Traumekartlegging av Barn og Unge med ADHD i en BUP-Populasjon

Mange barn og ungdom i Norge blir utsatt for vold og overgrep. Det foreligger til dels stor diskrepans mellom opplevde og rapporterte traumer innen psykisk helsevesen. Forskning har vist at hvordan behandlere kartlegger for traumehistorikk er avgjørende for hvorvidt pasienten rapporterer traumer. Fokus for denne studien var å undersøke kartleggingsrutiner for traumer i en ADHD-populasjon under utredning og behandling ved en BUP-klinikk. Studien baserer seg på retrospektiv pasientjournalgjennomgang. Utvalget bestod av 24 jenter og 49 gutter (n=73), med et aldersspenn på 4-17 år. Resultatene viser at om lag halvparten av pasientene ble kartlagt for traumehistorikk i behandlingsforløpet. Noen motsvarende forhold ble avdekket: Behandlere benyttet oftest anamnese som kartleggingsmetode, men denne genererte færrest traumerapporteringer fra pasientene. Flest traumetilfeller ble avdekket i samtale mellom pasient og behandler i ordninære behandlingstimer, men en forholdsvis lav andel pasienter ble kartlagt på denne måten. Informasjon om alvorlig sykdom i primærfamilien til pasienten var signifikant assosiert til hvorvidt traumekartlegging ble gjennomført. Funnene tyder på at traumekartleggingen gjennomføres, men ikke i tilstrekkelig grad av alle behandlere. De praktiske implikasjonene av disse funnene drøftes. En sentral anbefaling kan være innføring av tydelige rutiner for hvordan kartlegging av traumer skal gjennomføres ved BUP

Medical students’ experiences when empathizing with patients’ emotional issues during a medical interview – a qualitative study

Background There is evidence that empathy decreases as medical students go through clinical training. However, there are few in-depth studies investigating the students’ own experiences when trying to empathize in concrete clinical encounters. We therefore wanted to explore medical students’ perceptions, experiences, and reflections when empathizing with patients expressing emotional issues. Methods A qualitative content analysis of semi-structured interviews with third year medical students (N = 11) was conducted using video-stimulated recall from their own medical interview with a simulated chronically ill patient. Students were led to believe that the patient was real. Results Five themes which may influence student empathy during history-taking were identified through analysis of interview data: (1) Giving priority to medical history taking, (2) Interpreting the patient’s worry as lack of medical information, (3) Conflict between perspectives, (4) Technical communication skill rather than authentic and heart-felt and (5) The distant professional role. Conclusions The participating students described conflicts between a medical agenda, rules and norms for professional conduct and the students’ own judgments when trying to empathize with the patient. To our knowledge, this is the first study ever to document the students’ own perspective in concrete situations as well as how these reported experiences and reflections affect their empathy towards patients. Since we now know more about what is likely to hinder medical students’ empathy, educators should actively encourage group reflection and discussion in order to avoid these negative effects of history taking both inside and outside of the clinical setting

Medical students’ expressions of empathy: A qualitative study of verbal interactions with patients expressing emotional issues in a medical interview

Objective Explore medical students’ verbal responses to patients expressing emotional issues in a medical interview. Methods Eleven third-year students were instructed to conduct a medical interview with a simulated chronically ill patient while being videotaped (but were led to believe that the patient was real). An interaction analysis system (VR-CoDES) was used to identify patient utterances containing emotional expressions as well as student utterances responding to these emotional expressions. A qualitative content analysis of student utterances was then conducted. Results Four categories that depicted student responses were identified: (1) questions focusing on a medico-professional agenda, (2) allowing disclosure of emotions without explicit acknowledgment of emotions, (3) attempts at reassurance, and (4) explicit recognition of emotions, but most often on a factual and descriptive level. Conclusions Our analysis indicate that these students gave priority to medico-professional tasks and responsibilities in their responses. They demonstrated some interest in the patient’s emotional experiences whilst most often leaving out their own personal perspectives. Practice implications Communication skills curricula should address how the medical interview affects empathy and interaction with patients and encourage discussion and reflection on how to retrieve medical information while paying adequate attention to the patient’s and own emotions, experiences, and perspectives