Buetow Stephen
Department of General Practice and Primary Health Care, University of Auckland, Private Bag 92019, Auckland, New Zealand.
Health Care Anal. 2025 Mar;33(1):35-51. doi: 10.1007/s10728-024-00506-x. Epub 2025 Jan 3.
This paper questions the conventional wisdom that physicians must suppress anger in response to patient misbehaviour. It distinguishes the emotion of anger from its expression, which leans toward concerned frustration and disappointment for the sake of professionalism in patient care. Drawing on the framework of person-centred health care as a virtue ethic, the paper first suggests four reasons why and when physician anger toward patient behaviour may occasionally be appropriate: the inevitability of sometimes feeling angry, anger as a cognitive and behavioural resource, physician well-being, and potential patient benefit. The paper then proposes five conditions under which physician anger displays may be prudent as a measured response that balances emotional expression with professional conduct: ethical intention, rational justification, proportionality, problem-focused constructive expression, and precision. Potential benefits of this conceptualization of prudent anger include improved physician wellbeing, enhanced communication, and patient education to address perceived patient misbehaviour. The paper advocates for a cultural shift in health care environments to help allow for more authentic expression of physician frustration, aiming to harness prudent anger as a catalyst for positive change in patient-physician relationships and systemic improvements in health care delivery.
本文对传统观念提出质疑,即医生面对患者的不当行为时必须抑制愤怒。它将愤怒的情绪与其表达区分开来,为了在患者护理中保持专业精神,愤怒的表达更倾向于关切的挫败感和失望感。本文以以人为本的医疗保健作为一种美德伦理的框架为基础,首先提出了四个医生对患者行为偶尔感到愤怒可能是合适的原因及情形:有时感到愤怒的必然性、愤怒作为一种认知和行为资源、医生的幸福感以及对患者可能的益处。然后本文提出了五个条件,在这些条件下,医生表现出愤怒可能是审慎的,是一种将情感表达与专业行为相平衡的适度反应:道德意图、合理理由、相称性、以问题为导向的建设性表达以及精准性。这种审慎愤怒概念化的潜在益处包括改善医生的幸福感、加强沟通以及对患者进行教育以应对所察觉到的患者不当行为。本文倡导在医疗保健环境中进行文化转变,以帮助医生更真实地表达挫败感,旨在利用审慎的愤怒作为医患关系积极改变以及医疗保健服务系统改进的催化剂。