Hilden Hanna-Mari, Hautamäki Lotta, Korkeila Jyrki
Department of Psychiatry, University of Helsinki, Helsinki, Finland.
Faculty of Social Sciences, Tampere University, Tampere, Finland.
Nord J Psychiatry. 2021 Apr;75(3):194-200. doi: 10.1080/08039488.2020.1833983. Epub 2020 Oct 24.
Psychiatric patients' awareness of treatments options and their possibilities to influence their care has increased. For the clinicians, the management of evidence-based care, as well as organizational and resource aspects, set different goals for the clinical encounter. In this article we are focusing on the clinicians' experiences and ask: How do the clinicians view situations in which there is a conflict between patients' individual needs and goals and other aspects in decision-making?
We implemented a qualitative study of 13 thematic semi-structured interviews with clinicians working in psychiatry. We used discourse analysis to investigate how the clinician view the doctor-patient interaction.
We identified three discources which were termed the medical standpoint, the psychodynamic standpoint and the standpoint of the patient's experience.
In their talk, the clinicians use the three discources to make sense of the diverse expectations from both the patient and the mental health care system. The three discources also reflect different aspects in psychiatric treatment cultures, such as evidence-based medicine, the ideal of patient-centeredness, therapeutic interaction and organizational requirements.
精神科患者对治疗选择的认知以及他们影响自身治疗的可能性有所提高。对于临床医生而言，循证护理的管理以及组织和资源方面，为临床诊疗设定了不同的目标。在本文中，我们聚焦于临床医生的经历并提出问题：临床医生如何看待患者个体需求和目标与决策中的其他方面存在冲突的情况？
我们对13名精神科临床医生进行了主题半结构化访谈，开展了一项定性研究。我们运用话语分析来探究临床医生如何看待医患互动。
我们识别出三种话语，分别称为医学立场、心理动力学立场和患者体验立场。
在交谈中，临床医生运用这三种话语来理解来自患者和精神卫生保健系统的不同期望。这三种话语也反映了精神科治疗文化的不同方面，如循证医学、以患者为中心的理念、治疗互动和组织要求。
