Resident training in psychopathology and uncertainty in a clinical situation

• Published in: Health (London, England : 1997) Vol. 28; no. 2; pp. 290 - 312
• Main Authors: Hamui Sutton, Alicia, Sánchez-Guzmán, María Alejandra
• Format: Journal Article
• Language: English
• Published: London, England SAGE Publications 01-03-2024; Sage Publications Ltd
• Subjects: Communication; Humans; Mental Disorders - diagnosis; Mental Disorders - therapy; Narratives; Psychiatry; Psychopathology; Teaching; Training; Uncertainty; profession and professionalization; mental health; ethnography; narrative analysis
• ISSN: 1363-4593; 1461-7196; 1461-7196
• DOI: 10.1177/13634593221127821

The central theme of this article is the way in which psychiatry physicians-in-training deal with uncertainty in the discussion of clinical cases in Mexico. Methodologically, it is approached from the field of clinical ethnography and the narrative interpretation of plots in performative actions where there are sequences of communicative exchanges. In this way, it focuses on a detailed description of situations where clinical cases are reviewed to decipher, explain, and understand intersubjective meanings in the face of the emergence of uncertainty, its management, and the implications on decisions and actions. The study finds that limitations within the field of psychiatry lie in the nosographic construction of disease and its translation into the diagnostic hypotheses made by clinicians, where there are wide margins of ambiguity. The strategies implemented in the face of uncertainty are use of drugs, the collegiate review of the case, and utilization of intuition as a spontaneous, preconscious daily practice. The specific case described here provides a microscopic observation of the complex scenarios in which uncertainty occurs in educational and teaching processes, clearly revealing how patient care is articulated. The narratives and their interpretation are materials for training/curriculum and psychiatric clinical practice.