Article

How doctors feel: affective issues in patients' safety

Department of Emergency Medicine and Department of Medical Education, Dalhousie University, Halifax, NS, Canada B3H 2Y9.
The Lancet (Impact Factor: 45.22). 11/2008; 372(9645):1205-6. DOI: 10.1016/S0140-6736(08)61500-7
Source: PubMed
Download full-text

Full-text

Available from: Allan Abbass, Jun 10, 2014
1 Follower
 · 
72 Views
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Dealing with emotions is a critical feature of professional behaviour. There are no comprehensive theoretical models, however, explaining how medical students learn about emotions. We aimed to explore factors affecting their emotions and how they learn to deal with emotions in themselves and others. During a first-year nursing attachment in hospitals and nursing homes, students wrote daily about their most impressive experiences, explicitly reporting what they felt, thought, and did. In a subsequent interview, they discussed those experiences in greater detail. Following a grounded theory approach, we conducted a constant comparative analysis, collecting and then interpreting data, and allowing the interpretation to inform subsequent data collection. Impressive experiences set up tensions, which gave rise to strong emotions. We identified four 'axes' along which tensions were experienced: 'idealism versus reality', 'critical distance versus adaptation', 'involvement versus detachment' and 'feeling versus displaying'. We found many factors, which influenced how respondents relieved those tensions. Their personal attributes and social relationships both inside and outside the medical community were important ones. Respondents' positions along the different dimensions, as determined by the balance between attributes and tensions, shaped their learning outcomes. Medical students' emotional development occurs through active participation in medical practice and having impressive experiences within relationships with patients and others on wards. Tensions along four dimensions give rise to strong emotions. Gaining insight into the many conditions that influence students' learning about emotions might support educators and supervisors in fostering medical students' emotional and professional development.
    Advances in Health Sciences Education 08/2013; 19(3). DOI:10.1007/s10459-013-9477-1 · 2.71 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Physician cognition, metacognition and affect may have an impact upon the quality of clinical reasoning. The purpose of this study was to examine the relationship between measures of physician metacognition and affect and patient outcomes in obstetric practice. Reflective coping (RC), proactive coping, need for cognition (NFC), tolerance for ambiguity, state-trait anxiety and metacognitive awareness were assessed for obstetricians (n = 12) who provided intra-partum care to 4,149 women. Outcome measures included delivery mode and intrapartum asphyxia. Analysis was carried out using logistic regression and tree-based classification. Obstetricians with high RC scores were more likely to perform a caesarean section (OR 1.59, p < 0.0001), less likely undertake a mid-forceps or low forceps delivery (OR 0.41, p < 0.0001; OR 0.49, p < 0.0001), and more likely to supervise a spontaneous vaginal delivery (OR 1.17, p = 0.08). Obstetricians with high NFC scores were more likely to perform a caesarean section (OR 1.53, p = 0.03), more likely to undertake a vacuum delivery (OR 5.8, p = 0.001), less likely undertake a mid-forceps delivery (OR 0.45, p = 0.02) and less likely to supervise a spontaneous vaginal delivery (OR 0.47, p < 0.0001). Obstetricians high in trait anxiety were more likely to perform a mid forceps delivery (OR 2.49, p = 0.01) or a vacuum delivery (OR 5.08, p = 0.003), and less likely to supervise a spontaneous vaginal delivery (OR 0.38, p < 0.0001). NFC was negatively associated (OR 0.10, p < 0.001) and trait anxiety was positively associated with intrapartum asphyxia (p < 0.05, rho = 0.582). In summary, physician cognitive processes and affect have a significant impact on patient outcomes, particularly in situations where there is a higher level of clinical unpredictability.
    Advances in Health Sciences Education 09/2009; 15(2):229-50. DOI:10.1007/s10459-009-9194-y · 2.71 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Le raisonnement clinique est au coeur de la compétence médicale. Pourtant, dans le domaine de l’urgence, il a fait l’objet d’une attention très modeste de la part des chercheurs, au regard des autres déterminants de la performance des médecins. Le raisonnement clinique désigne les processus cognitifs mobilisés pour établir des diagnostics et décider d’actions thérapeutiques. À travers deux récits cliniques, nous décrivons les processus analytiques (réflexifs) et non analytiques (intuitifs) identifiés dans la littérature scientifique. Ceux-ci ont très majoritairement concerné les disciplines dites « conventionnelles ». Nous mettons en évidence le rôle déterminant de la pratique clinique, dans la mesure où elle permet aux praticiens d’élaborer des connaissances organisées et stockées en mémoire à long terme, qui sous-tendent le fonctionnement des processus de raisonnement. Nous évoquons également l’influence considérable du contexte sur le raisonnement, afin de justifier l’intérêt de mener des travaux de recherche visant à identifier si les médecins urgentistes mobilisent des processus cognitifs particuliers, au regard des spécificités qui caractérisent leur cadre d’exercice. La connaissance, par les praticiens, de la façon dont ils raisonnent est associée à des enjeux majeurs en termes de pratique de la médecine d’urgence et de formation dans cette discipline. Clinical reasoning is a major determinant of physicians’ competence. However, it has not been much studied in the emergency medicine literature, when compared to other determinants. Clinical reasoning refers to the cognitive processes used to make diagnoses and decisions. Through a couple of clinical histories, we give a description of the analytical (conscious) and non-analytical (intuitive) processes that have been identified through studies made in conventional fields of medicine. We highlight the importance of clinical practice, since it allows the development of knowledge organized and stored in physicians’ long-term memory, which underlie the functioning of the reasoning processes. We also underline the importance of context in clinical reasoning, which justifies the interest to carry out research works on clinical reasoning in the field of emergency medicine, in regard to the specific characteristics of emergency medicine practice. Physicians’ knowledge of the reasoning processes, which they use to make diagnoses and decisions, is associated with major issues in terms of emergency medicine practice and education. Mots clésRaisonnement clinique–Reconnaissance de formes–Raisonnement hypothéticodéductif–Chaînage avant–Intuition KeywordsClinical reasoning–Pattern recognition–Hypothetico-deductive reasoning–Forward reasoning–Intuition
    01/2010; 1(1):77-84. DOI:10.1007/s13341-010-0006-1