背景:我们当代时期的社会和技术突变破坏了医生与患者之间关系中普遍存在的传统二元关系。
目的:患者征求第二意见可能会改变这种二元关系,并降低相关利益相关者之间的相互信任。医患关系经常从病人的角度来研究,但是从脊柱外科医生的角度来看,数据很少。
方法:这项定性研究采用了扎根理论的方法,一种强调现场数据并拒绝预定假设的归纳法。
方法:我们采访了不同年龄的脊柱外科医生,经验,和练习地点。我们最初联系了30名从业者,但最终人数(24次访谈;11名骨科医师和13名神经外科医师)是由数据饱和度(即没有新主题出现的时间点)决定的.
方法:使用半结构化访谈分析主题和子主题,直到达到饱和为止。
方法:通过个人访谈收集数据,使用专门的软件独立地进行主题分析,由三名研究人员(一名人类学家,精神病医生,和神经外科医生)。
结果:当患者寻求第二意见时,就定义了索引外科医生,而求助外科医生则定义为被要求提供第二意见的外科医生。数据分析根据访谈中反复出现的因素确定了五个总体主题:(1)分析患者寻求第二意见的动机;(2)受损的信任和不忠;(3)自我,权威,和外科医生形象;(4)咨询追索权的管理(测量和道德);(5)作为回避策略的第二种意见。尽管医患关系存在固有的不对称性,外科医生和患者根据他们的观点(专业或消费主义者)共享两个对称的连续体,一方面涉及权力和控制,另一方面涉及忠诚和自治。这些共同的要素可以在索引咨询(寻求高层关怀/尊重信任/缩小忠诚度差距/管理脱离接触)和推荐咨询(客观和独立的建议/信任索引建议/避免消极和引起焦虑的情况)中找到。
结论:第二意见通常对脊柱外科医生具有负面含义,他们认为这违反了忠诚和信任,而不忽视他们与患者关系中的自我伤害。范式转变将使第二种意见被视为宝贵的资源,可以扩大医患关系并优化共享的手术决策过程。
BACKGROUND: The social and technological mutation of our contemporary period disrupts the traditional dyad that prevails in the relationship between physicians and patients.
OBJECTIVE: The solicitation of a second opinion by the patient may potentially alter this dyad and degrade the mutual trust between the stakeholders concerned. The doctor-patient relationship has often been studied from the patient\'s perspective, but data are scarce from the spine surgeon\'s point of view.
METHODS: This qualitative
study used the grounded theory approach, an inductive methodology emphasizing field data and rejecting predetermined assumptions.
METHODS: We interviewed spine surgeons of different ages, experiences, and practice locations. We initially contacted 30 practitioners, but the final number (24 interviews; 11 orthopedists and 13
neurosurgeons) was determined by data saturation (the point at which no new topics appeared).
METHODS: Themes and subthemes were analyzed using semistructured interviews until saturation was reached.
METHODS: Data were collected through individual interviews, independently analyzed thematically using specialized software, and triangulated by three researchers (an anthropologist, psychiatrist, and neurosurgeon).
RESULTS: Index surgeons were defined when their patients went for a second opinion and recourse surgeons were defined as surgeons who were asked for a second opinion. Data analysis identified five overarching themes based on recurring elements in the interviews: (1) analysis of the patient\'s motivations for seeking a second opinion; (2) impaired trust and disloyalty; (3) ego, authority, and surgeon image; (4) management of a consultation recourse (measurement and ethics); and (5) the second opinion as an avoidance strategy. Despite the inherent asymmetry in the doctor-patient relationship, surgeons and patients share two symmetrical continua according to their perspective (professional or consumerist), involving power and control on the one hand and loyalty and autonomy on the other. These shared elements can be found in index consultations (seeking high-level care/respecting trust/closing the loyalty gap/managing disengagement) and referral consultations (objective and independent advice/trusting of the index advice/avoiding negative and anxiety-provoking situations).
CONCLUSIONS: The second opinion often has a negative connotation with spine surgeons, who see it as a breach of loyalty and trust, without neglecting ego injury in their relationship with the patient. A paradigm shift would allow the second opinion to be perceived as a valuable resource that broadens the physician-patient relationship and optimizes the shared surgical decision-making process.