Malterud Kirsti, Hollnagel Hanne
Research Unit and Department of General Practice, Centre of Health and Society, University of Copenhagen, Denmark.
Scand J Prim Health Care. 2007 Jun;25(2):69-74. doi: 10.1080/02813430701237721.
To explore potentials for avoiding humiliations in clinical encounters, especially those that are unintended and unrecognized by the doctor. Furthermore, to examine theoretical foundations of degrading behaviour and identify some concepts that can be used to understand such behaviour in the cultural context of medicine. Finally, these concepts are used to build a model for the clinician in order to prevent humiliation of the patient.
Empirical studies document experiences of humiliation among patients when they see their doctor. Philosophical and sociological analysis can be used to explain the dynamics of unintended degrading behaviour between human beings. Skjervheim, Vetlesen, and Bauman have identified the role of objectivism, distantiation, and indifference in the dynamics of evil acts, pointing to the rules of the cultural system, rather than accusing the individual of bad behaviour. Examining the professional role of the doctor, parallel traits embedded in the medical culture are demonstrated. According to Vetlesen, emotional awareness is necessary for moral perception, which again is necessary for moral performance.
A better balance between emotions and rationality is needed to avoid humiliations in the clinical encounter. The Awareness Model is presented as a strategy for clinical practice and education, emphasizing the role of the doctor's own emotions. Potentials and pitfalls are discussed.
探讨在临床诊疗过程中避免羞辱的可能性，尤其是那些医生无意且未意识到的羞辱。此外，审视羞辱行为的理论基础，并确定一些可用于在医学文化背景下理解此类行为的概念。最后，运用这些概念为临床医生构建一个模型，以防止患者受到羞辱。
实证研究记录了患者就医时的羞辱经历。哲学和社会学分析可用于解释人与人之间无意的羞辱行为的动态变化。斯基耶尔韦姆、韦特勒森和鲍曼已经确定了客观主义、疏离和冷漠在恶行动态变化中的作用，指出文化系统的规则，而非指责个人行为不端。审视医生的职业角色，可以发现医学文化中存在的类似特征。根据韦特勒森的观点，情感意识对于道德认知是必要的，而道德认知对于道德行为又是必要的。
为避免临床诊疗中的羞辱，需要在情感与理性之间取得更好的平衡。提出了意识模型作为临床实践和教育的一种策略，强调医生自身情感的作用。讨论了其潜力和陷阱。
