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基层医疗中的“神圣相遇”:它们对家庭医生意味着什么?

[]"Sacred encounters" in primary care: What do they mean for family physicians?].

作者信息

Baza Bueno Mikel, Serrano Ferrández Elena, Dosio Revenga Ana, Diouri Nabil, Fernández de Sanmamed Santos M José, Calderón Gómez Carlos

机构信息

Consultorio de Dima, OSI Barrualde-Galdakao, Dima, Osakidetza, España.

EAP Encants, Institut Català de la Salut, Barcelona, España.

出版信息

Aten Primaria. 2020 May;52(5):335-344. doi: 10.1016/j.aprim.2018.12.006. Epub 2019 Apr 25.

DOI:10.1016/j.aprim.2018.12.006
PMID:31029459
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7231866/
Abstract

OBJECTIVE

To determine the perceptions and attitudes of the general practitioners (GP) towards consultations with great emotional component, initially called "sacred encounters", and to identify areas of improvement.

DESIGN

A qualitative methodology based on a socio-subjective approach and focused on health services research. Descriptive-interpretative study.

LOCATION

Health Centres of Alava and Biscay.

PARTICIPANTS

Selection of 23 GP from 23 urban and rural Health Centres.

METHOD

Intentional sampling aimed at looking for discursive diversity. Data generated in 2016 by means of 3 discussion groups and 3 individual interviews recorded and transcribed after informed consent. Presentation to the ethics committee of the Basque Country. Thematic analysis with the aid of conceptual maps and MaxQDA program. Triangulation of the results between researchers and verification by the participants.

RESULTS AND DISCUSSION

The findings were clustered into overlapping thematic areas related to the meaning of these encounters, attitudes of GP, health context, and patients. The importance of the emotions in primary care encounters and their invisibility is underlined, but the adequacy of the term "sacred" is questioned. This expression is built into the GP-patient relationship, if GP favours it and the patient also allows it, discussing the main circumstances that intervene in an essential dimension of integral care.

CONCLUSIONS

The attention to the emotional dimension in the encounters has deficiencies that need to be corrected. In addition to its recognition and evaluation, it would be necessary to modify the organisational, training and professional factors that determine the involvement of the GPs in their good health care.

摘要

目的

确定全科医生(GP)对伴有强烈情感因素的会诊(最初称为“神圣会诊”)的看法和态度,并找出可改进的方面。

设计

基于社会主观方法并聚焦于卫生服务研究的定性方法。描述性解释性研究。

地点

阿拉瓦省和比斯开省的健康中心。

参与者

从23个城乡健康中心挑选23名全科医生。

方法

旨在寻求话语多样性的立意抽样。2016年通过3个讨论小组和3次个人访谈收集数据,在获得知情同意后进行记录和转录。提交给巴斯克自治区伦理委员会。借助概念图和MaxQDA程序进行主题分析。研究人员之间对结果进行三角验证,并由参与者进行核实。

结果与讨论

研究结果分为与这些会诊的意义、全科医生的态度、健康背景和患者相关的重叠主题领域。强调了情感在初级保健会诊中的重要性及其无形性,但对“神圣”一词的恰当性提出了质疑。如果全科医生支持且患者也认可,这种表达就融入了医患关系,讨论了在整体护理的一个基本维度中起干预作用的主要情况。

结论

会诊中对情感维度的关注存在需要纠正的不足。除了对其进行认识和评估外,还需要改变决定全科医生参与良好医疗护理的组织、培训和专业因素。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/95b1/7231866/05aa3edf5241/gr1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/95b1/7231866/05aa3edf5241/gr1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/95b1/7231866/05aa3edf5241/gr1.jpg

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Examining the relationship between burnout and empathy in healthcare professionals: A systematic review.探究医疗保健专业人员职业倦怠与同理心之间的关系:一项系统综述。
Burn Res. 2017 Sep;6:18-29. doi: 10.1016/j.burn.2017.06.003.
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What does it take to be a good GP?成为一名优秀的全科医生需要具备什么?
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Compassion fatigue: A meta-narrative review of the healthcare literature.同情疲劳:对医疗保健文献的元叙事综述
Int J Nurs Stud. 2017 Apr;69:9-24. doi: 10.1016/j.ijnurstu.2017.01.003. Epub 2017 Jan 12.
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Definition of compassion in healthcare: a systematic literature review.医疗保健中同情心的定义:一项系统的文献综述。
Int J Palliat Nurs. 2016 Dec;22(12):599-606. doi: 10.12968/ijpn.2016.22.12.599.
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Managing barriers to empathy in the clinical encounter: a qualitative interview study with GPs.应对临床诊疗中同理心的障碍:一项针对全科医生的定性访谈研究
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