Mazouni Nedjma, Stiefel Friedrich, Bourquin Céline, Ludwig Gundula, Michaud Laurent
Psychiatric Liaison Service, Lausanne University Hospital and University of Lausanne, Avenue de Beaumont 23, Lausanne, 1011, Switzerland.
BMC Health Serv Res. 2024 Dec 4;24(1):1539. doi: 10.1186/s12913-024-12030-8.
Clinical supervision by psychiatric liaison clinicians is frequently provided in medical settings such as oncology and palliative care, but rarely in endocrinology. Consequently, the specific psychosocial issues faced by endocrinologists in their daily clinical practice and how they deal with them remain largely unknown. We aimed to explore individual supervisions of endocrinologists to gain insight into what kind of clinical situations they present, how they react to them and how this is worked through in supervision.
The data set consisted of eight audio-recorded first supervision sessions of endocrinologists conducted by liaison psychiatry clinicians, which were transformed into written core stories accounting for key components of each session. A secondary analysis of these core stories was conducted using an interpretative approach, focusing on (i) the types of clinical situations and (ii) the supervisees' counter-attitudes towards patients. Additionally, particular attention was given to how the supervisors worked through these elements.
Endocrinologists presented patients who did not adhere to treatment, behaved inexplicably, or held moral values that differed from their own. Challenged by these situations, supervisees experienced negative emotions (e.g., anxiety, irritation, guilt), associated with behavioral reactions (e.g., avoidance) and/or defensive stances (e.g., denial, rationalization). In half of the supervisions, addressing these difficulties allowed supervisees to link key characteristics of the patient interaction with their own unresolved issues; in the other half, supervisees were less inclined to confront themselves with their own contributions to the patient interaction and the supervisor adopted a more active stance, making specific contributions (e.g. support, advise).
The findings call for training programs addressing "difficult" patients and advocate for closer collaboration between endocrinologists and liaison psychiatry clinicians.
精神科联络临床医生的临床督导常见于肿瘤学和姑息治疗等医疗环境中，但在内分泌科却很少见。因此，内分泌科医生在日常临床实践中面临的具体心理社会问题以及他们如何应对这些问题，在很大程度上仍不为人所知。我们旨在探讨对内分泌科医生的个人督导，以深入了解他们呈现出何种临床情况、如何应对这些情况以及在督导过程中如何解决这些问题。
数据集包括由联络精神科临床医生对内分泌科医生进行的八次首次督导会议的音频记录，这些记录被转化为书面核心故事，涵盖每次会议的关键内容。使用解释性方法对这些核心故事进行二次分析，重点关注（i）临床情况的类型和（ii）被督导者对患者的反态度。此外，特别关注督导者如何处理这些因素。
内分泌科医生呈现出不坚持治疗、行为莫名其妙或持有与自己不同道德价值观的患者。面对这些情况，被督导者会经历负面情绪（如焦虑、恼怒、内疚），并伴有行为反应（如回避）和/或防御姿态（如否认合理化）。在一半的督导中，解决这些困难使被督导者能够将患者互动的关键特征与自己未解决的问题联系起来；在另一半督导中，被督导者不太愿意面对自己在患者互动中的作用，而督导者则采取更积极的姿态，做出具体贡献（如支持、建议）。
研究结果呼吁开展针对“难缠”患者的培训项目，并倡导内分泌科医生与联络精神科临床医生之间加强合作。
