'I deal with the small things': The doctor-patient relationship and professional identity in GPs' stories of cancer care.

May-Lill Johansen; Knut Arne Holtedahl; Annette Sofie Davidsen; Carl Edvard Rudebeck

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'I deal with the small things': The doctor-patient relationship and professional identity in GPs' stories of cancer care.

机译：“我处理小事”：全科医生在癌症护理方面的医患关系和专业身份。

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An important part of GPs' work consists of attending to the everyday and existential conditions of human being. In these life world aspects, biomedicine is often not the relevant theory to guide the GP; nevertheless they are a part of GPs' professional domain. In cancer care, previous studies have shown that GPs with a biomedical perspective on medicine could feel subordinate to specialists, and that doctors with a curative focus could see disease progression as a personal failure. The aim of this study was to explore in depth the experiences of being a GP for people with advanced cancer. Fourteen Norwegian GPs were interviewed about accompanying patients through a cancer illness. Their stories were analysed using a narrative approach. The GPs expressed a strong commitment to these patients, a loyalty which in some cases could be weakened due to judgements of distant specialists. In view of the GPs' close knowledge of their patients' background and history this subordination was a paradox, mirroring a hierarchy of medical knowledge. The GPs had an ideal of honesty and openness about death, which they sometimes failed. To reach the ideal of honesty, clinicians would have to abandon the biomedical ideal of mastering human nature through interventions and acknowledge the fundamental uncertainty and finiteness of human life. GPs may learn from being with their patients that bodily and existential suffering are connected, and thus learn implicitly to overlook the body-mind dualism. This practical wisdom lacks a theoretical anchoring, which is a problem not only for general practice.

机译：全科医生的工作的重要组成部分是关注人类的日常和生存条件。在这些生活世界方面，生物医学常常不是指导GP的相关理论;但是，它们是GP的专业领域的一部分。在癌症护理中，先前的研究表明，从生物医学角度看医学的全科医生可能会从属于专家，而以治疗为重点的医生则将疾病进展视为个人失败。这项研究的目的是深入探索成为晚期癌症患者的全科医生的经验。采访了14名挪威全科医生，介绍他们因癌症患病的情况。他们的故事采用叙述方式进行了分析。全科医生对这些患者表示了坚定的承诺，在某些情况下，由于远距离专家的判断，这种忠诚度可能会减弱。考虑到全科医生对患者背景和病史的了解，这种从属关系是一个悖论，反映了医学知识的层次。 GP对死亡具有诚实和开放的理想，但有时他们失败了。为了达到诚实的理想，临床医生将不得不放弃通过干预来掌握人性的生物医学理想，并承认人类生活的根本不确定性和局限性。全科医生可能会从与患者的相处中学习到身体痛苦与生存痛苦之间的联系，从而暗中学会了忽略身心双重主义。这种实践智慧缺乏理论基础，这不仅是一般实践的问题。

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《Health》 |2012年第6期|共16页
作者
May-Lill Johansen; Knut Arne Holtedahl; Annette Sofie Davidsen; Carl Edvard Rudebeck;
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中图分类保健组织与事业（卫生事业管理）;
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1. 'I deal with the small things': The doctor-patient relationship and professional identity in GPs' stories of cancer care. [J] . May-Lill Johansen, Knut Arne Holtedahl, Annette Sofie Davidsen, Health . 2012,第6期

机译：“我处理小事”：全科医生在癌症护理方面的医患关系和专业身份。
2. The ethical professional as endangered person: blog notes on doctor-patient relationships. [J] . Koch T, Jones S Journal of medical ethics . 2010,第6期

机译：作为濒临灭绝者的职业道德专家：关于医患关系的博客文章。
3. Satisfaction with referral relationships between general practice and allied health professionals in Australian primary health care. [J] . Chan B, Proudfoot J, Zwar N, Australian journal of primary health . 2011,第3期

机译：对澳大利亚初级卫生保健中的一般执业和专职医疗专业人员之间的转诊关系感到满意。
4. Who Are Waste Managers: A Story of Constructed Identities and Professional Training and Education Opportunities [C] . Georgina Davis 24th international conference on solid waste technology and management . 2009

机译：谁是废物管理者：一个有身份的身份以及专业培训和教育机会的故事
5. Cultural beliefs about health professionals, attributions for mistreatment, and continuity of cancer-related care. [D] . Tucker, Jennifer Anne. 2008

机译：关于医疗专业人员的文化信仰，虐待的归因和与癌症相关的护理的连续性。
6. Limited autonomy and partnership: professional relationships in health care. [O] . J Wilson-Barnett 1989

机译：有限的自主权和伙伴关系：卫生保健方面的专业关系。
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'I deal with the small things': The doctor-patient relationship and professional identity in GPs' stories of cancer care.

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