In the doctor-patient relationship, as a rule, there is a kind of "moral microclimate". Here, the unique nuances of communication between two personalities are important, the dialogue of which is conducted on a very specific moral basis - the authority of the doctor, on the one hand, and the patient's trust in him, on the other, that is, one expects help from the other, easing his suffering, the other is looking for ways to provide it more efficiently. In order for this communication to be productive and meet the patient's expectations, the doctor must be able to establish contact with the patient - and this is already from the field of speech art. Mastering the skill of establishing and maintaining contact with the patient is one of the main aspects of the medical profession. It is not only useful for every specialist, but also decorates him, strengthens his authority. Practice shows that the higher the level of speech skills of a doctor, the easier it is for him to communicate with the patient.

The relationship between the patient and the doctor depends not only on the individual characteristics of the patient, his psyche, but also on the personality and behavior of the doctor, his general and professional culture. The direct duty of the doctor is to break down the psychological barrier in contact with the patient, to arouse his trust, creating an environment of participation and warmth. Let's pay attention to the fact that gaining trust has always been considered the main goal of a rhetorician (orator) as a speech participant.

How a doctor listens to a patient

The features of a doctor's conversation with a patient consist in listening carefully to complaints and trying to understand the patient's experiences. The ability to listen helps the doctor to get the most necessary information about the patient. In addition, during the conversation, the patient calms down, relieves his internal tension, and a kind of conversation treatment takes place.

Rules for the listener represent a certain sequence of actions that are recommended in order to achieve success in communication.

The doctor should listen and study each statement of the patient, without interrupting him, only with short remarks and facial expressions.-

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showing your interest in what the patient is saying. If this is necessary, calmly object, showing tact and restraint.

As the doctor says

General rules for the speaker first of all warn about the danger of harm that the word can cause. "The word is not a sparrow, it will fly out - you will not catch it." This proverb emphasizes how important it is to watch your words carefully. And the doctor needs to be especially careful when talking to the patient.

Patients often share their experiences. An experienced and intelligent healthcare professional will always find a warm and encouraging word. In such cases, there is often a human understanding between the patient and the doctor. This attitude raises the mood, distracts a person from gloomy thoughts about the possible adverse outcome of the disease. It must be remembered that medical professionals of any profile should heal not only the body, but also the soul. The doctor's behavior and reaction should have a calming effect on the patient. The tone of speech, verbal form and emotional coloring are of great importance.

What should be the doctor's tone?

The general tone of the conversation should be serious, but calm and confident: the patient should make sure that the established diagnosis does not discourage the doctor, he does not dismiss fears, but simply does not share them and clearly understands what needs to be done. You should avoid familiarity, harsh tone in conversation - they interfere with the creation of normal relations and contact between the doctor and the patient. And the administrative-cold tone of the doctor can cause the patient to worry about his condition.

How to question the patient

What should be done, on the one hand, to get an idea of the inner life of the patient, and on the other-not to cause him hostility or protest with his seemingly inappropriate curiosity? This task is usually easier to complete than it seems at first glance. It is enough to ask only a few simple and seemingly neutral questions that the patient will not consider unnecessary, irrelevant, but which at the same time will not arouse his suspicions.

A sick person often does not know which details of their story are really important for diagnosis and treatment, and which have nothing to do with it. At the same time, it is necessary to allow the patient to talk freely for two or three minutes about what he considers necessary. Then, especially if the story is too poor with the necessary information,

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you need to start clearly asking specific, simple questions. For example: "And what was the pain - contractions or constant?""What color is the phlegm - yellow or gray?", " What do you call dizziness, did you stagger like a drunk, or did everything spin around like on a carousel?". The patient's disappointment will quickly pass as soon as he sees that the doctor is not at all indifferent and interrupts him not because he is in a hurry, but simply because he is interested in some other details that the patient himself does not attach importance to.

The doctor should be able to find such questions that, on the one hand, allow you to interrupt the endless verbalization, and on the other - help to identify additional details that are important for further treatment. Questions asked to the patient should always be clear and simple, otherwise the patient, not understanding and hesitating to ask again, will give the wrong answer and thus lead the doctor astray from the right path.

The question, similar to a hint, has the character of suggestion: "And the pain was given to the left arm?". Instead of directly asking "Do you have shortness of breath when walking?", it is better to modify the phrase:"If you are late, can you run to the bus stop or quickly cross the street?". Another question: "What is stopping you: do you get tired, or do your legs hurt, or do you get shortness of breath, or do your heart start beating fast?". In this example, the question is an alternative one: it allows you to choose an answer. Such questions are especially valuable because they allow you to avoid incorrect answers caused by suggestion or misunderstanding.

The patient's outward calmness may be just a mask that hides his fright, despair, and longing. Ask questions to the patient should be delicate. If you immediately ask :" Do you think you are a nervous person or not?", " Do you experience unreasonable fear or anxiety?", " How is your mood?", etc., the patient may take offense at the doctor and give incorrect answers.

It is better to start with the questions: "How do you sleep, good or bad?", " Do you get up easily in the morning?", "When do you feel better, more alert-in the morning, afternoon or evening?", "Do you go to the movies, visit friends, or don't want to go anywhere?""Do you often have a headache?", " Do you have any internal tremors, such as chills, any tension?". Only when you get positive answers to some of these questions does the doctor sympathetically say: "You probably often get nervous and anxious ... What's your mood like-depressed? Don't you want anything?" With such a sequence of conversations, the patient feels that the doctor is interested not only in the disease, but also in his mental world, his concerns; he is imbued with trust and gratitude to the doctor, seeing in him human participation. The doctor treats not only the disease, but also the patient.

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When talking, the patient is often wary and anxious, so the doctor must control his statements and take into account the impression that he has on the patient.

Ethical and speech requirements in the process of teaching students

The formation of ethical and deontological principles and worldview of the future doctor and the foundations of his professional knowledge essentially begins from the moment of admission to the medical institute.

Love for the noble profession of a doctor should be instilled in students from the first days of their studies, using not only conversations, classes in the classroom, but also possible visual means. Students should constantly feel the atmosphere of high medical culture. This culture includes as a necessary component the mastery of speech culture in a broad sense. Teachers should ensure that students strictly follow the established standards of medical ethics and deontology in hospital and outpatient settings. Deontology is the study of professional and moral duties and rules of behavior of a medical worker, mainly in relation to the patient.

How to approach the patient? How do I start a conversation? At the first stages of communication with him, it is overcoming shyness and embarrassment. To do this, of course, you need to be able to see, analyze, and quickly navigate by entering into a conversation. The student also tries to copy the teacher in everything: in the manner of speaking, in the formulas for starting and continuing the dialogue with the patient, in the tone of conversation. Communication with the patient requires a certain psychological attitude. Every student should know this and in the process of studying master the skill of establishing contact and communication with the patient.

When meeting a patient, you should first say hello and ask for permission to talk. It is always advisable to introduce yourself. It is necessary to try to arrange the patient for communication and lead the conversation in a pleasant aspect for him. You should ask about your health, appetite, sleep rhythm, and ask what the patient is complaining about. The desire to listen always encourages a frank conversation.

The future medical professional should also master the art of listening. Attention helps to establish good contact and mutual understanding, kindness, politeness, and the ability to be compassionate can bring the patient no less relief than prescribing certain medications.

Thus, the professional activity of a doctor finds itself at the junction between medicine as a science and rhetoric as an art.

Harbin, China

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