“你们就是为了挣钱反复给我采血”，发热待查患者如何沟通？

临床案例

一老年患者高热不退在当地医院做了许多检查未能确诊，入院后做血培养检查时，拒绝护士采血，并冲着护士太喊大叫，甚至说：“你们就是为了挣钱反复给我采血，不考虑患者的死活，还在我最严重时采，太不人道了”。

发热待查的定义

国内外文献和临床实践，可将发热待查分为４类：经典型发热待查和特殊人群 的发热待查，特殊人群的发热待查又包括住院患者的发热待查、粒细胞缺乏 患者的发热待查和HIV感染者的发热待查。

发热待查患者心理特征 

发热待查患者受多种未知影响，普遍存在心理问题， 表现为焦虑、紧张、恐惧、抑郁情绪。 

1.紧张、焦虑 

患者入院后，对于发热病因、疾病程度、治疗办法、 预后等情况均不了解，并受相关病例、网络自我症状查询 等因素影响，会出现错误的自我病情评估，可进一步增 加其紧张、焦虑情绪，表现出交感神经亢进、心理失衡情况，严重影响患者睡眠质量、免疫机能，不利于疾病诊 断及治疗，影响预后。 

2.恐惧、悲观 

发热病因较多，包括某些恶性肿瘤、白血病等，若患 者出现疑似症状后多伴有绝望、恐惧等情绪；或受周围患者、电视剧情节等因素干扰，认为自己病情无法通过现 有医疗手段治愈，或需要高额治疗费用，增加患者治疗压力，认为自己是家庭和社会的拖累，悲观情绪严重。

3.抑郁、否认 

出现发热症状，甚至出现反复发热，既往多次检查无 法获得明确病因者，多会出现抑郁情绪，认为可能因自身 病重，家属对自己病情刻意隐瞒，而产生抑郁情绪；或患 者存在疫区、疫源接触史而表现出相应症状，担心治疗会 增加经济压力或影响工作效率，出现拒不承认确诊病例接触史情况，干扰诊断结果、延误病情。

如何沟通？ 

沟通的效果直接影响到疾病的诊断和治疗。

永远都是对的：希波克拉底誓言！

I swear by Apollo, the healer, Asclepius, Hygieia, and Panacea, and I take to witness all the gods, all the goddesses, to keep according to my ability and my judgment, the following Oath and agreement:

To consider dear to me, as my parents, him who taught me this art; to live in common with him and, if necessary, to share my goods with him; To look upon his children as my own brothers, to teach them this art; and that by my teaching, I will impart a knowledge of this art to my own sons, and to my teacher's sons, and to disciples bound by an indenture and oath according to the medical laws, and no others.

I will prescribe regimens for the good of my patients according to my ability and my judgment and never do harm to anyone.

I will give no deadly medicine to any one if asked, nor suggest any such counsel; and similarly I will not give a woman a pessary to cause an abortion.

But I will preserve the purity of my life and my arts.

I will not cut for stone, even for patients in whom the disease is manifest; I will leave this operation to be performed by practitioners, specialists in this art.

In every house where I come I will enter only for the good of my patients, keeping myself far from all intentional ill-doing and all seduction and especially from the pleasures of love with women or men, be they free or slaves.

All that may come to my knowledge in the exercise of my profession or in daily commerce with men, which ought not to be spread abroad, I will keep secret and will never reveal.

If I keep this oath faithfully, may I enjoy my life and practice my art, respected by all humanity and in all times; but if I swerve from it or violate it, may the reverse be my life.

最新版的希波克拉底誓言(2017年10月，WMA大会，洛杉矶，美国)

作为一名医疗工作者，我正式宣誓：

把我的一生奉献给人类;

我将首先考虑病人的健康和幸福;

我将尊重病人的自主权和尊严;

我要保持对人类生命的最大尊重;

我不会考虑病人的年龄、疾病或残疾,信条，民族起源、性别、国籍、政治 信仰、种族、性取向、社会地位,或任何其他因素;

我将保守病人的秘密，即使病人已经死亡;

我将用良知和尊严，按照良好的医疗规范来践行我的职业；

我将继承医学职业的荣誉和崇高的传统;

我将给予我的老师、同事和学生应有的尊重和感激之情;

(原版：对传授我医术的老师，我要像父母一样敬重，并作为终身的职业；）

我将分享我的医学知识，造福患者和推动医疗进步;

我将重视自己的健康，生活和能力，以提供最高水准的医疗;

我不会用我的医学知识去违反人权和公民自由，即使受到威胁;

我庄严地、自主地、光荣地做出这些承诺。

参考文献：

1.《中华传染病杂志》编辑委员会. 发热待查诊治专家共识[J]. 中华传染病杂志,2017,35(11):641-655. DOI:10.3760/cma.j.issn.1000-6680.2017.11.001.

2.张美春. 发热待查患者的心理护理研究进展[J]. 临床医药文献电子杂志,2020,7(68):197-198.

3.希波克拉底誓言