Department of Surgery, Stanford University, Stanford, California, USA.
Department of Surgery, University of Wisconsin, Madison, Wisconsin, USA.
J Pain Symptom Manage. 2018 Nov;56(5):719-726.e1. doi: 10.1016/j.jpainsymman.2018.08.008. Epub 2018 Aug 23.
Medical students have limited instruction about how to manage the interpersonal relationships required to care for patients in pain.
The objective of this study was to characterize the experiences of medical students as they encounter pain, suffering, and the emotional experiences of doctoring.
We used qualitative analysis to explore the content of 341 essays written by third-year medical students who described their experiences with surgical patients in pain. We used an inductive process to develop a coding taxonomy and then characterized the content of these essays related to empathy, patient-clinician interaction, and descriptions of clinical norms.
Students found it difficult to reconcile patient suffering with the therapeutic objective of treatment. They feared an empathic response to pain might compromise the fortitude and efficiency required to be a doctor and they pursued strategies to distance themselves from these feelings. Students described tension around prescription of pain medications and worried about the side effects of medications used to treat pain. Students felt disillusioned when operations caused suffering without therapeutic benefit or were associated with unexpected complications. Although patients had expressed a desire for intervention, students worried that the burdens of treatment and long-term consequences were beyond patient imagination.
These observations about patient-doctor relationships suggest that there is a larger problem among clinicians relating to patient distress and personal processing of the emotional nature of patient care. Efforts to address this problem will require explicit instruction in skills to develop a personal strategy for managing the emotionally challenging aspects of clinical work.
医学生在如何处理照顾疼痛患者所需的人际关系方面所受的指导有限。
本研究的目的是描述医学生在遇到疼痛、痛苦和医生情感体验时的经历。
我们使用定性分析方法，探讨了 341 名三年级医学生的论文内容，这些学生描述了他们在疼痛外科患者方面的经历。我们使用归纳过程来开发编码分类法，然后描述这些论文中与同理心、医患互动和临床规范描述相关的内容。
学生发现很难调和患者的痛苦与治疗的治疗目标。他们担心对疼痛的共情反应可能会损害成为医生所需的坚韧和效率，因此他们采取了一些策略来远离这些感受。学生描述了在开具止痛药和担心用于治疗疼痛的药物的副作用方面的紧张局势。当手术造成痛苦而没有治疗效果或与意外并发症有关时，学生感到失望。尽管患者表示希望进行干预，但学生担心治疗负担和长期后果超出了患者的想象。
这些关于医患关系的观察表明，临床医生在处理患者痛苦和个人处理患者护理的情感性质方面存在更大的问题。解决这个问题需要在发展个人策略以处理临床工作中情感挑战方面的技能方面进行明确的指导。
