Department of Communication and Culture, University of Calgary, 2500 University Dr. NW, Calgary, Alberta, Canada.
Qual Health Res. 2010 Oct;20(10):1343-52. doi: 10.1177/1049732310372376. Epub 2010 Jun 7.
Current visions of family medicine and models of chronic illness management integrate evidence-based medicine with collaborative, patient-centered care, despite critiques that these constructs conflict with each other. With this potential conflict in mind, we applied a critical discursive psychology methodology to present discursive patterns articulated by 13 family physicians in Ontario, Canada, regarding care of patients living with multiple chronic illnesses. Physicians constructed competing versions of the terms "effective chronic illness management" and "patient involvement." One construction integrated individual responsibility for health with primacy of "evidence," resulting in a conceptualization consistent with paternalistic care. The second constructed effective care as involving active partnership of physician and patient, implying a need to foster the ability of both practitioners and patients to respond to complex challenges as they arose. The former pattern is inconsistent with visions of family medicine and chronic illness management, whereas the latter embodies it.
当前的家庭医学愿景和慢性病管理模式将循证医学与协作的、以患者为中心的护理相结合，尽管有人批评这些概念相互冲突。考虑到这种潜在的冲突，我们应用了批判话语心理学方法，展示了 13 名加拿大安大略省家庭医生在治疗患有多种慢性病患者方面表达的话语模式。医生们构建了“有效慢性病管理”和“患者参与”这两个术语的竞争版本。一种构建将健康的个人责任与“证据”的首要地位相结合，从而形成了一种符合家长式医疗的概念化。第二种构建将有效的护理理解为医生和患者的积极合作，这意味着需要培养医生和患者双方的能力，以便在出现复杂挑战时能够做出应对。前者模式与家庭医学和慢性病管理的愿景不一致，而后者则体现了这一愿景。
