病患担心与医师间的关系、获得照顾的机会多过技术上疏失


  July 29, 2004 - 虽然发生在门诊的医疗疏失不如开错刀引人注意,但试验显示,比起在医院发生的,它们是造成更多医疗错误的原因。然而,却不清楚到底什么样的错误,是实际发生在初级照料阶段,以及哪里一种错误或是伤害,对病患而言是最讨厌的。
  
  试验结果发现,不同于医师,担心的是医疗信息传递是怎么被中断,或是否有治疗疏失发生,病患更担心他们与医师间的关系及获得照料的机会中断。
  
  事实上,在电话访察中,病患指出221件有问题事件,有37%表示病患与医师间关系的中断,例如不尊重、不在乎或是花在病患上的时间不够;将近三分之一(29%)表示获得照料的机会中断是他们最在意的,而这可能导致一些可避免的医疗疏失,例如过长的诊间等待时间或是与医师约诊的时间太久。大约四分之一(24%)受访者表示技术上疏失,例如未能诊断、治疗或追踪;这项试验发表于7月/8月号的家庭医学学志(Annals of Family Medicine)。
  
  列治文维吉尼亚联邦大学家庭业务部门主任与教授,同时也是这项试验首席研究人员Anton J. Kuzel医师向Medscape表示,这项发现与我的经验相呼应,且忧心到底我们的健康系统发生了什么问题。他表示,如果这也引起群众的共鸣,这可能将争议推向什么样的问题应该是受到我们的注意,以及什么是值得我们关注的。
  
  为了评估病患关于发生在初级照护阶段,可能导致可避免的医疗疏失的看法,受过训练的电话征召人员访察成年受访者,包括有接受过家庭医师或是一般内科医师照料,或是他们的小孩有接受过小儿科医师或是家庭医师照料的人。有40位受访者回应,他们全都有医疗保险,分别代表俄亥俄州与维吉尼亚州的乡村、郊区、与乡村社区。病患总共提供38个描述221件有问题事件的记事,大部分都与特定伤害有关。
  
  在221件中有170件牵涉到可避免的精神上、身体上、或是经济上损害;病患最常描述的精神上损害(70%),例如发怒、挫折、对医师的信任下降、或是对于健康的忧虑。
  
  试验中,一位24岁男性受访者提供的意见,举出精神上受损病患说明他们与医师之间的互动情形。
  
  受试者表示,医师真的没有倾听我说些什么,以及我有什么感觉,我告诉他发生了什么事,但是他似乎早有定见,我告诉他并不如他想的那样,我的意思是,虽然我并不是医师,但是我知道我身体发生了什么事。
  
  Kuzel医师主张,虽然这样的认知可能不会引起象是药物不良反应这样令人注目的程度,它们应该与医师有关。有许多信息显示,如果病患与健康照料者之间维持有效治疗关系,这些病患可能较能配合他们,进而获得最好的治疗计画,就像控制糖尿病或高血压。他指出,我相信把注意力放在关系的质量上,将是十分重要的。
  
  试验发现,疼痛与无可避免的个人损失,是最常提到的身体以及经济上的损害。
  
  虽然这个试验样本数很小,且定性地将反应编码并不能用于统计分析其相关性,加上受访者年龄、性别、社经地位或是医师性别、专长或与病患关系的时间长短,并没有明显特征;不过,试验中发现,维吉尼亚州与俄亥俄州乡村、郊区以及乡村社区的非裔美人受访者,明显的受到种族歧视。
  
  Kuzel医师指出,虽然这项发现是很糟糕的,但不应该解释为初级照料医师在治疗他们的病患,或病患暴露在可避免的医疗疏失下,指责他们的一种手段。他表示,医师不需要被责备或是感到羞耻,但是我们要为发生这样事情的系统负责。

Patients More Worried About Cl

By Cathy Tokarski
Medscape Medical News

July 29, 2004 — Although medical errors that occur in clinic settings do not get the attention of a wrong-side surgery, studies show that they are the cause of more medical mistakes than those that take place in a hospital. Nevertheless, little is known about what kinds of errors actually occur in primary care settings and which mistakes or injuries are perceived to be most troublesome to patients.

Unlike physicians, who worry more about breakdowns in how medical information is transferred or whether treatment errors occur, patients are more concerned about breakdowns in the patient-clinician relationship and access to care, a new study finds.

In fact, 37% of the 221 problematic incidents described by patients during telephone surveys cited breakdowns in the patient-clinician relationship, such as disrespect or insensitivity or inadequate time spent. Nearly one third (29%) cited access breakdowns as their chief concern that could lead to a preventable medical error, such as an excessive office waiting time or lengthy delays in obtaining an appointment with a clinician. About one quarter (24%) of the respondents cited technical errors, such as a deficiency in a diagnosis or treatment and follow-up. The study appears in the July/August issue of the Annals of Family Medicine.

The findings "resonated with my own experience and worries about what is wrong with our health system," lead author Anton J. Kuzel, MD, MHPE, professor and chair of the Department of Family Practice at Virginia Commonwealth University in Richmond, told Medscape. "If this has resonance with people, it may push the debate about what constitutes problems that deserve our attention, and what is worthy of attention," he said.

To assess patients' opinions about events that occur in primary care settings that could lead to a preventable medical error, trained telephone recruiters sought adult respondents who had received care from a family physician or a general internist, or whose child had received care from a pediatrician or a family physician. Responses came from 40 individuals, all of whom had health insurance, and represented rural, suburban, and urban communities in Ohio and Virginia. Patients provided a total of 38 narratives describing 221 problematic incidents, most of which they linked to a specific harm.

Of the 221 incidents, 170 involved a preventable reported psychological, physical, or economic harm. Patients most often reported that a problematic incident caused a psychological harm (70%), such as anger, frustration, diminished trust in the clinician, or anxiety about health.

One of the comments offered by a 24-year-old male respondent in the study exemplified the psychological harm patients said they experienced in their encounters with clinicians.

"The doctor really wasn't listening to what I was saying, and it was like, I kinda told him what happened and he already had his mind made up about what happened, and I was trying to tell him that I didn't think that was it. I mean, I'm not a doctor or anything, but you kinda know what's going on with your body," the respondent said.

Although such perceptions may not rise to the same degree of concern as an adverse drug event, they should matter to physicians, Dr. Kuzel maintained. "There's a lot of information that shows if you have an effective therapeutic relationship between a patient and a health provider, those patients are more likely to adhere to the best treatment plans that are available to them," such as ones to control diabetes or hypertension, he said. "I believe that focusing on the [quality of] the relationship is terribly important in the long run."

Pain and unavoidable personal expenses were the most commonly mentioned physical and economic harms, the study found.

Although the study's small sample size and the qualitative coding of the responses do not permit a statistical analysis of association, there were no apparent patterns with respect to respondents' age, sex, or socioeconomic status, or clinicians' sex, specialty, or duration of the patient relationship. However, concerns about "apparent racism" were also heard from African-American respondents, which were mentioned in narratives from rural, suburban, and urban communities in both Virginia and Ohio, the study found.

The findings, although troubling, should not be interpreted as a criticism of the manner in which primary care physicians treat their patients or patients' exposed to preventable medical errors, Dr. Kuzel said.

"It's no blame or shame on physicians, but on us for having a system where this kind of stuff happens," he said.

Ann Fam Med. 2004;2(4):333-340

Reviewed by Gary D. Vogin, MD

    
相关报导
年长者的最大风险来自治疗本身而非治疗错误
2015/10/7 上午 09:25:09
骨盆检查:无症状妇女的新指引
2012/7/27 下午 01:48:38
小儿科住院医师支持减少工时
2012/6/13 上午 10:22:50

上一页
   1   2   3  




回上一页