Kalateh Sadati Ahmad, Bagheri Lankarani Kamran
Assistant Professor, Department of Social Sciences, Yazd University, Yazd, Iran.
Professor, Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran.
J Med Ethics Hist Med. 2017 Oct 18;10:9. eCollection 2017.
Doctor-patient interaction (DPI) includes different voices, of which the educator voice is of considerable importance. Physicians employ this voice to educate patients and their caregivers by providing them with information in order to change the patients' behavior and improve their health status. The subject has not yet been fully understood, and therefore the present study was conducted to explore the pattern of educator voice. For this purpose, conversation analysis (CA) of 33 recorded clinical consultations was performed in outpatient educational clinics in Shiraz, Iran between April 2014 and September 2014. In this qualitative study, all utterances, repetitions, lexical forms, chuckles and speech particles were considered and interpreted as social actions. Interpretations were based on inductive data-driven analysis with the aim to find recurring patterns of educator voice. The results showed educator voice to have two general features: descriptive and prescriptive. However, the pattern of educator voice comprised characteristics such as superficiality, marginalization of patients, one-dimensional approach, ignoring a healthy lifestyle, and robotic nature. The findings of this study clearly demonstrated a deficiency in the educator voice and inadequacy in patient-centered dialogue. In this setting, the educator voice was related to a distortion of DPI through the physicians' dominance, leading them to ignore their professional obligation to educate patients. Therefore, policies in this regard should take more account of enriching the educator voice through training medical students and faculty members in communication skills.
医患互动（DPI）包含不同的声音，其中教育者的声音相当重要。医生运用这种声音，通过向患者及其护理人员提供信息来对他们进行教育，以改变患者的行为并改善其健康状况。这个主题尚未得到充分理解，因此开展了本研究以探索教育者声音的模式。为此，2014年4月至2014年9月期间，在伊朗设拉子的门诊教育诊所对33次临床会诊录音进行了会话分析（CA）。在这项定性研究中，所有话语、重复内容、词汇形式、轻声笑和语气词都被视为并解释为社会行为。解释基于归纳性数据驱动分析，旨在找出教育者声音的反复出现模式。结果显示教育者声音有两个总体特征：描述性和规定性。然而，教育者声音的模式包括诸如表面化、患者边缘化、一维方法、忽视健康生活方式以及机械性等特征。本研究结果清楚地表明了教育者声音的不足以及以患者为中心对话的欠缺。在这种情况下，教育者声音与由于医生的主导导致的医患互动扭曲相关，使他们忽视了教育患者的职业义务。因此，这方面的政策应更多地考虑通过对医学生和教职员工进行沟通技能培训来丰富教育者声音。
