BACKGROUND Although it is the moral duty of physicians to protect vulnerable patients, there are no data on how vulnerability is perceived in clinical practice. This study explores how physicians classify someone as "vulnerable". METHOD Thirty-three physicians were initially questioned about resource allocation problems in their work. The results of these interviews were examined with qualitative study software to identify characteristics associated with vulnerability in patients. Data were conceptualized, classified and cross-linked to highlight the major determinants of vulnerability. The findings revealed the principal factors that make patients vulnerable in clinical practice, according to our definition of vulnerability: the likelihood of having one's interests unjustly considered. RESULTS Vulnerability can arise as a result of a mismatch between the characteristics of patients and physicians, the healthcare system, the treatment, or the communication between physicians and patients. Vulnerability appears as a gap between a patient's needs and the means intended to meet them. Vulnerability can further be the result of doing too little or too much for patients. This result suggests that structures provided by healthcare systems are not as differentiated as they should be to cover all situations. Our initial definition of vulnerability was illustrated and supported by our results, showing that it encompasses all factors involved, not solely personal characteristics, indicating the need for a more pragmatic approach for use in clinical practice. CONCLUSION Vulnerability is not due to a single factor but appears under certain circumstances when there is a discrepancy between a patient's interests and the care provided, despite existing compensation systems.

中文翻译：

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在临床实践中发现的漏洞：定性分析。

背景技术尽管保护脆弱的患者是医师的道德义务，但是没有关于如何在临床实践中感知脆弱性的数据。这项研究探索了医生如何将某人归类为“弱势群体”。方法最初向33位医生询问了工作中的资源分配问题。使用定性研究软件检查了这些访谈的结果，以确定与患者脆弱性相关的特征。对数据进行概念化，分类和交叉链接，以突出显示脆弱性的主要决定因素。根据我们对脆弱性的定义，研究结果揭示了使患者在临床实践中容易受到伤害的主要因素：不公正地考虑了自身利益的可能性。结果由于患者和医师的特征，医疗保健系统，治疗方法或医师与患者之间的沟通不匹配，可能导致漏洞。脆弱性表现为患者需求与满足需求的手段之间的鸿沟。漏洞可能是对患者做的太少或太多的结果。该结果表明，医疗保健系统提供的结构没有涵盖所有情况的差异。我们的结果阐明并支持了我们对漏洞的最初定义，表明该漏洞涵盖了所涉及的所有因素，而不仅仅是个人特征，这表明需要在临床实践中使用更务实的方法。