12-11 03:06 首页 SIBCS


  • 作者:安德鲁·麦克唐纳(2007年被诊断为帕金森病,2010年被诊断为前列腺癌,2014年退休前为英国独立议会标准管理局首席执行官,现任英国伦敦残疾人慈善组织Scope基金会理事长)

  • 翻译:杨路(中国医学科学院肿瘤医院)

  • 审校:王燕(中国医学科学院肿瘤医院)

  • 引用:英国医学杂志中文版. 2017;20(10):593-594.






  • 患者的理解:这个人的癌症已经治愈了。

  • 医生的意思:这个人从诊断为癌症以后5年还活着。



  • 患者的理解:虽然癌症没有治愈,但是它在以后很长一段时间内不会再出现了。

  • 医生的意思:目前我们暂时没有发现癌症进展的证据。


  • 患者的理解:虽然这不是什么好消息,但是这个肿瘤不会危害我的生命。

  • 医生的意思:在你体内,有一团组织在不受控制地生长,但是它不会转移。


  • 患者的理解:这是坏消息,它会危害我的生命。

  • 医生的意思:这个肿瘤会转移。根据肿瘤的分期与病理类型,有的恶性肿瘤可能意味着坏消息,甚至可能危及到你的生命;有的或许也没有那么糟糕。


  • 患者的理解:尽管我没有特别明白,但这肯定是个非常可怕的事情。

  • 医生的实际意思是:这个肿瘤不仅可以侵犯临近组织,还可以通过循环系统转移到全身其他脏器。如果它已经转移了,那么这的确是一个坏消息。


  • 患者的理解:这代表我到了生命的终点站。

  • 医生的意思:我们无法治愈它。但是根据肿瘤的分期和类型,我们采取相应治疗后,或许可以在相当长一段时间内控制病情。


  • 患者的理解:人生谢幕。

  • 医生的意思:人生谢幕可能还有6个月。


  • 患者的理解:人生谢幕之前,医生想做的只是让我舒服一些,他们帮我把枕头弄鼓一些,然后给我维持生命的葡萄糖和减缓疼痛的吗啡。

  • 医生的意思:人生谢幕之前,我们仍会提供治疗,必要时也可能会用巴祖卡反坦克火箭炮(猛药)。



BMJ. 2016 Aug 16;354:i4453.

What doctors say and what patients hear.

McDonald A.

Scope, 6 Market Road, London N7 9PW.

When discussing serious health problems doctors and patients must speak a common language, says Andrew McDonald

This autumn the National Theatres repertoire will include a musical called A Pacifists Guide to the War on Cancer. Whats your first reaction? Revulsion at the poor taste of those involved? Despair that the theatre has nothing better to do? Or relief that a serious topic may be stripped of its mythology?

Im in that last camp. But then, my perspective might be deemed somewhat peculiar: Ive had prostate cancer since 2010, and three years ago it was declared incurable. Along the way Ive acquired an interest in how health professionals communicate with patients about serious illnesses—and how this might be done better. To me, improving communication must start with looking at our use of metaphor in discussions of disease and working to ensure that professionals and patients use a common language to communicate.

Let me illustrate that last point by citing some terms often used by oncologists when discussing cancer treatments with their patients:

Cancer survivor

  • What patients hear: Somebody cured of cancer

  • What doctors mean: Somebody still breathing five years after diagnosis. (So, Im a cancer survivor. It doesnt feel like that)

In remission

  • What patients hear: Not cured, but the cancer wont be around for a good while

  • What doctors mean: We cant see evidence of cancer in your body today

Benign tumour

  • What patients hear: It isnt good news, but it wont kill me

  • What doctors mean: You have a mass of tissues growing out of control, but theyre not capable of metastasis

Malignant tumour

  • What patients hear: Its bad news, and it might kill me

  • What doctors mean: The tumour is capable of metastasis. Depending on the tumour type and stage, it might be bad news and it might kill you . . . or not


  • What patients hear: I dont really know, but its very bad news

  • What doctors mean: Your tumour is capable of spreading systemically through your body and not just to adjacent tissues. If it has already performed this trick, then this is bad news


  • What patients hear: Terminal

  • What doctors mean: We cant cure it. But, depending on the grade and type, we might be able to keep it at bay for a long time


  • What patients hear: Curtains

  • What doctors mean: Curtains within six months


  • What patients hear: Prelude to curtains—theyre just going to plump up my pillow and give me Lucozade and morphine

  • What doctors mean: It is curtains, but well still offer to treat you, in some cases with big bazookas

Do these misunderstandings hamper patient care? Well, not if the doctor closes the gap by explaining what he or she means—or, better still, avoids the more slippery terms altogether. I agree that some of the differences in meaning might seem modest; but put yourself in the patients place and those shades of meaning become much, much more important. And, of course, terms are often used in combination, which only confuses matters further. I, for example, might be described as a cancer survivor with malignant, metastatic tumours. Is it perhaps time for a new, shared language of cancer?

The development of such a language, securely founded in shared meanings, would be a good first step towards better communication between professionals and patients. It would not, of course, deliver the goal of full participation in decision making, but that goal will remain elusive unless we begin by understanding one another.

PMID: 27530907

DOI: 10.1136/bmj.i4453

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