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在临床判断中培养谦逊与诊断开放性。

Cultivating Humility and Diagnostic Openness in Clinical Judgment.

作者信息

Stone John R

机构信息

A professor at Creighton University in Omaha, Nebraska, and the co-founder and co-director of the Center for Promoting Health and Health Equality, a community-academic partnership.

出版信息

AMA J Ethics. 2017 Oct 1;19(10):970-977. doi: 10.1001/journalofethics.2017.19.10.ecas1-1710.

Abstract

In this case, a physician rejects a patient's concerns that tainted water is harming the patient and her community. Stereotypes and biases regarding socioeconomic class and race/ethnicity, constraining diagnostic frameworks, and fixed first impressions could skew the physician's judgment. This paper narratively illustrates how cultivating humility could help the physician truly hear the patient's suggestions. The discussion builds on the multifaceted concept of cultural humility as a lifelong journey that addresses not only stereotypes and biases but also power inequalities and community inequities. Insurgent multiculturalism is a complementary concept. Through epistemic humility-which includes both intellectual and emotional components-and admitting uncertainty, physicians can enhance patients' and families' epistemic authority and health agency.

摘要

在这种情况下,一名医生驳回了患者关于受污染的水正在伤害患者及其社区的担忧。关于社会经济阶层和种族/民族的刻板印象和偏见、受限的诊断框架以及固定的第一印象可能会扭曲医生的判断。本文通过叙事说明了培养谦逊如何能帮助医生真正倾听患者的建议。该讨论基于文化谦逊这一多方面的概念,它是一段终身的旅程,不仅要解决刻板印象和偏见,还要解决权力不平等和社区不平等问题。反叛多元文化主义是一个互补的概念。通过认知谦逊(包括智力和情感成分)并承认不确定性,医生可以增强患者及其家庭的认知权威和健康自主权。

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