The “Handling” of power in the physician-patient encounter: perceptions from experienced physicians

BMC Medical Education

Research Article

Laura Nimmon¹  Terese Stenfors-Hayes² 

[1] Centre for Health Education Scholarship, Vancouver, Canada;Department of Occupational Science and Occupational Therapy, 429 – 2194 Health Sciences Mall, Faculty of Medicine, University of British Columbia, V6T 1Z3, Vancouver, British Columbia, Canada;Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, 17177, Stockholm, Sweden;

关键词: Physician-patient relationship;    Patient-centred care;    Qualitative research;   

DOI  :  10.1186/s12909-016-0634-0

 received in 2016-01-22, accepted in 2016-04-10,  发布年份 2016

来源: Springer

【 摘 要 】

BackgroundModern healthcare is burgeoning with patient centered rhetoric where physicians “share power” equally in their interactions with patients. However, how physicians actually conceptualize and manage their power when interacting with patients remains unexamined in the literature. This study explored how power is perceived and exerted in the physician-patient encounter from the perspective of experienced physicians. It is necessary to examine physicians’ awareness of power in the context of modern healthcare that espouses values of dialogic, egalitarian, patient centered care.MethodsThirty physicians with a minimum five years’ experience practicing medicine in the disciplines of Internal Medicine, Surgery, Pediatrics, Psychiatry and Family Medicine were recruited. The authors analyzed semi-structured interview data using LeCompte and Schensul’s three stage process: Item analysis, Pattern analysis, and Structural analysis. Theoretical notions from Bourdieu’s social theory served as analytic tools for achieving an understanding of physicians’ perceptions of power in their interactions with patients.ResultsThe analysis of data highlighted a range of descriptions and interpretations of relational power. Physicians’ responses fell under three broad categories: (1) Perceptions of holding and managing power, (2) Perceptions of power as waning, and (3) Perceptions of power as non-existent or irrelevant.ConclusionsAlthough the “sharing of power” is an overarching goal of modern patient-centered healthcare, this study highlights how this concept does not fully capture the complex ways experienced physicians perceive, invoke, and redress power in the clinical encounter. Based on the insights, the authors suggest that physicians learn to enact ethical patient-centered therapeutic communication through reflective, effective, and professional use of power in clinical encounters.

【 授权许可】

CC BY   
© Nimmon and Stenfors-Hayes. 2016