Shapiro Johanna, Rakhra Pavandeep, Wong Adrianne
a Department of Family Medicine , University of California Irvine School of Medicine , Orange , CA , USA.
b College of Osteopathic Medicine, Kansas City University of Medicine and Biosciences, College of Osteopathic Medicine , Kansas City , MO , USA.
Med Teach. 2016 Oct;38(10):1033-1040. doi: 10.3109/0142159X.2016.1147535. Epub 2016 Mar 24.
Physicians have long had patients whom they have labeled "difficult", but little is known about how medical students perceive difficult encounters with patients.
In this study, we analyzed 134 third year medical students' reflective essays written over an 18-month period about difficult student-patient encounters. We used a qualitative computerized software program, Atlas.ti to analyze students' observations and reflections.
Main findings include that students described patients who were angry and upset; noncompliant with treatment plans; discussed "nonmedical" problems; fearful, worried, withdrawn, or "disinterested" in their health. Students often described themselves as anxious, uncertain, confused, and frustrated. Nevertheless, they saw themselves behaving in empathic and patient-centered ways while also taking refuge in "standard" behaviors not necessarily appropriate to the circumstances. Students rarely mentioned receiving guidance from attendings regarding how to manage these challenging interactions.
These third-year medical students recognized the importance of behaving empathically in difficult situations and often did so. However, they often felt overwhelmed and frustrated, resorting to more reductive behaviors that did not match the needs of the patient. Students need more guidance from attending physicians in order to approach difficult interactions with specific problem-solving skills while maintaining an empathic, patient-centered context.
长期以来，医生们都有他们认定为“难相处”的患者，但对于医学生如何看待与患者的艰难接触却知之甚少。
在本研究中，我们分析了134名医科三年级学生在18个月期间撰写的关于与患者艰难接触的反思性文章。我们使用了定性计算机软件程序Atlas.ti来分析学生的观察和反思。
主要发现包括，学生们描述了愤怒和心烦意乱的患者；不遵守治疗计划的患者；讨论“非医疗”问题的患者；害怕、担忧、孤僻或对自身健康“不感兴趣”的患者。学生们经常将自己描述为焦虑、不确定、困惑和沮丧。然而，他们认为自己的行为富有同理心且以患者为中心，同时也依赖于不一定适合具体情况的“标准”行为。学生们很少提到从带教老师那里得到关于如何处理这些具有挑战性互动的指导。
这些医科三年级学生认识到在困难情况下表现出同理心的重要性，并且经常这样做。然而，他们常常感到不堪重负和沮丧，诉诸于更简单的行为，而这些行为并不符合患者的需求。学生们需要带教医生给予更多指导，以便在保持同理心和以患者为中心的背景下，运用特定的解决问题技能来处理困难的互动。
