Department of Learning Health Sciences, University of Michigan, 1111 E. Catherine St., Suite 209, Ann Arbor, MI, 48109, USA.
Department of Sociology, Drexel University, USA.
Soc Sci Med. 2020 Apr;251:112904. doi: 10.1016/j.socscimed.2020.112904. Epub 2020 Feb 29.
The ongoing social transformation of the American healthcare system brings both structural and interpersonal changes to the delivery of healthcare. Some of these changes have been motivated by patients, who increasingly desire emotionally warm interactions with physicians. This is a departure from the detached concern that characterized physician-patient interactions in the mid-twentieth century. Concurrently, medical training continually adapts to trends in medical practice so that future physicians are prepared to enter practice. In this paper, we examine the rise of clinical skills training courses and assessments in medical school, highlighting the changing role of emotion in training about communication in the doctor - patient relationship. Drawing on an interpretive analysis of interviews with and ethnographic observations of medical students and residents from two United States medical schools, we elaborate the concept of clinical empathy to describe the character of emotional engagement in the contemporary clinical encounter. In the analysis we show how standards of emotional conduct are taught in medical school, how clinical empathy is operationalized in the patient encounter, and how clinical empathy may be used instrumentally to smooth the physician's work. Finally, we position the consistent performance of clinical empathy as a form of emotional labor, expanding the reach of studies of emotional labor in professions.
美国医疗体系的持续社会变革给医疗服务的提供带来了结构和人际方面的变化。这些变化的部分动力来自于患者，他们越来越渴望与医生进行情感温暖的互动。这与 20 世纪中期医患互动中表现出的冷漠关注截然不同。与此同时，医学培训不断适应医疗实践的趋势，以便未来的医生能够准备好进入实践。在本文中，我们考察了医学院临床技能培训课程和评估的兴起，强调了情感在医患关系沟通培训中的作用变化。我们通过对来自美国两所医学院的医学生和住院医师的访谈和民族志观察进行解释性分析，详细阐述了临床同理心的概念，以描述当代临床接触中情感参与的特征。在分析中，我们展示了医学院如何教授情感行为标准，临床同理心如何在医患互动中实施，以及临床同理心如何被工具化地用于简化医生的工作。最后，我们将临床同理心的一贯表现定位为一种情感劳动形式，扩展了职业情感劳动研究的范围。
