Talking medicine

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Speaking medicine is used as a collective term for all medical interventions that use communication between doctor and patient as an effective factor. This attempts to cover a large number of different and in some cases strongly overlapping topics, such as B. doctor-patient relationship , doctor-patient communication, medical discussion, psychoeducation within the framework of patient and family information (developing adequate ideas about the complained of complaints or health disorders, expectations for treatment and prognosis), breaking bad news (Communication of serious diagnostic facts), giving medical advice, questions of adherence to therapy (consent and adherence to diagnostic and therapeutic procedures; compliance, adherence).

There are also overlaps with the concept of narrative medicine (narrative medicine, English narrative medicine or narrative based medicine ) and the Balint groups (including interaction-related casework and “relational medicine ”).

In the context of medical training and patient care, there are also close overlaps with the terms psychosocial medicine, psychosomatic medicine and psychotherapeutic medicine (as the application of psychotherapeutic interventions in a medical setting) and psychotherapy.

In its entirety, speaking medicine sees itself as the opposite pole and at the same time an extension of "apparatus medicine" or "engineering medicine", which is based on the strictly scientifically oriented biomedical model of human medicine. In this medical theory, which has dominated to this day, the human being does not appear primarily as a (thinking, feeling and shaping) subject, but as an object: the human organism as a complex machine that can be repaired pharmacologically or surgically and technically in the event of damage (for criticism, see for example Ivan Illich and Paul Watzlawick (1991), Thure v. Uexküll and Wolfgang Wesiack (2003), George L. Engel (1976) Josef W. Egger (2010)).

The WORD as an effective factor

The effective elements of speaking medicine are often simplified with the symbol "word" as the sum of all communicative effective factors. "Healing words" form the third foundation of scientific medicine in addition to the two pillars "medicament" (sum of all medicinal factors) and "knife" (sum of all technical / surgical interventions). The networking of these 3 effective areas is explained using the so-called bio-psychosocial model of illness or health. The empirical evidence for this scientifically founded "holistic approach" comes from many interdisciplinary medical research areas, but predominantly from "neurobiology " (see e.g. Wolf Singer , Gerhard Roth ), " psychoimmunology " (see Christian Schubert ) and " neuropsychology " ( see below B. Klaus Grawe ). Here it becomes clear that all life is based on communication, exchange and networking. There is also a constant exchange of information in the human organism. B. between the control systems "central nervous system", "vegetative nervous system", "hormonal system" and "immune system". As soon as words - specifically the sound waves - are converted into physico-chemical signals in the inner ear, it is already a physiological process. The impulses passed on to the brain together with the scenic embedding (i.e. with the other sensory information present at the same time) are "processed" (integrated) there and given specific meaning, which induce the organism to corresponding "readiness reactions" or impulses to act. This shows how what is spoken is capable of producing a physiological effect. Words that cause positive activation in the patient (essentially positive activating emotions, which in turn contribute to increasing self-efficacy, resource activation or calming, etc.) can in principle be described as having a healing effect. However, just as one can "heal" with words, one can also "hurt" with them. - On the basis of these findings, a bio-psychosocial holistic approach is established for the medical procedure, which emphasizes the perpetual entanglement of physical, mental and eco-social processes within a process. A strict separation of “body” and “soul” or of matter and spirit becomes superfluous, even though our language system does not take this into account to this day.

Neuroscientific Aspects

Insights from neuroscience can clarify how words work on a neurobiological background. Based on the individual genetic matrix, a person's life experiences shape their brain structure by forming synapses and neural networks in different ways as they grow. The brain is in a lifelong (but increasingly slower) growth process of neural connections and enables change through learning processes . Neurobiological processes in the brain affect the entire human organism because of the networking of the control systems. Incoming perception impulses (e.g. seeing , hearing , smelling , touching ) are compared with internal concepts / schemes , evaluated accordingly and the result is passed on in the form of nerve signals. In a diversely interconnected physiological process (see stress research and stress medicine), these nerve impulses cause, for example, the release of activation and stress hormones such as, for example, in threateningly interpreted situations (dangerous situations , stressful situations). B. Adrenaline and Cortisol . These put the organism into a state of excitement that provides energy for attack or flight ( fight-or-flight ). Only in the event that the threat is experienced as completely unmanageable is the dead-play reflex (freezing, fainting) activated - primarily via corticosteroids . On the other hand, the neurotransmitters serotonin and dopamine, for example, are released more in friendly situations - but also oxytocin , which, along with some other (less desirable) effects, promotes attachment behavior and trust, reduces anxiety and stress and promotes balance.

The ability of the brain to change lifelong - albeit with decreasing ability with age (" neural plasticity ") is of essential importance for all learning processes. Words, a therapeutic conversation, thoughts, autosuggestion or a person's communication with themselves (self-communication, “ inner child ”) can change synaptic structures and thus influence health processes. If it is initially mostly functional disorders (such as painful chronic muscle tension, cardiovascular disorders, complaints in the gastrointestinal tract or immune deficiency, etc.), manifest diseases can develop in the further course. As the results of neuropsychoimmunology show, a more favorable emotion regulation can be built up through a tailor-made "speech cure" (i.e. through "healing words"), which can also weaken established (established) neural connections.

The entire organism is always involved in the process, especially the brain, neural networks, neurotransmitters, hormones, and the immune system, with their interactions in experience , thinking and behavior . It can be seen that spoken words, thoughts or imagination and the emotions triggered by them (which themselves represent physiological processes in their core) have a positive and negative influence on the functioning and consequently also on the material structure of the neural networks takes.

Communication is used to a special extent by psychotherapy (cf. Gerhard Roth on the neurobiological aspects of psychological treatment). It seems neurobiologically certain that psychological conflicts or stressful early childhood experiences are associated with the development of certain dysfunctional ("wrong") connections in neural networks of the limbic system . Such undesirable connections can be (at least partially) corrected through psychotherapeutic interventions, in that positive (problem-solving) experiences in therapy create “equivalent circuits” in the tonsils and in other regions of the brain. Talking medicine can change the brain (and because of the parallel interconnection with the other organ systems, the entire organism), as can psychotropic drugs - often both and more are needed to be successful.

Historical aspects

Linguistic communication was known as a healing factor as early as ancient Greece. Asklepios (Latin Aesculapius; German Aesculapius, English Asclepius) - in Greek mythology the god of healing - the following motto for medical action is ascribed: "First heal with the WORD, then with the MEDICINE and finally with the KNIFE" (analogous translation from ancient Greek). It is also passed down from Socrates that he intervened effectively in problem solving due to a special way of conducting a conversation (" Socratic dialogue ").

Some authors also associate the concept of “speaking medicine” with dialogical thinking in so-called humanistic medicine and V. v. Attributed to Weizsäcker. The dialogic thinking was in the 1920s, with the further involvement of Ferdinand Ebner , Martin Buber , Franz Rosenzweig and Gabriel Marcel developed. In the context of so-called humanistic psychology and its psychotherapeutic approach, there are plausible connections to conversation psychotherapy (or client-centered psychotherapy ) by Carl Rogers and Reinhard Tausch , but also to hypnotherapy by Milton H. Erickson . Further cross-connections can also be made to the concept of narrative medicine , English narrative based medicine (Rita Charon). The term was coined to delimit and supplement evidence-based medicine (evidence-based medicine). Narrative medicine and evidence-based medicine are now understood as mutually complementary concepts of patient-oriented medicine: the more scientific evidence there is for the type and extent of those factors that are effective in different aspects of narrative medicine, the less meaningful the distinction between evidence-based and narrative becomes Medicine.

The doctor and psychoanalyst Michael Balint was convinced that the most important remedy is the doctor himself. It is not the preparation that is decisive, but the way in which the doctor prescribes it, the atmosphere in which the medicine is administered. He is referring to Socrates (according to Plato ) when he told Charmides that the requested remedy only works if it is given credibly with the right words.

outlook

Social changes in the direction of an increased need for sufficient information on diagnosis, therapy and prognosis prove that ever larger parts of the population want to be actively involved in their treatment process. This has already contributed to far-reaching modifications of medical training and further education and continues to do so. In the entire German-speaking area and in most countries with western-oriented scientific medicine, there are more or less elaborate training and further education programs that aim to professionalize doctor-patient communication or medical discussions. In 2011, the Medical University of Graz established its own professorship for the first time in the German-speaking area. Professional doctor-patient contacts are increasingly seen as an independent medical task and as a relevant medical intervention. Nevertheless, speaking medicine is still undervalued in comparison to mainstream western medicine (buzzwords repair medicine , apparatus medicine and engineering medicine ) with its focus on pharmaceutical and technical-surgical interventions. So far, health policy has not succeeded sufficiently in creating adequate framework conditions for speaking medicine. However, empirical research shows that patient-specific information and sufficient motivation for the patient to actively participate in improving his or her health parameters as well as in coping with the disease or in general for the desired success of the treatment are essential. The goal of speaking medicine is consequently the informed (enlightened) patient who knows about his illness, is sufficiently motivated and is also able to participate in the respective treatment process.

See also

literature

Books

magazine

  • Psychological medicine, Vienna: Facultas

Web links

Individual evidence

  1. ^ Trisha Greenhalgh, Brian Hurwitz: Narrative-based Medicine - Speaking Medicine. Dialogue and discourse in everyday clinical practice. Huber, Bern 2005, ISBN 3-456-84110-8 .
  2. ↑ Wulf Rössler (Ed.): The therapeutic relationship. Springer, Berlin 2004, ISBN 3-540-21670-7 .
  3. ↑ Friedrich Schulz von Thun: Talking to one another. General psychology of communication. Volumes 1–3, Rowohlt, Reinbek near Hamburg 2006.
  4. ↑ Ivan Illich, Paul Watzlawick: What makes people sick? 18 critical analyzes. 1991, ISBN 3-7643-2583-6 .
  5. ↑ Thure v. Uexküll, Wolfgang Wesiack: Integrated medicine as an overall concept of medicine: a biopsychosocial model. In: Thure v. Uexküll: Psychosomatic Medicine. Models of medical thought and action. Urban & Fischer, Munich 2003, pp. 3–42.
  6. ↑ George L. Engel: Mental behavior in health and illness. Huber, Bern 1976.
  7. ^ Klaus Grawe: Neuropsychotherapy. Hogrefe, Göttingen 2004.
  8. ^ Josef W. Egger: Health - Aspects of a complex biopsychosocial construct and its correlation to optimism and happiness. In: Psychological Medicine. 21 (1), 2010, pp. 38-48.
  9. ↑ a b c d e Josef W. Egger: Integrative behavior therapy and psychotherapeutic medicine. A biopsychosocial model. Springer, Berlin 2015, ISBN 978-3-658-06802-8 .
  10. ↑ ER Kandel: Psychiatry, psychoanalysis and the new biology of the mind. Suhrkamp, ​​Frankfurt am Main 2006.
  11. ↑ Johann Caspar Rüegg: Brain, Psyche and Body. Neurobiology of Psychosomatics and Psychotherapy . 1. corr. Reprint of the 5th, updated and exp. Edition. Schattauer, Stuttgart 2014, ISBN 978-3-7945-2652-9 .
  12. ↑ Hans Selye: Stress dominates our life. Heyne 1991.
  13. ↑ JW Egger: From psychobiological stress research to neuropsychoimmunology. In: Pediatrics and Pedology. 27, 1992, pp. 91-96.
  14. ^ A b Christian Schubert: Psychoneuroimmunology and Psychotherapy. Schattauer, Stuttgart 2015.
  15. ↑ G. Hüther: Biology of fear. How stress turns into feelings. Vandenhoeck, 2012.
  16. ↑ M. Spitzer: Learning - networked thinking. Müllheim: auditorium 2005.
  17. ↑ JE Young, JS Klosko, ME Weishaar: Schema Therapy. Junfermann, Paderborn 2005.
  18. ↑ a b G. Roth: Feeling, thinking, acting. How the brain controls our behavior. Suhrkamp, ​​Frankfurt am Main 2003.
  19. ↑ a b W. Singer: The observer in the brain - essays for brain research. Suhrkamp, ​​Frankfurt 2005.
  20. ^ H. Weiner: The organism as a body and soul functional unit - conclusions for a psychosomatic medicine. In: Psychotherapy, Psychosomatics, Medical Psychology. 41, 1991, pp. 465-481.
  21. ↑ JE LeDoux: The network of feelings. Deutscher Taschenbuch Verlag, Munich 2001.
  22. ↑ H.-P. Kapfhammer: The connection between depression, anxiety and heart disease - a psychosomatic challenge. In: Psychiatria Danubia. 23, 4, 2011, pp. 412-424.
  23. ↑ JW Egger: First heal with the word ...? On the importance of communication in human medicine. In: Psychological Medicine. 23 (1), 2012, pp. 38-49.
  24. ^ Trisha Greenhalgh: Narrative based medicine in an evidence based world. In: T. Greenhalgh, B. Hurwitz (Ed.): Narrative based Medicine. Dialogue and Discourse in Clinical Practice. BMJ Books, London 1998, pp. 247-265. [German. Translation: 2005]
  25. ↑ Peter F. Matthiessen, Stefan Wilm, Vera Kalitzkus: Narrative Medicine - What is it, what is it, how do you implement it? In: ZFA magazine for general medicine. No. 2, 2009. online-zfa.de doi: 10.3238 / zfa.2009.0060
  26. ↑ Cf. Plato's dialogue “Charmides” (Plato 1993) as well as the miracles of Jesus mentioned in the New Testament (see e.g. LK 4, 31-42; Mk 2, 1-12) in Johann Caspar Rüegg: Brain Psyche and Body .
  27. ↑ s. in addition Plato's dialogue “Charmides” (Plato 1993) as well as the miracles of Jesus mentioned in the New Testament (see e.g. LK 4, 31-42; Mk 2, 1-12) in Johann Caspar Rüegg: Brain Psyche and Body. 2014.
  28. ↑ T. Langer, MW Schnell (Ed.): The doctor-patient / patient-doctor conversation . Marseille, Munich 2009.
  29. ^ WR Miller, S. Rollnick: Motivating conversation . Lambertus, Freiburg 2009.
  30. ↑ Ralf Adler, W. Hemmeler: Anamnesis and physical examination. Fischer, Stuttgart 1992.
  31. ↑ Linus Geisler : Doctor and patient - meeting in conversation. 5th updated edition. Pmi-Verlag, Frankfurt am Main 2008, ISBN 978-3-89786-076-6 .
  32. ^ A. Schweickhardt, Kurt Fritzsche: Course book medical communication: Basics and case studies from clinic and practice . Deutscher Ärzteverlag, 2009.