《The Medical Republic》案例分享——分享快乐是一剂良药

Leon Piterman(著)，梁艳嫦(译)，黄文静(译)，杨 辉(译)

《The Medical Republic》案例分享
——分享快乐是一剂良药

Leon Piterman(著)1，梁艳嫦(译)2，黄文静(译)2，杨 辉(译)1

全科医生；幽默；医患关系

PITERMAN L.分享快乐是一剂良药[J].梁艳嫦，黄文静，杨辉,译.中国全科医学，2017,20(17)：2148-2150.[www.chinagp.net]

PITERMAN L.Sharing a laugh can be good medicine[J].LIANG Y C,HUANG W J，YANG H，translators.Chinese General Practice,2017,20(17)：2148-2150.

皮特曼医生写道：这个世界真狡猾[1]，医生不怕讲笑话。

患者受到各种健康问题的困扰，虽然正在遭受痛苦，毫无疑问笼罩在恐惧之中，但很多患者还是能展颜一笑，看到事情有趣的一面。这也同样适用于照顾患者的全科医生们。

有人说，“喜剧就是悲剧加上时间”[2]。在全科医学环境中，这种悲喜之间的变换时间可能会很短。在全科医生和患者之间，特别是彼此非常熟悉的医患之间，互相开开玩笑并不稀奇。当然，有些时候全科医生看到了事情的有趣一面，可是患者却一头雾水。这种可笑的事情只能与同事分享，或可能与朋友分享。

笑声是一剂良药[3]。在临床诊疗过程中，如果医患双方能同时笑起来，那会是非常有帮助的。接下来的两个故事，讲的是我是怎样为患者“幽默看病”的。

故事1：一份标本

比尔是一位23岁的男性，正申请一份在当地仓库做叉车司机的工作。他身材高大、金发、体格结实，病历上没有任何异常记录。这是他第一次做体检，对于一个健康的年轻人来说，这也许没什么不寻常的。

对我的大多数提问，他都是用“没有，医生”“是的，医生”这样的简单回答。有一项检查，是检测尿液样本中是不是有尿糖、尿蛋白、尿隐血。一般情况下，我让患者去厕所留一个尿液标本，然后回来把标本容器交给我。在我让比尔做这件事情的时候，并没有什么不寻常。我指着厕所的方向，递给他一个塑料容器，并让他把“标本”(specimen)给我。

通常情况下，我认为患者在几分钟内就可以送回标本，即便是没有排出尿液，也会回来告诉我的。可是5 min过去了，我还是没有见到比尔的身影，我开始有些担心。10 min过去了，我不得不去查看一下他是不是安全。我有礼貌的敲了敲厕所的门，然后问：“比尔，你还好吗？”厕所里一个颤抖的声音回答：“马上，医生。”

又过了几分钟，比尔回来了。他看上去脸色潮红，目光呆滞、疲惫，带回的塑料罐里盛着牛奶样液体。他取的是精液(semen specimen)[4]，而不是尿液(urine specimen)。他问我：“医生，这些够了吗？”

我该怎样跟他解释生育能力并不是驾驶叉车的先决条件呢？他应聘的那家公司更想知道的，应该是他有没有糖尿病或慢性肾病，而不是想要知道他的精子数量吧？在这种情况下，我应该怎样跟比尔说呢？既不让他感到尴尬，同时也不忍住我的幽默感呢？

我的医学职业化指示我板起严肃的表情，有礼貌地请他再去一次厕所。

故事2：脑震荡

之前，我是一名服务于著名澳式足球队的队医[5]。那时的澳式足球比赛不像现在那么职业。球队要获胜，既要靠训练方法，也要靠医学干预的水平。

医学干预特别与脑震荡的评估和管理有关，这是肢体接触运动所造成的常见伴随疾病。

作为一个接受过神经病学基本培训的全科医生，我习惯于用简单提问的方式来评估一个人的心理状态，即我们常说的简易精神测验。谁是总理？谁是反对派领袖？女王叫什么名字？100减7等于多少？等等，这些是简易精神测验中的常用提问。

前一场比赛的球队教练有礼貌地告诉我说，这些问题可能不适合问那些明星球员，因为他们对政治不感兴趣，甚至对这个国家的君主是谁都不感兴趣。他们唯一可能正确回答的问题，就是说出反对派领袖的名字，不过那可不是政治上的反对党党魁，而是指对手球队的场上队长。

掌握了这个重要信息，我为下一次的脑震荡评估做好了准备。

没多久的一个周六，我们队的一名球员头部受到严重撞击，并昏迷了5 min。在球场我给他进行了紧急的医疗处理，然后安排救护车送他到医院做进一步的评估和CT扫描。

我拿着修改过的简易精神测验表格，把我的提问简化成“请说出一周以T字母开头的两天”。那个受伤球员闪电式地答到“今天和明天”(today and tomorrow)[6]。

我懂了，球员的记忆中最后被抹掉的东西，一定是他的幽默感。

译者注

[1]It′s a funny old world(这个世界真狡猾)。这是英国前首相撒切尔夫人的一句名言，她在1990年底最后一次参加内阁会议上，宣布辞职首相职务后说的这句话。她想要说的是，她一生中从没有输过选举，这次是被人逼着下台的，所以，这个世界真狡猾。这句话也是英国英语的习惯用语，如果有人给你讲了一件很奇怪或惊奇的事情，你就可以回应说“这个世界真狡猾”。

[2]Comedy is tragedy plus time(喜剧就是悲剧加时间)。这是一个悲剧与喜剧之间的“公式”(喜剧=悲剧+时间)。据说最早是Steven Allen于1957年在《大都会》杂志上写出这个公式。他写到，“我最近跟一个朋友解释说，喜剧的很多素材实际上是悲剧色彩的。我的朋友反问说，你是说可以用幽默的笔触来评论每天发生的悲剧事件吗？我说，不是的，悲剧过后，也会让人发笑。人们会自嘲那些让自己不顺心的事情，通常的做法是等待时日，让不好的事情成为过去。不是吗，有些按照悲剧设计的角色，过后却成了人们开玩笑的话柄。我想用个数学公式来表示一下：悲剧=喜剧+时间”。之后，有很多人使用这个公式。比如美国著名喜剧演员Carol Burnett说过，“我的幽默是我妈妈给我的。我给她讲我遇到的倒霉事，她却逗我笑，她说以后再看现在的倒霉事，一定很好玩”。伍迪艾伦的作品《罪与错》也用过这句话。

[3]笑声是一剂良药。这句话是皮特曼教授对本文的点睛之笔。在通常情况下，诊所里很难听到笑声，医生和患者一起笑起来的情况更是罕见。然而如果医生能使用恰当的机智和幽默，让病室内有笑声，那么我们会发现无论是对医患关系，还是对患者和医生的心情，都会发生意想不到的出奇效果。当然，皮特曼教授并没有让大家刻意和生硬地制造笑料，而是机会性地恰当地使用幽默的效果。

[4]在英文中，sperm(精子)与specimen(标本)发音相似。

[5]澳式足球(Aussie Footy)是世界上3种橄榄球比赛之一，以球员不穿戴任何防护直接肢体冲撞为特点的激烈和刺激的运动。

[6]正确答案应该是星期二(Tuesday)和星期四(Thursday)。

It′s a funny old world and GPs shouldn′t be afraid of cracking a joke every now and then, writes Dr Leon Piterman.

Patients often present with troubling problems, however, despite their suffering and undoubted fears, many are still able to crack a smile and see the funny side of things.The same applies to the GPs who care for them.

It is said that "comedy is tragedy plus time". In the context of general practice, the time taken for that transition from can be quite short.It is also not uncommon for GPs and patients, particularly those we know well, to share jokes.Of course, there are times when GPs see the funny side of things with their patients left wondering.Those are the funny situations we share only with colleagues, and possibly with friends.

Laughter is thought to be therapeutic.In the course of a clinical encounter it helps if both parties can laugh together.The following two stories represent reflections on humorous encounters with my patients.

The specimen

Bill was a 23-year-old man applying for a job as a forklift driver in a local warehouse.He was tall, blond, solidly built and had nothing of note to reveal medically.This was the first time he had undergone a medical examination, perhaps not so unusual for a healthy young man.

Most of my questions were met with a simple "no doc", "yes doc" response.Included in the examination is the need to test a urine specimen for sugar, protein, blood.Having requested patients to pass such a specimen in the toilet and return the container to me, I saw nothing unusual in asking Bill to do the same.I pointed him in the direction of the toilet and handed him the plastic container and asked him to return the "specimen " to me.

Normally I would expect the patient to return within minutes even if attempts to pass urine have been unsuccessful.After five minutes, and no sign of Bill, I began to worry.After 10 minutes I felt compelled to enquire as to his welfare.I politely knocked on the toilet door and asked "Bill are you OK?".A tremulous voice replied:"Nearly there, doc".

A few minutes later, Bill, looking rather flushed and with somewhat glazed eyes, returned the plastic jar filled with milky fluid.He had produced a semen specimen and not a urine specimen."Is that enough doc? " he asked.

How was I to explain to him that fertility is not a prerequisite for forklift driving? That the company was more interested in knowing that he is not diabetic or suffering from chronic renal disease than knowing his sperm count? What could I possibly say to Bill without embarrassing him and at the same time subduing my sense of humour about the situation?

Professionalism dictated that I keep a straight face and politely request a further visit to the toilet.

Concussion

For a period of time in the early 1980s I was the doctor to one of our elite Aussie Rules football teams.The game was not as professional as it is now and this applied both to the training methods as well as the level of medical intervention.

This was particularly relevant to the assessment and management of concussion, a frequent accompaniment of body-contact sports.

As a GP with basic training in neurology I was accustomed to asking simple questions to assess one′s mental state: the so called mini-mental examination.Who is the prime minister? Who is the leader of the opposition? What is the name of the Queen? What is 100 minus seven? And so on.

I was politely informed on a previous occasion by the team coach that these questions might not be appropriate for elite footballers with no interest in politics and even less in the monarchy, and possibly the only question they might answer correctly would be naming the leader of the opposition, as long as that question was referring to the captain of the opposing team.

Armed with this vital information, I prepared myself for the next encounter with concussion.

I did not have long to wait.The following Saturday one of our players received a serious knock to the head and remained unconscious for five minutes.After attending to his immediate medical needs I arranged the ambulance to take him to hospital for further assessment and a CT scan.

Armed with a revised schedule for a mini-mental examination I confined my question to: "Name two days of the week starting with T?" In a flash he replied: "Today and tomorrow."

I learned that the last thing to be erased in a footballer′s memory is his sense of humour.

(本文编辑：吴立波)

·全科医生知识窗·

Sharing a Laugh Can Be Good Medicine

General practitioners；Humor；Doctor-patient relationship

注：本文首次刊登于《The Medical Republic》

R 192.3

A

10.3969/j.issn.1007-9572.2017.17.002

2017-05-01)

1.3168 Monash University，Melbourne，Australia

2.518003广东省深圳市，罗湖医院集团黄贝岭社区健康服务中心