看我，感觉我，触摸我，治愈我：个人反思
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中文
尽管我们一直专注于以患者为中心的护理和这种护理的预期益处，但大多数就诊的患者报告了不良的护理经历。1,2具体来说，患者报告不喜欢他们与之互动的医生，或感到羞耻或被个人评判。3
最近，我不得不与几位以肿瘤学为重点的医疗保健提供者（医生和护士）接触，并分享了一些个人对这些经历的反思。当我与这些人互动时，摇滚乐队The Who的歌曲“See Me，Feel Me”中的歌词一直在脑海中播放。可能只有我们婴儿潮一代记得这首美妙的歌曲;然而，如果你为病人提供护理，值得在手机上播放这首歌。这首歌为我们提供了很好的指导，告诉我们如何能够和应该提供护理。歌曲由Pete Townshend创作。它最初是由谁人乐队在1969年的专辑《汤米》中发行的。这首歌后来成为乐队最知名的歌曲和歌词之一。这首歌是更大的摇滚歌剧《汤米》的一部分，这是一个关于一个男孩在目睹创伤事件后变得又聋又哑又瞎的故事。这首歌，“看到我，感觉我，”出来的故事结束时，汤米终于恢复理智。这首歌的歌词简单，清晰，与健康有关。这首歌以“看我，感觉我，触摸我，治愈我”开始。下一节则表达了一些更深层次的想法，包括以下内容：
听着你的歌，我懂了音乐
凝视着你，我感受到了热量
跟着你，我爬上了山
我在你的脚下感到兴奋
就在你身后，我看到了
在你身上，我看到了荣耀
我从你那里得到意见
从你那里，我得到了故事
这首歌的信息是一个连接和倾听他人，并提醒我们作为人和医疗保健提供者倾听和听到别人在说什么。听、听、摸和感觉并不集中在任务完成、专利患者教育或表达我们对患者应该知道和做什么的信念上。
同情心往往是提出关于病人提供者的互动。同理心是理解和分享他人感受的能力。这对于以病人为中心的护理很重要，但与世界卫生组织的建议不同。它是真正的倾听，支持，获得病人的故事，并从病人那里学习，通过与病人的互动和攀登我们自己的新山峰来成长自己。它实际上是看到、感受、触摸和治愈。用史蒂夫·利文森的话来说，这将是一个很好的全面的历史和身体。
提供确保看到、感觉、触摸和愈合的护理的障碍
今天的医疗保健是快节奏的，有压力，以快速分类，诊断，治疗和释放。在这些压力下，你很容易忘记你是在和一个有情绪、恐惧、担忧以及临床问题的个体体征和症状的人打交道。每个病人都不一样。其他障碍包括越来越多地使用患者生成的健康数据和患者报告的结果，这可能会提高患者的健康意识和获得他们的医疗保健信息，但实际上可能会减少与临床医生的沟通，并对患者-临床医生关系产生负面影响。4不幸的是，一些提供者继续恢复推动自己的信念和议程，他们认为这对病人最有意义。同情心的减少，特别是自COVID-19以来，导致对患者观点的理解减少，患者转诊的使用减少，以及以人为本的护理计划减少。5环境和组织可能不是为了促进同理心而建立的。例子包括让工人加班，工人流动，医疗事故的关注，缺乏私人领域的病人提供者的互动可能发生，并确保团队的所有成员的工作，以他们的范围的顶部。
干预措施，以加强我们的能力，看到，感觉，触摸和治愈病人
有许多干预措施可用于改善我们的护理互动，如表1.这些方法不需要更多的时间。此外，通过观察、感受、触摸和治愈病人，我们可以防止倦怠，并记住是什么让我们进入医疗保健行业。
表1.看、感觉、触摸和治愈患者的干预措施
| 干预 | 描述 |
|---|---|
| 听 | 不要只是说话或说教，而是首先倾听病人的经历，他们的目标，以及他们解决问题的方法。虽然你可能不同意病人所做的所有行为，但要为他们所做的事情提供积极的支持（例如，口服补液vs静脉补液;接种流感疫苗但拒绝接种肺炎疫苗）。 |
| 记住你明天可能就是那个病人 | 我们中的任何一个人都可以从一个提供者变成一个病人。对待你的病人，就像你希望被对待一样。这包括倾听，感受他们正在经历的事情，通过适当的检查和/或同情来触摸他们，并尽可能现实地关注他们想要治愈的东西。 |
| 不做评判 | 对病人所做的自我护理保持积极和支持。如果想要添加额外的建议，请以支持而不是惩罚的方式进行（将“拒绝水合作用是愚蠢的”和“你应该服用所有的抗生素”改为“这很好，你摄入了这么多液体，下次如果你想让它更容易，你可以在需要时进行静脉补液”和“你服用抗生素5天真是太好了。这是可能的，可能是足够的，我们将只是监测”）。 |
| 表现出同情心 | 同情心是将同理心付诸行动。它包括感受到另一个人的痛苦，恐惧或不适，并采取措施帮助他们科普。同情这个词来自拉丁语，意思是“一起受苦”。表达同情心的一种方法是在急性事件或手术干预或其他类型的治疗后进行随访电话并检查患者。 |
| 开放式双向通信 | 避免只是和病人谈话，给他们时间与你分享他们的想法，经验和目标。在某些情况下，对于某些患者，需要设定限制，或者我们需要计划沟通时间，以便我们不匆忙。 |
| 温暖，善良，分享自我 | 我们中的一些人被教导要专业永远不要和病人一起哭泣，永远不要表现出情绪，永远不要分享我们自己的问题。虽然这可能对所有患者都有帮助，但有些人发现他们的医疗保健提供者是人类，这让人感到安慰。分享以前的经验特别有帮助，可以告知患者正在经历什么（例如，计算机断层扫描期间发生了什么，白内障摘除期间经历了什么，化疗或放疗是什么样的）。 |
结论和Take Home
我们中的一些人在老年病学方面刚刚起步，而另一些人自己已经是老年病患者了（在马里兰州，老年病患者是指年龄≥55岁的人！）。不管你在衰老的连续体中处于什么位置，总有一天你会成为一个病人。记得了不幸的是，我有机会作为病人站在医疗保健的另一边，再次忍受着接触肿瘤学的世界。我没有被看到，感觉到，触摸，或者以我希望我为病人提供护理的方式治愈。花一点时间，听听谁人乐队的音乐，让它让你恢复活力，帮助你提供你希望在轮到你的时候得到的照顾。
英文
Despite our persistent focus on patient-centered care and the anticipated benefits of this care, most patients who visit a physician report undesirable care experiences.1,2 Specifically, patients report not liking the physician they have interacted with or feeling shamed or judged by the individual.3
Recently, I have had to be in contact with several oncology-focused health care providers (physicians and nurses) and am sharing some personal reflections of those experiences. As I was interacting with these individuals, the words from the song “See Me, Feel Me” from the rock band The Who, kept playing in the back of mind. It may only be us baby boomers who remember this wonderful song; however, it is worth pulling it up on the cell phone if you provide care to patients. The song provides us with wonderful guidance on how we can and should provide care. The song was written by Pete Townshend. It was originally released by The Who on the album, Tommy, in 1969. The song has since become one of the band's most well-known songs and lyrics. The song is part of the larger rock opera, Tommy, which is a story about a boy who becomes deaf, dumb, and blind after witnessing a traumatic event. The song, “See Me, Feel Me,” comes out at the end of the story as Tommy finally regains his senses. The words of the song are simple, clear, and relevant to health care. The song starts with “see me, feel me, touch me, heal me.” The next section then expresses some deeper thoughts including the following:
Listening to you, I get the music
Gazing at you, I get the heat
Following you, I climb the mountain
I get excitement at your feet
Right behind you, I see the millions
On you, I see the glory
From you, I get opinions
From you, I get the story
The song's message is one of connection and listening to others and reminds us as people and as health care providers to listen and hear what others are saying. Listening, hearing, touching, and feeling is not focused on task completion, patent patient education, or expression of our beliefs about what the patient should know and do.
Empathy is often raised regarding patient–provider interactions. Empathy is the ability to understand and share the feelings of another person. It is important for patient-centered care but not the same as the recommendations by The Who. It is really listening, supporting, getting the patient's story, and learning from the patient and growing ourselves through the interaction with the patient and climbing our own new mountain. It is literally seeing, feeling, touching, and healing. In the words of Steve Levenson this would be doing a good comprehensive history and physical.
Barriers to Providing Care that Assure Seeing, Feeling, Touching, and Healing
Today's health care is fast-paced and there is pressure to quickly triage, diagnose, treat, and release. It is easy under these pressures to forget that you are dealing with a human being with emotions, fears, concerns, and individual signs and symptoms of the clinical problem being addressed. Every patient is not the same. Other barriers include the increasing use of patient-generated health data and patient-reported outcomes, which may improve patient health awareness and access to their health care information, but may actually decrease communication with clinicians and negatively affect patient–clinician relationships.4 Unfortunately, some providers continue to revert to pushing their own beliefs and agendas which they feel make the most sense for the patient. A decrease in empathy, particularly since COVID-19, has resulted in decreased understanding of the patient perspective, decreased use of referrals for patients, and decreased person-centered care planning.5 Environments and organizations may not be setup to facilitate empathy. Examples include having workers work overtime, worker turnover, malpractice concerns, lack of private areas where patient-provider interactions can occur, and assuring that all members of the team work to the top of their scope.
Interventions to Strengthen Our Ability to See, Feel, Touch, and Heal Patients
There are a number of interventions that can be used to improve our care interactions, as shown in Table 1. These approaches do not take more time. Furthermore, by seeing, feeling, touching, and healing patients, we can prevent burnout and remember what brought us into health care.
Table 1
| Intervention | Description |
|---|---|
| Listening | Don't just speak or lecture but listen first to what the patient is experiencing, their goals, and their approaches to the problem. Although you may not agree with all behaviors done by the patient, provide positive reinforcement for what they have done (eg, working on hydration orally vs going in for intravenous hydration; getting a flu vaccine but refusing a pneumonia vaccine). |
| Remember you could be that patient tomorrow | Any one of us can flip from being a provider to being a patient. Treat your patient as you would want to be treated. This includes listening, feeling what they are going through, touching them through an appropriate examination and/or in compassion, and focusing on what they want healed as realistically as is possible. |
| Be nonjudgmental | Be positive and supportive about the self-care the patient has done. If wanting to add additional suggestions do so in a way that is supportive and not punitive (change “that was stupid to refuse hydration” and ‘you should have taken all the antibiotics” to “that was great you got in so much fluid and next time if you want to make it easier you could get the intravenous hydration if needed” and “it is great that you took the antibiotics for 5 days. It is possible that may be sufficient we will just monitor”). |
| Show compassion | Compassion is putting empathy into action. It involves feeling another person's pain, fear, or discomfort and taking steps to help them cope. The word compassion comes from the Latin and means “to suffer together.” One way to show compassion is to do a follow-up call and check on a patient after an acute event or surgical intervention or other type of treatment. |
| Open 2-way communication | Avoid just talking at a patient and giving them time to share with you their thoughts, experiences, and goals. In some cases, and with some patients, limits need to be set or we need to plan times for communication so that we are not rushed. |
| Warmth, kindness, and sharing of self | Some of us were taught to be professional—never cry with a patient, never show emotion, and never share our own issues. Although this may not be helpful for all patients, some find it comforting to learn that their health care provider is human. It is particularly helpful to share prior experiences that can inform what the patient is going through (eg, what happens during a computed tomography scan, what one goes through during cataract removal, what chemotherapy or radiation is like). |
Conclusions and Take Home
Some of us in geriatrics are just starting out, whereas others are already geriatric patients ourselves (in the State of Maryland geriatric patients are those who are ≥55 years of age!). Regardless of where you are in aging continuum, you will be a patient one day. Remember that. I, unfortunately have had the opportunity to be on the other side of the health care dime as the patient and again am enduring exposure to the world of oncology. I have not been seen, felt, touched, or healed in the way that I hope I provide care to my patients. Take a moment and listen to the music of The Who and let it rejuvenate you and help you provide the care that you would want to receive when it is your turn.
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