Avoiding humiliations in the clinical encounter.
OBJECTIVE
To explore potentials for avoiding humiliations in clinical encounters, especially those that are unintended and unrecognized by the doctor. Furthermore, to examine theoretical foundations of degrading behaviour and identify some concepts that can be used to understand such behaviour in the cultural context of medicine. Finally, these concepts are used to build a model for the clinician in order to prevent humiliation of the patient.
Empirical studies document experiences of humiliation among patients when they see their doctor. Philosophical and sociological analysis can be used to explain the dynamics of unintended degrading behaviour between human beings. Skjervheim, Vetlesen, and Bauman have identified the role of objectivism, distantiation, and indifference in the dynamics of evil acts, pointing to the rules of the cultural system, rather than accusing the individual of bad behaviour. Examining the professional role of the doctor, parallel traits embedded in the medical culture are demonstrated. According to Vetlesen, emotional awareness is necessary for moral perception, which again is necessary for moral performance.


CONCLUSIONS
A better balance between emotions and rationality is needed to avoid humiliations in the clinical encounter. The Awareness Model is presented as a strategy for clinical practice and education, emphasizing the role of the doctor's own emotions. Potentials and pitfalls are discussed.
Malterud
Kirsti
K
Research Unit and Department of General Practice, Centre of Health and Society, University of Copenhagen, Denmark. kirsti.malterud@isf.uib.no
Hollnagel
Hanne
H
D001291:Attitude of Health Personnel; D001364:Awareness; D004644:Emotions; D006801:Humans; D008962:Models, Theoretical; D010819:Physician's Role; D010817:Physician-Patient Relations; D012752:Shame