Clinical essentialising: a qualitative study of doctors' medical and moral practice.
Clinical essentialising: a qualitative study of doctors' medical and moral practice.
复制标题
DOI：
10.1007/s11019-009-9193-z
复制
发表时间：
2010-05
影响因子：
2.1
通讯作者：
Wifstad, Age
中科院分区：
文献类型：
--
作者：
Agledahl, Kari Milch;Forde, Reidun;Wifstad, Age
关键词：
虽然医疗保健中的某些实质性道德困境受到了很多关注，如堕胎，安乐死或基因测试，但医生很少反思他们日常临床工作的道德含义。然而，医学的目的是帮助患者并减轻痛苦，因此充满了道德决定。在这项定性研究中，我们分析了医生如何处理日常临床实践的道德方面。观察了大约100次咨询，并与来自不同实践的15名临床医生进行了访谈。事实证明，医生处理临床病例的方法在各个专业领域都遵循一种相当严格的模式，这意味着通过“本质化”的过程将患者的各种担忧转化为具体的医学问题：医生将患者的故事分解，将患者的投诉具体化，并将症状归类为医学意义。病人的存在意义被移除，重点放在病人的功能上。通过本质化，医生能够处理复杂和模糊的现实，并建立一个医学相关的问题。然而，这一过程涉及道德和实际的简化。忽视存在的意义，关注病人的纯功能性方面，是临床实践的一个组成部分，而不是个人的缺陷。因此，这项研究质疑了解决医生有意识的道德评价的价值。然而，医生们应该意识到，他们的日常临床工作系统地强调了以牺牲他人为代价的益处，而这对病人来说可能更重要。
While certain substantial moral dilemmas in health care have been given much attention, like abortion, euthanasia or gene testing, doctors rarely reflect on the moral implications of their daily clinical work. Yet, with its aim to help patients and relieve suffering, medicine is replete with moral decisions. In this qualitative study we analyse how doctors handle the moral aspects of everyday clinical practice. About one hundred consultations were observed, and interviews conducted with fifteen clinical doctors from different practices. It turned out that the doctors’ approach to clinical cases followed a rather strict pattern across specialities, which implied transforming patients’ diverse concerns into specific medical questions through a process of ‘essentialising’: Doctors broke the patient’s story down, concretised the patient’s complaints and categorised the symptoms into a medical sense. Patients’ existential meanings were removed, and the focus placed on the patients’ functioning. By essentialising, doctors were able to handle a complex and ambiguous reality, and establish a medically relevant problem. However, the process involved a moral as well as a practical simplification. Overlooking existential meanings and focusing on purely functional aspects of patients was an integral part of clinical practice and not an individual flaw. The study thus questions the value of addressing doctors’ conscious moral evaluations. Yet doctors should be aware that their daily clinical work systematically emphasises beneficence at the expense of others—that might be more important to the patient.
登录
查看更多内容
影响因子：
5.4
作者：
Kälvemark, S;Höglund, AT;Arnetz, B
通讯作者：
Arnetz, B
影响因子：
3
作者：
McGuire, AL;McCullough, LB;Whitney, SN
通讯作者：
Whitney, SN
影响因子：
5.4
作者：
McKinlay, JB;Potter, DA;Feldman, HA
通讯作者：
Feldman, HA
影响因子：
9.6
作者：
Carrese, Joseph A.;Sugarman, Jeremy
通讯作者：
Sugarman, Jeremy
影响因子：
4.1
作者：
Sayers, GM;Perera, S
通讯作者：
Perera, S