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Constructing denial as a disease object: Accounts by medical students meeting dying patients

机译：构建否认为疾病对象：医学生遇见垂死患者的账目

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摘要

As part of the general shift in contemporary healthcare from a focus on specific diseases to treating the whole person, doctors are now expected to be reflective and engage empathetically with patients. Yet, the context of end of life potentially confounds this commitment. Here we draw on the written submissions of UK medical students confronting dying patients to offer insight into a range of entangled issues. Although the exercise is designed to highlight the value of listening to patients and to encourage reflective practice, the experience of ultimately not being able to treat or cure frequently challenges the students' understanding of the central purpose of clinical care and their future role as doctors. Because they invariably draw on the notion of 'good death', whenever they have to make sense of patient behaviour deemed as irrational or obstructive the students employ the concept of 'denial' as a strategic category. In this context denial is referred to as a disease-like object that the students feel they can, and should, diagnose and treat. Such conceptual operations consequently illustrate a tension arising from trying to acknowledge the value of a whole-patient approach while simultaneously reproducing the emphasis placed on identifying those discrete elements that determine legitimate medical intervention.
机译：作为现代医疗保健从关注特定疾病转向治疗整个人的总体转变的一部分，现在希望医生能够反思并同情患者。然而，生命终结的背景可能会混淆这一承诺。在这里，我们借鉴了英国医学生面对垂死患者的书面意见，以洞悉一系列纠缠的问题。尽管练习的目的是强调听病人的价值并鼓励反思性练习，但最终最终无法治疗或治愈的经历经常挑战学生对临床护理的中心目的及其未来医生角色的理解。因为他们总是借鉴“善后”的概念，所以每当他们不得不理解被认为是不合理或阻碍性的患者行为时，学生就会将“拒绝”的概念用作战略类别。在这种情况下，否认被认为是一种疾病样的东西，学生认为他们可以并且应该诊断和治疗。因此，这种概念上的操作说明了由于试图承认全病人方法的价值而引起的压力，同时又强调了确定那些确定合法医疗干预措施的离散因素。

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