背景:先前的研究表明,医学法律投诉通常是由影响患者不满的各种因素引起的,包括医疗错误,医患关系,通信,信任,知情同意,感知的护理质量,和护理的连续性。然而,这些发现通常不是来自实际患者的病例。这项研究旨在使用真实的患者案例来确定影响医生和患者之间人际关系动态的因素,以了解患者如何看待可能导致不满和随后的医学法律投诉的医患关系问题。
方法:我们在2015年1月1日至2020年12月31日期间,使用来自加拿大医学保护协会(CMPA)的封闭医疗监管机构投诉案件的数据进行了回顾性研究。研究人群包括经历脓毒症并存活的患者,病人自己写的投诉。采用布劳恩和克拉克的方法进行多阶段标准化主题分析。两名研究人员独立对文件进行编码,以确保已识别代码和主题的可靠性。
结果:对50例患者的主题分析揭示了四个广泛的主题:(1)医师工作中的道德,(2)护理质量,(3)沟通,和(4)影响患者满意度的医疗保健系统/政策。关键子主题包括保密,诚实,患者参与,感知到的疏忽,感知到缺乏关注,积极参与和同理心,透明度和清晰度,知情同意,尊重和举止,缺乏资源,漫长的等待时间,和医生在一起的时间不够。
结论:这项研究确定了影响医生和患者之间关系问题的各种因素,并对其进行了分类。旨在提高患者满意度,减少医疗案件。提高医生在沟通等领域的技能,伦理实践,和病人的参与,以及解决系统问题,如等待时间长,可以提高护理质量,减少医疗法律投诉。额外的沟通和其他技能培训可能有助于促进医生和患者之间更牢固的关系。
BACKGROUND: Previous research suggests that medico-legal complaints often arise from various factors influencing patient dissatisfaction, including medical errors, physician-patient relationships, communication, trust, informed consent, perceived quality of care, and continuity of care. However, these findings are not typically derived from actual patients\' cases. This study aims to identify factors impacting the interpersonal dynamics between physicians and patients using real patient cases to understand how patients perceive doctor-patient relational problems that can lead to dissatisfaction and subsequent medico-legal complaints.
METHODS: We conducted a retrospective study using data from closed medical regulatory authority complaint cases from the Canadian Medical Protective Association (CMPA) between January 1, 2015, and December 31, 2020. The study population included patients who experienced sepsis and survived, with complaints written by the patients themselves. A multi-stage standardized thematic analysis using Braun and Clarke\'s approach was employed. Two researchers independently coded the files to ensure the reliability of the identified codes and themes.
RESULTS: Thematic analysis of 50 patient cases revealed four broad themes: (1) Ethics in physician\'s work, (2) Quality of care, (3) Communication, and (4) Healthcare system/policy impacting patient satisfaction. Key sub-themes included confidentiality, honesty, patient involvement, perceived negligence, perceived lack of concern, active engagement and empathy, transparency and clarity, informed consent, respect and demeanor, lack of resources, long wait times, and insufficient time with physicians.
CONCLUSIONS: This study identifies and categorizes various factors impacting relational issues between physicians and patients, aiming to increase patient satisfaction and reduce medico-legal cases. Improving physicians\' skills in areas such as communication, ethical practices, and patient involvement, as well as addressing systemic problems like long wait times, can enhance the quality of care and reduce medico-legal complaints. Additional training in communication and other skills may help promote stronger relationships between physicians and patients.