(a) When patients with cerebrovascular accident or craniocerebral trauma are admitted to the hospital, we will tell the patient’s family: 1, the patient currently has a cerebral hemorrhage (or cerebral infarction or craniocerebral trauma), this disease is not like a cold or pneumonia, you should know that the brain and heart are the most important in our body, any one of them will be life-threatening. 2, got a brain hemorrhage (or cerebral infarction or cranial trauma), then please understand that your family will be aggravated in the next few days, just like your arm to the injury swollen, it will be more and more swollen in the next few days, to reach the peak, and then slowly swelling, no matter how you use drugs, it has to go through such a process, which is often encountered in our daily life, but also common sense, the cranial brain also The same, the onset of the disease will also slowly enter the peak of the disease, about a week or so before slowly recede, the disease can slowly stabilize. 3, we use drug treatment or surgery, only to bring down the peak of its peak, but it will still aggravate, or will go through the peak period, if the patient can survive this peak period, then may survive, if the disease is so severe that it can not survive, then it will die. (B) 1, proactive to communicate, do not often passively waiting for family members to ask; family members are not present also take the initiative to call to contact (to ensure open communication with family members is very important); in most cases, let the main family members than let the patient understand the condition is more important. 2, the main family members and secondary family members: in the face of critical illness and personal financial situation, different family members will have different ideas; at the same time, different family members have different personalities; therefore, to seize the “management” of the main family members to talk about the condition. Especially to deal with some of the more difficult to deal with more family members, find a major family members out, let him to solve the interference brought about by the different views of the family members, this is called “to barbarians. 3, the face of a difficult situation, more senior physicians, even consulting physicians and senior experts to come together to talk, often with better results. 4, the face of the hospital stereotypes or hostility to the family, take the initiative to send a business card, so that he has something to contact you, to obtain each other’s goodwill and respect, often to win each other’s further trust. 5, it is worth noting that communication with the family, can not speak too much, can not talk nonsense, different doctors to try to maintain a consistent caliber, so it is best to communicate well by the same person, because more words will be lost. 6, not all the requirements of the family to meet the. Medical work has its principles and bottom line. (C) 1, for the patient’s family’s cultural level and professional characteristics, understanding, more graphic metaphors, in-depth explanation of the causes of disease, severity, etc.. 2.First of all, we should understand the patient’s family’s mentality, such as the degree of trust in the hospital and doctors. 3, make full use of the patient’s family’s existing medical knowledge to deepen the understanding of the disease, factual introduction of the disease, frank and honest, honest attitude, do not blindly fool, intimidate the patient. 4.Take the initiative to let the patient’s family to find their trustworthy medical knowledge to consult, for circumstantial evidence and support, trust. 5.Before talking, make clear the status of each member of the patient’s family in the family, the proximity to the patient, etc., and find out the person at the helm, who is your main talker. 6, the patient’s condition for detailed, meticulous analysis, to find out the patient’s morbidity characteristics, organized, hierarchical, well-founded talk, showing your in-depth understanding of the patient’s condition, and strive for the family’s maximum trust. 7.Introduce to the family as much as possible the relevant knowledge of the disease, such as new advances, new technologies, new treatments, etc. Demonstrate your level of knowledge, which can increase the patient’s family’s compliance with the doctor. 8.Fully respect and understand the choices of patients and families, and do your best to provide assistance. In short, people have their own minds and their own judgment. (D) to talk about the experience: 1, and the patient’s conversation, first of all, we have to clarify the purpose of this conversation, especially the diagnosis and treatment operations, we combined with the condition and other clear their intentions; if I think the operation I am very experienced, the condition allows, the estimated risk is not large, my intention is to hope that the patient’s family agreed to do; then I talk more about the benefits of the operation, and talk about adverse reactions in a calm tone, and tell them. Some of these serious adverse reactions may only have a 1 in 10,000 or 1 in 1,000 chance of occurring, but they are also part of the conversation; in terms of treatment, this operation is one of the means of active treatment and therapy, and many families of patients entering the ICU think they want the treatment to be active; if I feel that this operation is too risky or inappropriate for the patient at this time, then we Many patients do not have much knowledge about the operation and the decision, so the doctor’s intention and conversation guide their decision; however, it is also the most critical conversation, and finally we throw the decision to the patient’s family, so that they understand that the real decision is their own; 2, for different patients’ families, take different ways of conversation; for patients from rural areas with a low level of education The introduction of the condition of the patient to simple and easy to understand, generally such patients are more respectful of doctors, the conversation is easier; for some people who think they have a high level of knowledge and arrogance, the conversation needs to be more logical and comprehensive, so that he does not have too many loopholes to find; 3, think about the patient’s family’s thoughts and purposes at the time, looking for the main conflict between doctors and patients; last month encountered a patient with craniocerebral trauma, because the condition changes too quickly there medical disputes, through the conversation with the patient’s family agreed to automatic discharge, before the automatic discharge, the doctor on duty talk: this patient’s condition is too serious, the road will occur at any time cardiac arrest, the possibility of death is very high, require the family to sign; family immediately flip-flopped (some local customs of patients dying before the home to do something fancy, dead will not be allowed to enter the village), said they can not guarantee that the home alive, then they will not go back I looked at the patient, the condition of the mechanical ventilation ventilator is not high, the amount of antihypertensive drugs is not very large, the general estimate of the patient on the road for an hour is not a big problem, say the patient and the patient’s family does not go to our pressure; I found one or two of their family main, I said to them, if there are no accidents, in general the patient will have a heartbeat to the home, if placed again I told them that if there was no accident, the patient would normally be sent home with a heartbeat, and if the patient was left here for a long time, it would be difficult to say, and that sending it early would certainly be more certain than sending it late, and that the doctor was not pushing any responsibility by asking you to sign, it was just a formality and routine; the family thought about it, and agreed to the automatic discharge, and signed; the patient was sent away immediately, and we were glad to avoid a dispute; 4. 5, communication with the patient’s family should be active and timely; ICU patient’s condition is heavy, changing, the cost of treatment, and is closed different from ordinary wards; daily communication with the patient’s family at least once, and to ensure that the way of communication (e) 1, some patients ask how much the success rate of surgery: it is not easy to say, such as 99%, but if this 1% happens to you is 100%. 2.Some patients ask if there is any risk of surgery or treatment: it is like walking from your home to the hospital, some people are safe and sound, and some people may have car accidents. 3, some ask whether the surgery can be cured: just like broken glass, sticky how firmly, there are cracks. 4.For those who question the effect of surgery: like you go to Beijing, you can get there on foot, but it takes 1 year, surgery is like taking a plane, you can get there in a few hours, although the result is the same. 5. For critically old patients: it is like a candle that has burned to the end, and then a gale blows, the result is predictable. (F) 1, understand the mood of the patient’s family, express sympathy, serious attitude, temporarily put aside writing records dedicated to the family to talk. 2, talk to the most critical people in the family, such as husband, wife, son, child patients only to the guardian. I think it is best not to talk to those who come to care about relatives, friends, neighbors and other people who do not care about the patient and love to come up with ideas. Especially some “culture” think they are well versed in medicine, pay special attention to say less. 3, to the critically ill should be directly said: soon, may die at any time, is actively rescued. When the diagnosis is unclear should be directly said: the diagnosis is not clear, while resuscitation as soon as possible to check. For diseases that cannot be cured, the family should be told directly. 4. When reminding the family of the fee, it is better for the doctor to just say that the fee is owed, please pay it. The nurse tells the specific cost is better. 5.When the patient’s family questions your work, promptly report to your superiors; if you do the right thing, tell your superiors directly, and give appropriate explanations. If you do not do the right thing, should also be clear to the superiors, to avoid the superiors passive. (7) 1, whether you are sure or not, account for the condition to be decisive, less ambiguous words, not the slightest hesitation, in order to obtain the trust of the sick family. 2, as far as possible to use examples to illustrate the problem, more imaginative and objective. 3, patience, enough, twelve points as well as extraordinary patience! 4.Master the principle of asking the family to make the worst possible plan. 5, as far as possible to imagine the patient and family members as their own relatives, the old my old as well as others. 6.How much more abominable the unruly people also please forgive her ignorance, do not lower yourself to the status, and, pity them. 7, regardless of whether they can understand, your appropriate use of jargon, you can improve their awe and trust in you. 8, the most important one, do not forget that we are doctors, the environment is bad, the situation is embarrassing, saving lives and helping people is our responsibility, explain the condition of writing medical records are secondary, the real concern is the patient’s condition. Believe that your attitude is the best way to appease the family. Even if wronged, we can afford to have a conscience! Finally, provide a few commonly used metaphors 1, the condition and treatment is in a race, the condition runs fast, you will die. 2, drugs are not a panacea hospitals are not safes, otherwise, so many national leaders would not die. 3, the liver is the factory that makes protein, the factory does not produce, where does the protein come from? 4, emphysema, is one of the most blown up balloon, blowing to the end, there is no elasticity, can not shrink back! 5, heart valve disease, like the door is broken! 6, add one, to protect peers: if the patient and you complain about the following hospital treatment for a long time are not good, you can say so, eat a bun is not full, eat two on the full, that can not thus think that the first bun in vain. (H) When talking about clinical decision and prognosis, as a neurologist, I used to link the patient’s condition with the fate of famous people to strengthen the effect, easy to understand and support. 1. Patients with Parkinson’s disease or advanced Parkinson’s syndrome, mostly associated with severe infections (such as fallout or aspiration pneumonia) and dysfunction, I will cite the case and ultimate fate of comrade ***. Great men are inevitably sacrificed in the end, not to mention the ordinary people. And dysfunction will cite the case of boxer Ali. 2, motor neuron disease from the initial diagnosis on the example of *** comrades case (according to internal communication within the medical community), after all, it is considered incurable, the final outcome is very poor. 3, cerebral infarction ultra-early thrombolytic therapy is responsible for the patient, although facing a great risk of bleeding. What to do? Just cite the case of former Japanese Prime Minister Keizo Obuchi, that is, he died of bleeding after thrombolysis, so that the family can weigh again and then sign. 4, cerebral artery amyloidosis patients for anticoagulant therapy, but face the risk of bleeding, just cite the former Israeli Prime Minister Sharon, after all, became a vegetative state, the family will understand. 5, the performance of depression and the dangers, just cite the encounter of Cui Yongyuan, the patient also compared their performance and causative factors, more understanding. 6, Alzheimer’s disease, cite the case of former U.S. President Reagan, the results of its short-term death so that more patients to strengthen compliance and reduce friction between doctors and patients. These are just a few examples, other doctors actually use this method in their work, so we can communicate and improve together.