Härgestam Maria, Jacobsson Maritha, Bååthe Fredrik, Brulin Emma
Department of Nursing, Umeå University, Umeå, Sweden.
Department of Social Work, Uppsala University, Uppsala, Sweden.
Front Psychol. 2023 Jun 8;14:1083047. doi: 10.3389/fpsyg.2023.1083047. eCollection 2023.
The COVID-19 pandemic was a tremendous challenge to the practice of modern medicine. In this study, we use neo-institutional theory to gain an in-depth understanding of how physicians in Sweden narrate how they position themselves as physicians when practicing modern medicine during the first wave of the pandemic. At focus is medical logic, which integrates rules and routines based on medical evidence, practical experience, and patient perspectives in clinical decision-making.
To understand how physicians construct their versions of the pandemic and how it impacted the medical logic in which they practice, we analyzed the interviews from 28 physicians in Sweden by discursive psychology.
The interpretative repertoires showed how COVID-19 created an experience of knowledge vacuum in medical logic and how physicians dealt with clinical patient dilemmas. They had to find unorthodox ways to rebuild a sense of medical evidence while still being responsible for clinical decision-making for patients with critical care needs.
In the knowledge vacuum occurring during the first wave of COVID-19, physicians could not use their common medical knowledge nor rely on published evidence or their clinical judgment. They were thus challenged in their norm of being the "good doctor". One practical implication of this research is that it provides a rich empirical account where physicians are allowed to mirror, make sense, and normalize their own individual and sometimes painful struggle to uphold the professional role and related medical responsibility in the early phases of the COVID-19 pandemic. It will be important to follow how the tremendous challenge of COVID-19 to medical logic plays out over time in the community of physicians. There are many dimensions to study, with sick leave, burnout, and attrition being some interesting areas.
新冠疫情对现代医学实践构成了巨大挑战。在本研究中，我们运用新制度理论，深入了解瑞典医生在疫情第一波期间实践现代医学时，如何讲述他们作为医生的自我定位。重点在于医学逻辑，它在临床决策中整合了基于医学证据、实践经验和患者视角的规则与常规。
为了解医生如何构建他们对疫情的描述以及疫情如何影响他们所实践的医学逻辑，我们运用话语心理学分析了来自瑞典28位医生的访谈。
解释性语库展示了新冠疫情如何在医学逻辑中造成知识真空的体验，以及医生如何应对临床患者困境。他们不得不寻找非传统的方法来重建医学证据感，同时仍要为有重症护理需求的患者负责临床决策。
在新冠疫情第一波期间出现的知识真空中，医生既无法运用他们的常规医学知识，也无法依赖已发表的证据或他们的临床判断。因此，他们作为“好医生”的规范受到了挑战。这项研究的一个实际意义在于，它提供了丰富的实证描述，让医生能够反思、理解并使他们在新冠疫情早期为维护专业角色和相关医疗责任而进行的个人挣扎（有时是痛苦的挣扎）正常化。跟踪新冠疫情对医学逻辑的巨大挑战在医生群体中如何随时间演变将很重要。有许多维度可供研究，病假、职业倦怠和人员流失是一些有趣的领域。
