Surgeon as Double Agent: Perception of Conflicting Expectations of Patient Care and Stewardship of Resources.,Journal of the American College of Surgeons

当前位置： X-MOL 学术 › J. Am. Coll. Surg. › 论文详情

Our official English website, www.x-mol.net, welcomes your feedback! (Note: you will need to create a separate account there.)

Surgeon as Double Agent: Perception of Conflicting Expectations of Patient Care and Stewardship of Resources.
Journal of the American College of Surgeons ( IF 3.8 ) Pub Date : 2020-05-16 , DOI: 10.1016/j.jamcollsurg.2020.04.037
Piroska K Kopar ₁ , Felix Y Lui ₂

Affiliation

Background

Physicians must satisfy 2 competing expectations: advocate for patients and serve as stewards of resources. No guidelines exist for surgeons on resolving this conflict. We surveyed surgeons’ perceptions about these dual obligations.

Study Design

We conducted our study at 2 large university hospitals in 3 distinct steps, each built on the previous one. First, we surveyed 40 surgery residents and medical students using a 10-question assessment tool as the quantitative portion of our analysis. Next, a focus group of attending surgeons was surveyed to identify themes for the qualitative part of our study. Based on these, 5 attending surgeons from varying specialties were interviewed in a semi-structured format. We used the Wilcoxon signed rank test for quantitative analysis and content analysis to report our qualitative findings.

Results

Students and residents did not think that they faced resource allocation decisions; however, they observed attending surgeons face them regularly (p = 0.0003). Attending surgeons from various specialties agreed that they thought they were obligated to both provide excellent care and serve as a steward of resources. All surgeons agreed these obligations can conflict. Individual practices varied with all erring on the side of patient care. Concern about being an outlier in one’s section was a greater motivator to alter practice than was fear of litigation. No surgeon thought that patients had an adequate understanding of surgeons’ dual agency.

Conclusions

Surgeons balance the responsibilities of patient care and stewardship of resources with great variability. Diverse practices likely add to inequalities in healthcare delivery and increase mistrust. Surgeons’ social contract with patients calls for transparent strategies to address their dual agency.

中文翻译：

外科医生作为双重代理人：对患者护理和资源管理的期望发生冲突的看法。

背景

医师必须满足两个相互竞争的期望：倡导患者并担任资源管理者。没有针对外科医生解决此冲突的准则。我们调查了外科医生对这些双重义务的看法。

学习规划

我们在3个不同的步骤中分别在2家大型大学医院中进行了研究，每个步骤均基于前一个步骤。首先，我们使用10个问题的评估工具对40名外科住院医师和医学生进行了调查，以此作为我们分析的定量部分。接下来，对参加手术的外科医生的一个焦点小组进行了调查，以确定了本研究定性部分的主题。基于这些，以半结构化格式采访了5名来自不同专业的主治外科医生。我们使用Wilcoxon符号秩检验进行定量分析和内容分析，以报告我们的定性结果。

结果

学生和居民认为他们没有面临资源分配的决定。但是，他们观察到主治医生定期面对他们（p = 0.0003）。来自各个专业的外科医生都同意，他们认为他们有义务提供出色的护理并充当资源的管理者。所有外科医生都同意这些义务可能会发生冲突。个别做法各有不同，在患者护理方面都有所犯错。与担心诉讼相比，关注自己所在部门的异常是改变实践的更大动机。没有医生认为患者对医生的双重代理有足够的了解。