpsychology.com\/sk\/wp-json\/wp\/v2\/media\/1190"}],"wp:attachment":[{"href":"https:\/\/practicalhealthpsychology.com\/sk\/wp-json\/wp\/v2\/media?parent=1123"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/practicalhealthpsychology.com\/sk\/wp-json\/wp\/v2\/categories?post=1123"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/practicalhealthpsychology.com\/sk\/wp-json\/wp\/v2\/tags?post=1123"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}