What to do when patients and physicians disagree? Qualitative research among physicians with different working experiences
Autor: | F.U.S. Mattace-Raso, Rozemarijn L van Bruchem-Visser, Ernst J. Kuipers, Inez de Beaufort |
---|---|
Přispěvatelé: | Internal Medicine, Public Health |
Jazyk: | angličtina |
Rok vydání: | 2020 |
Předmět: |
medicine.medical_specialty
media_common.quotation_subject 03 medical and health sciences 0302 clinical medicine Physicians medicine Terminal care Humans Narrative 030212 general & internal medicine Qualitative Research media_common Physician-Patient Relations business.industry Geriatrics gerontology Communication Distress Treatments General medicine Comprehension 030220 oncology & carcinogenesis Family medicine business Know-how Autonomy Qualitative research Research Paper |
Zdroj: | European Geriatric Medicine, 11(4), 659-666. Elsevier Masson European Geriatric Medicine |
ISSN: | 1878-7649 |
Popis: | Key summary points Aim To understand the challenges experienced by physicians when their opinion on medical decisions differ from those of patients or relatives. Findings Physicians felt uncomfortable when there was disagreement between themselves and patients or relatives. Frustration was felt when relatives spoke on behalf of the patient, while there was no evidence the desired decision was ever expressed by the patient. A disagreement with a patient was described as being less frustrating, when the patient was able to explain the reasons for making a decision. Differences in background, especially religious, were often mentioned as complicating communication. Message Efforts must be made to establish a bond of trust between patient, relatives and physician. The use of advance directives should be encouraged. In case of an impasse between a physician and patient or relative, advice can be sought from other professionals. Purpose Impasses between patients, relatives and physicians occur frequently. With the growing attention for shared decision making, it is valuable to know how impasses arise. To understand the challenges experienced by physicians when their opinion on medical decisions differ from those of patients or relatives. Methods Fifteen physicians with different working experiences, from five medical specialties were interviewed using a narrative approach. Interviews were based on two patient stories provided by the physician. First of a patient (or relative) who did not want to adhere to a treatment the physician deemed necessary, and the second of a patient (or relative) who requested a treatment the physician felt was unnecessary. Data were analyzed using a bottom-up approach, with identification of five themes (autonomy of the patient, communication, emotions, circumstances and metaphors). Twenty subthemes were formed. Results 693 references were made. Six major nodes were identified: frustration experienced by the physician, role of the relatives, agreement, cultural/religious aspects, comprehension by the patient of the situation and the existence of an established relationship between patient and physician. Conclusions Physicians felt uncomfortable when there was disagreement between themselves and patients or relatives. Frustration was felt when relatives spoke on behalf of the patient, while there was no evidence the desired decision was ever expressed by the patient. A disagreement with a patient was described as being less frustrating, when the patient was able to explain the reasons for making a decision. Differences in background, especially religious, were often mentioned as complicating communication. |
Databáze: | OpenAIRE |
Externí odkaz: |