Practicing Medicine in the Real World: Challenges to Empathy and Respect for Patients
Practicing Medicine in the Real World: Challenges to Empathy and Respect for Patients
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DOI：
10.1086/jce200314411
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发表时间：
2003-12
期刊：
影响因子：
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通讯作者：
J. Halpern
中科院分区：
文献类型：
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作者：
J. Halpern
很高兴能够回复如此深思熟虑的评论。我将逐一回复，但想强调一些主题。四篇评论中的三篇提出了关于同理心以及同理心如何有助于尊重自主权的问题。玛丽亚·梅里特（Maria Merritt）质疑忙碌的医生如何能够对患者的主观性产生丰富的理解，而这是同理心所需的。玛丽·马霍瓦尔德 (Mary Mahowald) 指出，限制临床同理心的不仅是医疗机构的后勤工作，还有每位医生的个人情况。她用女权主义立场理论来提问：医生如何才能理解患者的不同经历？玛莎·蒙特洛强调了同理心的要求是多么高，理解其他人的主观经历的目标是多么困难。然而她认为，这不仅是一个重要的目标本身，而且对于真正尊重他人的自主权也至关重要。鉴于当前的医疗实践结构，三位受访者共同对真正的同理心和尊重自主权的可能性提出了怀疑性挑战。我并不是当前医疗实践结构的捍卫者，包括严格的时间限制，但我确实认为同理心和对自主权的尊重仍然是可能的，尽管在不完美的版本中，每个版本都会引发不同的问题。首先，同理心不仅是可能的，而且实际上一直在发生；医生每天都会同情病人（尽管我们可能更担心错过很多同情的机会）。也就是说，这通常是不完美的同理心——也就是说，如果我们利用同理心来丰富理解每个患者的主观世界。医生常常不了解疾病和治疗对患者的具体意义。但他们仍然可以培养好奇心和共鸣。这些态度可以促进同理心沟通。我的评论将集中于指出治疗方法
It is a great pleasure to respond to such thoughtful comments. I will respond to each individually, but want to highlight some themes. Three of the four commentaries raise questions about empathy and how empathy contributes to respecting autonomy. Maria Merritt questions how busy physicians can develop the rich understanding of patients’ subjectivity that is needed for empathy. Mary Mahowald states that it is not only the logistics of healthcare organizations, but each physician’s individual situatedness that restrict possi-bilities for clinical empathy. She uses feminist standpoint theory to ask: How can physicians possibly understand the diverse experiences of their patients? Martha Montello emphasizes how demanding empathy is, how difficult the goal of understanding any other person’s subjective experience. Yet she suggests that this is not only an important goal in itself, but crucial to genuinely respecting another’s autonomy. Together the three respondents can be taken to raise a skeptical challenge about the possibility of genuine empathy and respect for autonomy given the current structure of medical practice. I am no defender of the structure of current medical practice, including the severe time constraints, but I do think that empathy and respect for autonomy are still possible, although in imperfect versions, each of which raises distinct problems. First, empathy is not only possible, it actually occurs all the time; physicians empathize with patients every day (even though we might worry more that many opportunities for empathy are missed). That said, often this is imperfect empathy—that is, if we take empathy to aim for a rich understanding of each patient’s subjective world. Physicians often lack knowledge about what specific meanings illness and treatment have for their patients. Yet they can still cultivate curiosity and resonance. These attitudes can foster empathic communication. My comments will focus on pointing out the therapeutic