Cocksedge Simon, May Carl
Division of Primary Care, Rusholme Health Centre, University of Manchester, Manchester, UK.
Commun Med. 2009;6(2):109-16.
Definitions of professional roles and appropriate care are increasingly inclusive in primary care but many subjective factors influence the care that is actually delivered. One such factor is the boundary a clinician puts on his or her self in interactions with patients. This qualitative study investigated doctors' perceptions of personal boundaries to primary care consultations by exploring two examples: touch and spiritual care. Respondents reported clear but contrasting boundaries: some neither used touch nor explored spiritual care; others regularly undertook both. Some interviewees deliberately varied these boundaries, irrespective of their own views, if they felt this was in their patients' best interests. Such subjective limits may affect the quality of primary health care offered to some patients and contrast with theoretical definitions which assume both all-encompassing primary care, and doctors' conscious awareness of themselves and their personal boundaries. The existence of these boundaries, and some doctors' lack of awareness of them, has educational implications if patient-centred professional role definitions are to be realistically delivered in everyday primary care.
在初级保健中，专业角色的定义和适当护理的范畴越来越具有包容性，但许多主观因素会影响实际提供的护理。其中一个因素是临床医生在与患者互动时对自身设定的界限。这项定性研究通过探讨两个例子——触摸和精神关怀，调查了医生对初级保健会诊中个人界限的看法。受访者报告了明确但相互矛盾的界限：一些医生既不使用触摸，也不探讨精神关怀；另一些医生则经常同时进行这两项。一些受访者会根据他们认为是否符合患者的最大利益，而有意改变这些界限，无论他们自己的观点如何。这种主观限制可能会影响为一些患者提供的初级卫生保健质量，这与理论定义形成对比，理论定义假定初级保健涵盖一切，且医生对自己及个人界限有清醒的认识。如果要在日常初级保健中切实实现以患者为中心的专业角色定义，这些界限的存在以及一些医生对它们的缺乏认识就具有教育意义。
