Schulte Heike, Lutz Gabriele, Kiessling Claudia
Witten/Herdecke University, Faculty of Health, Chair for the Education of Personal and Interpersonal Competencies in Health Care, Witten, Germany.
Witten/Herdecke University, Faculty of Health, Witten, Germany.
GMS J Med Educ. 2024 Nov 15;41(5):Doc66. doi: 10.3205/zma001721. eCollection 2024.
Current research increasingly describes physicians' health as endangered. Interventions to improve physicians' health show inconsistent results. In order to investigate possible causes for weak long-term effects, we examined senior physicians' perceptions about the relevance of their own health and analyzed whether and how these might affect the difficulty to improve physicians' health.
The authors conducted 19 semi-structured interviews with senior physicians from different medical disciplines, analyzed the data and developed theory using the grounded theory method.
Based on the interviews, we developed a conceptual model which identifies reinforcing factors for physicians' hesitancy in self-care as well as barriers to change. Participants regarded their own health needs as low and equated health with performance. These perceptions were described as being part of their professional identity and mirrored by the hospital culture they work in. Mechanisms as part of the collective professional identity (CPI) of physicians help to stabilize the status quo through early socialization and pride in exceptional performance. In addition, the tabooing of weakness and illness among colleagues, and dissociation from patients as well as sick doctors were identified as stabilizing mechanisms.
Findings support the assumption that one cause of physicians' health problems might lie in a CPI that includes tendencies to rate one's health as secondary or irrelevant. Identified mechanisms against change are, according to Social Identity Theory, typical group strategies which ensure the stability of CPI and make existing attitudes and beliefs difficult to change. However, barriers against change could possibly be overcome by addressing these underlying mechanisms and by a change process that is supported by experienced and competent members of the in-group for the benefit of both physicians and patients.
当前研究越来越多地将医生的健康描述为受到威胁。改善医生健康的干预措施结果不一。为了调查长期效果不佳的可能原因，我们研究了资深医生对自身健康相关性的看法，并分析了这些看法是否以及如何影响改善医生健康的难度。
作者对来自不同医学学科的资深医生进行了19次半结构化访谈，运用扎根理论方法分析数据并构建理论。
基于访谈，我们构建了一个概念模型，该模型确定了医生自我保健犹豫的强化因素以及变革的障碍。参与者认为自己的健康需求较低，并将健康与工作表现等同起来。这些看法被描述为他们职业身份的一部分，并在他们工作的医院文化中得到体现。作为医生集体职业身份（CPI）一部分的机制通过早期社会化和对卓越表现的自豪感有助于维持现状。此外，同事之间对弱点和疾病的忌讳、与患者以及患病医生的疏离被确定为维持现状的机制。
研究结果支持这样一种假设，即医生健康问题的一个原因可能在于一种集体职业身份，这种身份包括将自己的健康视为次要或无关紧要的倾向。根据社会认同理论，已确定的抵制变革的机制是典型的群体策略，这些策略确保了集体职业身份的稳定性，并使现有态度和信念难以改变。然而，通过解决这些潜在机制以及在群体内经验丰富且有能力的成员支持下进行变革过程，变革的障碍可能会被克服，这对医生和患者都有益。
