Beyond medical errors: exploring the interpersonal dynamics in physician-patient relationships linked to medico-legal complaints.

Autor: Mostafapour M; Department of Safe Medical Care Research, Canadian Medical Protective Association, Ottawa, Canada. mmostafapour@cmpa.org., Smith JD; Department of Safe Medical Care Research, Canadian Medical Protective Association, Ottawa, Canada., Fortier JH; Department of Safe Medical Care Research, Canadian Medical Protective Association, Ottawa, Canada., Garber GE; Department of Safe Medical Care Research, Canadian Medical Protective Association, Ottawa, Canada. research@cmpa.org.; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada. research@cmpa.org.; Faculty of Medicine, Department of Medicine, School of Public Health and Epidemiology, University of Ottawa, Ottawa, Canada. research@cmpa.org.
Jazyk: angličtina
Zdroj: BMC health services research [BMC Health Serv Res] 2024 Aug 29; Vol. 24 (1), pp. 1003. Date of Electronic Publication: 2024 Aug 29.
DOI: 10.1186/s12913-024-11457-3
Abstrakt: Background: Previous research suggests that medico-legal complaints often arise from various factors influencing patient dissatisfaction, including medical errors, physician-patient relationships, communication, trust, informed consent, perceived quality of care, and continuity of care. However, these findings are not typically derived from actual patients' cases. This study aims to identify factors impacting the interpersonal dynamics between physicians and patients using real patient cases to understand how patients perceive doctor-patient relational problems that can lead to dissatisfaction and subsequent medico-legal complaints.
Methods: We conducted a retrospective study using data from closed medical regulatory authority complaint cases from the Canadian Medical Protective Association (CMPA) between January 1, 2015, and December 31, 2020. The study population included patients who experienced sepsis and survived, with complaints written by the patients themselves. A multi-stage standardized thematic analysis using Braun and Clarke's approach was employed. Two researchers independently coded the files to ensure the reliability of the identified codes and themes.
Results: Thematic analysis of 50 patient cases revealed four broad themes: (1) Ethics in physician's work, (2) Quality of care, (3) Communication, and (4) Healthcare system/policy impacting patient satisfaction. Key sub-themes included confidentiality, honesty, patient involvement, perceived negligence, perceived lack of concern, active engagement and empathy, transparency and clarity, informed consent, respect and demeanor, lack of resources, long wait times, and insufficient time with physicians.
Conclusions: This study identifies and categorizes various factors impacting relational issues between physicians and patients, aiming to increase patient satisfaction and reduce medico-legal cases. Improving physicians' skills in areas such as communication, ethical practices, and patient involvement, as well as addressing systemic problems like long wait times, can enhance the quality of care and reduce medico-legal complaints. Additional training in communication and other skills may help promote stronger relationships between physicians and patients.
(© 2024. The Author(s).)
Databáze: MEDLINE
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