PDF(Pubmed)
Abstract：
The current trend in healthcare is to actively involve patients in their own treatment; however, in practice, healthcare providers may adhere to paternalistic views, which may not align with ideals related to patient involvement. This tension may become visible when providers talk about service encounters that they experienced as being interactionally troubling. In this empirical qualitative study, we utilize Bamberg\'s narrative positioning analysis to explore how healthcare providers construct patients\' roles in narratives about such troubling exchanges. Data consist of 20 audio-recorded interviews with healthcare providers. We found two types of narratives in which healthcare providers\' perceptions of interactionally troubling patient exchanges were consistently related to their implicit evaluations of patients along a continuum of activeness versus passiveness. In the first, an active patient was considered ideal, and the problematic patient was one who is passive. In the second, a patient\'s over-activeness was thought to interfere with the healthcare delivery. While providers\' complaints about patient passiveness were unproblematically presented from the perspective of the patient participation ideal, complaints about patient over-activeness were difficult to account for due to their inherent connotations with paternalism. Thus, we conclude that there is a need for training and interventions aiming to develop healthcare providers\' critical awareness of shifting cultural models, including patient involvement ideals and providers\' capacity to reflect paternalistic tendencies.
摘要：
目前医疗保健的趋势是让患者积极参与自己的治疗；然而，在实践中,医疗保健提供者可能会坚持家长式的观点，这可能不符合与患者参与相关的理想。当提供者谈论他们所经历的交互麻烦的服务遭遇时,这种紧张关系可能变得可见。在这项实证定性研究中，我们利用Bamberg的叙事定位分析来探索医疗保健提供者如何在关于这种令人不安的交流的叙述中构建患者的角色。数据包括对医疗保健提供者的20次录音采访。我们发现了两种类型的叙述，其中医疗保健提供者对相互困扰的患者交流的看法与他们对患者的内隐评估始终相关。在第一,活跃的病人被认为是理想的，有问题的病人是被动的。在第二个，患者的过度活跃被认为会干扰医疗服务的提供。虽然提供者对患者被动性的抱怨是从患者参与理想的角度毫无问题地提出的，关于患者过度活跃的抱怨很难解释，因为他们固有的家长式的内涵。因此，我们得出的结论是，需要培训和干预措施，旨在培养医疗保健提供者对转变文化模式的关键意识，包括患者的参与理想和提供者反映家长式倾向的能力。
