Kempainen Robert R, Bartels Dianne M, Veach Patricia McCarthy
Department of Internal Medicine, University of Minnesota, Minneapolis, Minnesota, USA.
Acad Med. 2007 Feb;82(2):207-13. doi: 10.1097/ACM.0b013e31802d9513.
Clinical empathy is integral to forging therapeutic patient-physician relationships. Illness narratives are a potentially rich source of insight into what it feels like to be a patient or patient's family member. The authors performed a qualitative analysis of illness narratives to develop an explicit framework for understanding what it feels like to be a health care recipient and to explore how providers' behaviors influence that experience.
The authors used consensual qualitative research, a methodology based on principles of grounded theory, to analyze 24 illness narratives found in that number of essays from the Annals of Internal Medicine's "On Being a Patient" series published between January 1, 1999, and December 31, 2003. Trustworthiness was demonstrated via essayists' feedback on the analysis.
Patients and their families faced formidable physical and psychosocial challenges. Providers' behaviors influenced the illness experience in profoundly positive and negative ways, independent of the technical quality of care. Consistent with previous studies of patient-physician relationships, providers' advocacy for patients and expressions of compassion were prominent determinants of patients' satisfaction. The experience of simultaneously being a health care provider and consumer was an additional source of stress for essayists, but it positively influenced their subsequent practice.
Illness narratives vividly illustrate fundamental aspects of the illness experience and are a potentially rich resource for cultivating empathy. The authors' analysis provides a framework for enhancing trainees' and practitioners' ability to understand and meet patients' and families' psychosocial needs. The experiences of health care recipients with medical backgrounds are uniquely challenging and beneficial.
临床同理心是建立治疗性医患关系的重要组成部分。疾病叙事是深入了解患者或患者家属感受的潜在丰富来源。作者对疾病叙事进行了定性分析，以建立一个明确的框架，用于理解作为医疗服务接受者的感受，并探讨医疗服务提供者的行为如何影响这种体验。
作者采用了共识定性研究方法，这是一种基于扎根理论原则的方法，对1999年1月1日至2003年12月31日期间发表在《内科学年鉴》“作为患者”系列中的多篇文章中找到的24篇疾病叙事进行分析。通过作者对分析的反馈来证明研究的可信度。
患者及其家属面临着巨大的身体和心理社会挑战。医疗服务提供者的行为以积极和消极的方式深刻影响着疾病体验，这与护理的技术质量无关。与之前关于医患关系的研究一致，医疗服务提供者对患者的支持和同情表达是患者满意度的重要决定因素。同时作为医疗服务提供者和消费者的经历给作者带来了额外的压力，但对他们随后的实践产生了积极影响。
疾病叙事生动地说明了疾病体验的基本方面，是培养同理心的潜在丰富资源。作者的分析提供了一个框架，以提高实习生和从业者理解和满足患者及其家属心理社会需求的能力。有医学背景的医疗服务接受者的经历具有独特的挑战性和益处。
