少即是多:探索看 "这个病人 "而非 "这样的病人 "的意义。

IF 1.8 3区 哲学 Q2 ETHICS
M Bobbio, M Chiarlo, P Arcadi, E Kidd
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引用次数: 0

摘要

在过去十年中,以 "少即是多 "为主题的文献主要以临床病例为代表,描述了侵略性、冗余、非个性化和非尊重性的过度医疗。这些文章大多以 "越多越糟糕 "的方法为重点,围绕医疗过度使用的下游负面影响展开。我们发现有关 "少即是多 "的经验和实践而非过度使用的危害的文献存在空白,因此对 "少即是多 "方法在实践中如何发挥作用开展了一项探索性定性研究。我们采用了诠释学现象学方法,将生活经验作为有效的数据来源和 "从床边 "理解 "少即是多 "方法的途径进行研究。实践现象学 "被选为本研究更具体的框架,因为它更加关注行动和在专业环境中的实际应用。我们收到并分析了由医生、病人、护士、护理人员和其他医疗专业人员撰写的 70 个故事。这些故事是作为 "慢故事 "项目的一部分收集的,该项目旨在收集通过采用 "少即是多 "的方法来积极解决病人护理问题的临床案例。在分别和作为一个小组进行深入分析后,研究人员确定了五个关键的现象学主题:联系的时间就是治愈的时间;做得更多并不意味着做得更好;慢药的设置;生命末期的慢护理;个性化治疗与标准化治疗。每一个主题都为如何在实践中使用 "少即是多 "方法提供了启示,并说明了 "少即是多 "策略如何在积极解决某些临床病例方面发挥重要作用。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Practising Less is More: An Exploration of What it Means to See "This Patient" Not a "Patient Like This".

In the last decade literature focused on a "less is more" approach has been primarily represented by clinical cases describing the excesses of an aggressive, redundant, non-personalized, and non-respectful medicine. Most of these articles focus on a "more is worse" approach and centre around the downstream negative consequences of medical overuse. Having identified a gap in the literature on the experience and practice of less, rather than the harms of excess, we carried out an exploratory qualitative study into how a "less is more" approach works in practice. A hermeneutic phenomenological approach was adopted to allow us to examine the realm of lived experience as a valid data source and as a path from which to understand a "less is more" approach "from the bedside." A Phenomenology of Practice was chosen as a more specific frame for this research because of its added focus on action and practical application in professional settings. Seventy stories written by physicians, patients, nurses, caregivers, and other health professionals have been received and analysed. These stories were gathered as part of a project called "Slow Stories" which aimed to collect clinical cases that have been positively resolved by adopting a "less is more" approach to patient care. After having conducted an in-depth analysis, separately and as a group, the researchers identified five key phenomenological themes; Time to relate is time to heal; Doing more does not mean doing better; Settings for a slow medicine; Slow care at the end of life; and Personalized vs. standardized treatment. Each of these themes offers insights into how a "less is more" approach can be used in practice and illustrates how a "less is more" strategy can play a significant role in positively resolving certain clinical cases.

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来源期刊
Journal of Bioethical Inquiry
Journal of Bioethical Inquiry 医学-医学:伦理
CiteScore
5.20
自引率
8.30%
发文量
67
审稿时长
>12 weeks
期刊介绍: The JBI welcomes both reports of empirical research and articles that increase theoretical understanding of medicine and health care, the health professions and the biological sciences. The JBI is also open to critical reflections on medicine and conventional bioethics, the nature of health, illness and disability, the sources of ethics, the nature of ethical communities, and possible implications of new developments in science and technology for social and cultural life and human identity. We welcome contributions from perspectives that are less commonly published in existing journals in the field and reports of empirical research studies using both qualitative and quantitative methodologies. The JBI accepts contributions from authors working in or across disciplines including – but not limited to – the following: -philosophy- bioethics- economics- social theory- law- public health and epidemiology- anthropology- psychology- feminism- gay and lesbian studies- linguistics and discourse analysis- cultural studies- disability studies- history- literature and literary studies- environmental sciences- theology and religious studies
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