Malterud Kirsti, Hollnagel Hanne
Department of General Practice, University of Copenhagen, Panum Institute, Denmark.
Ann Fam Med. 2005 Jul-Aug;3(4):348-52. doi: 10.1370/afm.314.
We wanted to explore those clinical events when doctors had exposed their vulnerability toward patients in a potentially beneficial way.
We undertook a qualitative study based on memory work, a structured approach to transform memories into written texts. Study participants were 9 members of a research group who had known each other a couple of years. They were asked in advance to recall a clinical event during which vulnerability was perceived and exposed in a way appreciated positively by the patient. During a group meeting, participants wrote their individual memory stories recalling these events, and the subsequent group discussion was audiotaped, transcribed, and analyzed using a phenomenological approach, applying specific linguistic cues to reveal points of special interest. The main outcome measure was the vulnerability expressed by practitioners.
Vulnerability had been experienced and exposed by the participants on several occasions during which the patients had confirmed its potentially beneficial effect. All reported events could be interpreted as different ways of personal disclosure toward the patient. We identified two kinds of disclosure: spontaneously appearing emotions and considered sharing of experiences.
A spontaneous exposure of emotions from the doctor may help the patient, and sharing personal experiences may lead to constructive interaction. We need to know more about when and how personal disclosure and other aspects of vulnerability exposed by the doctor are experienced as beneficial by the patient.
我们想要探究医生以一种潜在有益的方式向患者暴露自身脆弱性的那些临床事件。
我们开展了一项基于记忆工作的定性研究,这是一种将记忆转化为书面文本的结构化方法。研究参与者是一个研究小组的9名成员,他们彼此相识已有数年。事先要求他们回忆一个临床事件,在此事件中,他们的脆弱性被患者以一种积极认可的方式察觉到并暴露出来。在一次小组会议上,参与者写下他们回忆这些事件的个人记忆故事,随后的小组讨论进行了录音、转录,并采用现象学方法进行分析,运用特定的语言线索来揭示特别感兴趣的点。主要的结果衡量指标是从业者所表达的脆弱性。
参与者在若干场合经历并暴露了脆弱性,在此期间患者证实了其潜在的有益效果。所有报告的事件都可被解释为向患者进行个人披露的不同方式。我们识别出两种披露方式:自发出现的情绪和经过思考的经验分享。
医生自发地暴露情绪可能对患者有帮助,分享个人经历可能会带来建设性的互动。我们需要更多地了解医生进行个人披露以及暴露脆弱性的其他方面在何时以及如何被患者视为有益的。