[[alternative]]Preliminary Study on the Emergency Physicians' Empathy and It's Implications in Medical Education

[[abstract]]醫學教育之首要目標在培養醫師具有利他主義的同理心，也就是近年台灣醫學教育所強調的人文醫學。然而同理心要教什麼？尤其在繁忙的急診情境下要教什麼？這些問題卻沒有明確的答案。本研究目的在描述急診醫師同理心的表達現況，並進一步探討其在同理心醫學教育之意涵。本研究選擇台灣北部二家教學醫院急診室為研究場景，採質性研究設計，資料收集與分析依現象學研究取向進行，基於醫病互動是一個過程，且有護理人員與病人家屬參與，因此，資訊提供者包括病人、病人家屬、及其負責治療的主治醫師與護理人員各五位。依Barnett-Lennard的同理心環架構設計訪談指引與分析資料。研究結果包括: (一)急診醫師對病人感受是選擇性的共鳴; (二) 急診醫師的同理心表達重點在病人的疾病，缺乏社會及心理層面的關懷和醫病互動成效的反思評量; (三)醫師被期望要能專注傾聽、以適當之語言與肢體技巧回應病人和良好之態度與助人行為；(四)醫師同理心表達過程受環境因素影響，包括:醫療團隊及急診行政流程等，此為過去有關溝通技巧之醫學教育文獻所忽略。基於上述結果及發現，本研究建議醫學教育過程中除了要訓練醫師的溝通技巧外，也應涵化醫師對病人感受的認知能力及反思評量的態度，更要重視環境因素對醫師同理心表達過程的影響。[[abstract]]In recent years, Taiwan medical education is emphasizing more on humanities and ethics, and so the main objective in cultivating a good physician must have altruistic empathy. However, what should be taught in cultivating physician’s empathy, especially in emergency clinical settings? The answer is still unclear. The purposes of this article were to describe how the emergency physicians (EPs) convey their empathy and explore the implications in medical education. The authors carried out a qualitative study in the emergency departments (EDs) of two teaching hospitals in which 5 patients, 5 relatives, 5 EPs and 5 emergency nurses reflected on how the EPs demonstrate the empathy to patients. The theory of Barnett-Lennard’ s empathy cycle was used as designing interview questions. The methodology applied for collecting and interpreting data were based on phenomenological approach. The results showed that (A) the EPs resonated to patients’ feeling in a selective way；(B) the EPs focused their empathy mainly on patients’ illness but neglected the psychosocial problems, and lack of self-evaluation on the outcome of doctor-patient interaction；(C) the EPs were expected to be able to actively attend and listen, respond appropriately to patients using verbal and nonverbal techniques, demonstrate appropriate attitudes and helpful behaviors；(D) the process of conveying empathy to patients was influenced by environmental factors, including medical team members and administrative procedures in EDs, which had been neglected by previous studies regarding the communication skills. Based on the results and findings, we suggested that the implications of empathy in medical education, aside from training physicians’ communication skills, it is necessary to cultivate physicians the ability to recognize patients’ feeling and have self-evaluation attitudes. Environmental factors should also be considered