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医学职业体验:采用叙事促进者的定性研究。

Experiences of the medical profession: A qualitative study using narrative facilitators.

机构信息

Psychiatric Liaison Service, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland.

出版信息

Work. 2023;76(4):1419-1427. doi: 10.3233/WOR-220343.

Abstract

BACKGROUND

Physicians' narratives are means to approach and comprehend the practice of medicine, and physicians' embedment in their work and the healthcare context.

OBJECTIVE

This study aimed to explore physicians' professional experiences and to examine how they are affected by factors related to their inner (psychological) and outer (institutional and social) worlds.

METHODS

The study was designed as an exploratory qualitative study based on "narrative facilitators" (NF). Their goal is to encourage storytelling and to support the narrative process. The analytic approach was specific for each NF.

RESULTS

Thirty-three physicians participated in the study. The findings showed a focus on the transformations of a profession, the need for physicians to adapt in terms of role and status, and their withstanding of conflicting projections from the public and patients (NF: press articles). The institutional context was described as not welcoming and impersonal (NF: photo-based story). When reacting to the quotes from their peers, participants showed a variety of un-patterned stances with respect to different aspects of medicine and the medical profession, illustrating heterogeneity with regard to professional attitudes and identities (NF: quotes from biographies/narrative accounts). Finally, findings also indicated that physicians often limited their narratives to a description of the materiality of the elements put into play (NF: blurred video sequences).

CONCLUSION

Disenchanted physicians are not beneficial, neither for the patient nor for the health care system, and their feeling of being worn out may do harm and negatively affect themselves and their families.

摘要

背景

医生的叙述是接近和理解医学实践的一种手段,也是医生融入他们的工作和医疗环境的一种方式。

目的

本研究旨在探讨医生的专业经验,并研究他们如何受到与内在(心理)和外在(制度和社会)世界相关因素的影响。

方法

该研究基于“叙事促进者”(NF)设计为探索性定性研究。他们的目的是鼓励讲故事并支持叙述过程。分析方法针对每个 NF 都是特定的。

结果

33 名医生参与了这项研究。研究结果表明,研究重点是职业的转变、医生在角色和地位方面需要适应的需求,以及他们承受来自公众和患者的相互冲突的期望(NF:新闻文章)。制度环境被描述为不友好和缺乏人情味(NF:基于照片的故事)。当对同行的引述做出反应时,参与者对医学和医疗行业的不同方面表现出各种不成形的立场,说明了职业态度和身份方面的异质性(NF:传记/叙述性叙述中的引述)。最后,研究结果还表明,医生经常将他们的叙述仅限于对所涉及元素的物质性的描述(NF:模糊的视频序列)。

结论

不满的医生对患者和医疗保健系统都没有好处,他们感到疲惫不堪可能会造成伤害,并对自己和家人产生负面影响。

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