家庭医生的体检经历。
Family Physicians' Experiences of Physical Examination.
机构信息
Department of Family Medicine, Cumming School of Medicine, University of Calgary, Alberta, Canada
Department of Family Medicine, Faculty of Medicine & Dentistry, University of Alberta, Alberta, Canada.
出版信息
Ann Fam Med. 2019 Jul;17(4):304-310. doi: 10.1370/afm.2420.
PURPOSE
The increased availability of reliable diagnostic technologies has stimulated debate about the utility of physical examination in contemporary clinical practice. To reappraise its utility, we explored family physicians' experiences.
METHODS
Guided by principles of phenomenology, we conducted in-depth qualitative interviews exploring 16 family physicians' experiences of conducting physical examination: 7 (44%) men and 9 women (56%) whose clinical experience varied widely, from 11 (69%) urban and 5 (31%) rural locations. We recorded the interviews, transcribed them verbatim, and identified initial themes using template analysis. We worked reflexively, critiquing our own and other team members' interpretations, in order to synthesize and write a final interpretation.
RESULTS
Participants described 2 facets of physical examination: making diagnoses and estimating prognoses rationally and objectively; and responding subjectively and intuitively to patients' illnesses, which formed relationships between doctor and patient that enacted medical care in the moment. Physical examination allowed physicians to use their own bodies to experience patients' illnesses. Performing physical examination was integral to being a family doctor because it promoted rapport and developed trust.
CONCLUSIONS
Physical examination is part of the identity of family physicians. It not only contributes diagnostic information but is a therapeutic intervention in and of itself. Physical examination contributes to relationship-centered care in family practice.
目的
可靠诊断技术的可用性增加引发了关于体格检查在当代临床实践中效用的争论。为了重新评估其效用，我们探讨了家庭医生的经验。
方法
受现象学原则的指导，我们进行了深入的定性访谈，探讨了 16 名家庭医生进行体格检查的经验：7 名（44%）男性和 9 名（56%）女性，他们的临床经验差异很大，来自 11 名（69%）城市和 5 名（31%）农村地区的医生。我们记录了访谈，逐字转录，并使用模板分析确定了初步主题。我们进行了反思性工作，对自己和其他团队成员的解释进行了批判，以综合和撰写最终解释。
结果
参与者描述了体格检查的两个方面：理性和客观地做出诊断和估计预后；以及主观和直观地对患者的疾病做出反应，这形成了医生和患者之间的关系，从而在当下实施了医疗保健。体格检查使医生能够用自己的身体来体验患者的疾病。进行体格检查是家庭医生身份的一部分，因为它促进了融洽关系并建立了信任。
结论
体格检查是家庭医生身份的一部分。它不仅提供诊断信息，而且本身就是一种治疗干预。体格检查有助于家庭实践中以关系为中心的护理。
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