Gutgeld-Dror Maayan, Laor Nathaniel, Karnieli-Miller Orit
Department of Medical Education, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Cohen-Harris Resilience Centre, OTI The Israeli Autism Association, Tel Aviv, Israel.
Med Educ. 2024 Apr;58(4):392-404. doi: 10.1111/medu.15222. Epub 2023 Sep 19.
Good relationships between physicians, patients, families and the healthcare team are essential for high-quality care. Medical encounters are sometimes challenging. They may include conflicts, requiring physicians to be assertive: that is to share and protect their needs, rights and values while preserving those of others. Whereas assertiveness has been studied in patients and nursing staff (those with less power in healthcare), physicians' assertiveness, which must be mindful of these power differences, lacks a comprehensive review. Thus, this scoping review focuses on assertive communication in physicians' encounters.
A literature search of four online databases: MEDLINE, Embase, PsycINFO and WoS, seeking articles on physicians' assertiveness as a communication style published until February 2022. The Joanna Briggs Institute approach and the Preferred Reporting Items for Systematic Reviews checklist underpinned the review protocol.
We identified 1513 articles relating to assertiveness, reviewed 153 full-text articles and selected 22 for full review, 68% from the last decade. The articles focused mainly on assertive communication and relationships with medical staff, with 54% focusing on bottom-up power relations. In 40% of the articles, no clear definition of assertiveness was included. Definitions included had varied focus: on self, on the other or both. Overall, assertiveness measures varied widely, precluding a methodical comparison.
Despite the growing interest in physicians' assertiveness, a clearer definition and in-depth exploration of assertiveness are needed alongside development of valid measures of assertiveness appropriate to physicians. Based on the review, we offer a relational definition of assertiveness as the capacity to communicate one's views, concerns, rights and needs while respecting others and preserving therapeutic, collegial and educational professional alliances. This definition may serve to expand research in the field while offering a professional alternative to problematic communication styles-passive and self-denying or paternalistic and aggressive -that obfuscate and thus undermine physician-patient relationships.
医生、患者、家属与医疗团队之间的良好关系对于高质量医疗至关重要。医疗互动有时具有挑战性。其中可能包括冲突，这就要求医生坚定自信：即在维护他人需求、权利和价值观的同时，分享并保护自己的需求、权利和价值观。虽然已经对患者和护理人员（医疗保健中权力较小的群体）的坚定自信进行了研究，但医生的坚定自信由于必须考虑到这些权力差异，却缺乏全面的综述。因此，本范围综述聚焦于医生互动中的坚定自信沟通。
对四个在线数据库进行文献检索：MEDLINE、Embase、PsycINFO和WoS，查找截至2022年2月发表的关于将医生的坚定自信作为一种沟通方式的文章。乔安娜·布里格斯研究所的方法和系统评价的首选报告项目清单为综述方案提供了支撑。
我们识别出1513篇与坚定自信相关的文章，审阅了153篇全文文章，并挑选出22篇进行全面审查，其中68%来自过去十年。这些文章主要关注坚定自信沟通以及与医务人员的关系，54%关注自下而上的权力关系。40%的文章未包含对坚定自信的明确定义。所包含的定义关注点各不相同：有的关注自我，有的关注他人，还有的两者都关注。总体而言，坚定自信的衡量标准差异很大，无法进行系统的比较。
尽管对医生的坚定自信的兴趣日益浓厚，但仍需要更清晰的定义以及对坚定自信的深入探索，同时要开发适用于医生的有效坚定自信衡量标准。基于该综述，我们给出了一个关于坚定自信的关系性定义，即能够在尊重他人并维护治疗、同事及教育专业联盟的同时，表达自己的观点、关切、权利和需求的能力。这个定义可能有助于拓展该领域的研究，同时为有问题的沟通方式——消极和自我否定型或家长式和激进型——提供一种专业替代方案，这些沟通方式会模糊并破坏医患关系。
