Ventres William, Tunzi Marc
Ben Saltzman, MD, Distinguished Chair in Rural Family Medicine, Department of Family and Preventive Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas USA.
Associate Director of the Family Medicine Residency Program, Natividad Medical Center; Family Medicine Specialist, Salinas, California USA.
J Clin Ethics. 2020 Summer;31(2):184-190.
The practice of generalist medicine differs from the practice of other clinical disciplines. We postulate that the application of ethics in generalist practice similarly differs from its application in other healthcare settings. In contrast to the problem-focused practice of ethics in other medical specialties, the practice of ethics in generalist medicine blends habits of mind with behaviors applied routinely over time-an ethical way of being. Using a graphic summary and tabular matrix, we present five "T" habits of mind (time, talk, tact, touch, and trust), associate them with applicable practice characteristics, and link them to observable clinician behaviors to demonstrate how the application of ethics in generalist practice is a day-to-day endeavor and not simply a means to resolve episodic conflicts. We textually review key aspects of the matrix and present two case studies that illustrate how such habits of mind and practice behaviors inform the ethical way of being we espouse. We invite generalist practitioners to incorporate the five "T" habits and associated behaviors into their daily care of patients, and we encourage clinical ethicists and other clinical faculty members to consider using them as a model for ethics education with medical students and resident physicians.
全科医学的实践与其他临床学科的实践有所不同。我们推测，伦理学在全科医学实践中的应用同样不同于其在其他医疗环境中的应用。与其他医学专科以问题为导向的伦理学实践不同，全科医学中的伦理学实践将思维习惯与长期常规应用的行为相结合——一种伦理存在方式。通过图形总结和表格矩阵，我们呈现了五种“T”思维习惯（时间、交谈、机智、接触和信任），将它们与适用的实践特征相关联，并将它们与可观察到的临床医生行为联系起来，以展示伦理学在全科医学实践中的应用是一项日常工作，而不仅仅是解决偶发冲突的手段。我们对矩阵的关键方面进行了文本回顾，并给出了两个案例研究，以说明这种思维习惯和实践行为如何为我们所倡导的伦理存在方式提供信息。我们邀请全科医生将这五种“T”习惯及相关行为纳入他们对患者的日常护理中，并且我们鼓励临床伦理学家和其他临床教员考虑将它们用作医学生和住院医师伦理学教育的模式。
