دانلود رایگان مقاله انگلیسی مدیریت درخواست پزشکی پزشکان خانواده از خانواده و دوستان - NCBI 2018

ABSTRACT

PURPOSE Although guidelines generally state that physicians should not treat their family members or friends (nonpatients), physicians regularly receive medical requests from nonpatients. We aimed to explore junior and senior family physicians’ experiences with and attitudes toward managing medical requests from nonpatients. METHODS We conducted a qualitative study with 7 focus groups with junior and senior physicians. We performed a thematic analysis during an iterative cycle of data collection and analysis. RESULTS When confronted with a medical request from a nonpatient, physicians first oriented themselves to the situation: who is this person, what is he or she asking of me, and where are we? Physicians next considered the following interrelated factors: (1) nature/strength of the relationship with the nonpatient, (2) amount of trust in his/her own knowledge and skills, (3) expected consequences of making mistakes, (4) importance of work-life balance, and (5) risk of disturbing the physician-patient process. Senior physicians applied more nuanced considerations when deciding whether to respond, whereas junior physicians experienced more difficulties dealing with these requests, were less inclined to respond, and were more concerned about disturbing the existing relationship that a person had with his/her own physician. CONCLUSIONS This study provides insight into the complexity that physicians face when managing medical questions and requests from nonpatients. Facilitated group discussions during which experiences are shared can help junior physicians become more confident in dealing with these complex issues as they formulate their own personal strategy regarding provision of medical advice or treatment to family and friends.

DISCUSSION

All physicians in our study had experiences with requests for medical care from nonpatients. Our findings provide a framework for understanding how physicians engage with these requests, recognizing the central need for physicians to orient themselves to the situation (who, what, where) and articulating the 5 important subsequent considerations: what is the nature of the relationship with the person, how much do you trust your own expertise, are you afraid of making mistakes considering the consequences, how do you separate work and private lives, and how do you view the potential impact of advising or treating nonpatients on the physician-patient process? Senior physicians were more confident with handling medical questions from family or friends; through positive and negative experiences, they had learned to manage these dilemmas over time. Junior physicians found this process more difficult, and they were more cautious about avoiding the potential consequences and pitfalls.