The inner life of physicians and care of the seriously ill
The inner life of physicians and care of the seriously ill
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DOI：
10.1001/jama.286.23.3007
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发表时间：
2001-12-19
影响因子：
120.7
通讯作者：
Morrison, RS
中科院分区：
文献类型：
--
作者：
Meier, DE;Back, AL;Morrison, RS
重病患者在通常旷日持久的病程中情绪脆弱。医生用自己的情绪来回应这些病人的需求和情绪，这可能反映出需要抢救病人，病人病情发展时的失败感和挫败感，对疾病及其相关损失的无能为力的感觉，悲伤，对自己生病的恐惧，或者想要与病人分开并避免病人逃避这些感觉的愿望。这些情绪既会影响医疗质量，也会影响医生自身的幸福感，因为未经检查的情绪也可能导致医生痛苦、脱离工作、精疲力竭和判断力不佳。在这篇面向执业的非精神病学临床医生的文章中，我们描述了一个提高医生自我意识的模型，其中包括识别和处理可能影响患者护理的情绪。我们的方法是基于危险因素、体征和症状、鉴别诊断和干预的标准医学模型。虽然在照顾病人时产生情绪是正常的，但医生应该在识别和控制这些情绪方面发挥积极的作用。
Seriously ill persons are emotionally vulnerable during the typically protracted course of an illness. Physicians respond to such patients' needs and emotions with emotions of their own, which may reflect a need to rescue the patient, a sense of failure and frustration when the patient's illness progresses, feelings of powerlessness against illness and its associated losses, grief, fear of becoming ill oneself, or a desire to separate from and avoid patients to escape these feelings. These emotions can affect both the quality of medical care and the physician's own sense of well-being, since unexamined emotions may also lead to physician distress, disengagement, burnout, and poor judgment. In this article, which is intended for the practicing, nonpsychiatric clinician, we describe a model for increasing physician self-awareness, which includes identifying and working with emotions that may affect patient care. Our approach is based on the standard medical model of risk factors, signs and symptoms, differential diagnosis, and intervention. Although it is normal to have feelings arising from the care of patients, physicians should take an active role in identifying and controlling those emotions.