Mediation: an approach to intractable disputes between parents and paediatricians
Mediation: an approach to intractable disputes between parents and paediatricians
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DOI：
10.1136/adc.2010.191833
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发表时间：
2011-07-01
影响因子：
5.2
通讯作者：
Barclay, Sarah
中科院分区：
文献类型：
--
作者：
Meller, Simon;Barclay, Sarah
儿科从来都不是一帆风顺的，为了患病儿童的最大利益做出明智的治疗决定的过程，有时会导致卫生专业人员和父母之间的观点冲突。领导医疗保健小组的儿科医生通常会制定策略，在大多数这些争议中达成共识，通常是在与父母和小组其他成员讨论几天之后。如果任何健康专业人士认为，只有经验不足的同事缺乏必要的沟通技巧，才会发生棘手的纠纷，那将是愚蠢的。说“这种事绝不会发生在我身上”就是把自己的头埋在沙子里。最强烈表达的意见分歧可能出现在资源配给或撤销或停止维持生命治疗的情况下，特别是当问题涉及儿童生命的可能持续时间和质量时。因此，大多数严重的争议发生在新生儿、呼吸重症监护、肿瘤学、移植和姑息治疗领域。然而，在儿科实践的任何领域都可能出现棘手的僵局。如果儿科医生意识到自己正陷入其中一种情况，他们该如何应对？寻求第二医学意见通常是有帮助的，但它可能并不总是被视为完全独立的，如果第二医学意见与第一医学意见一致，则可能被视为顾问之间的勾结，甚至是一种微妙的胁迫形式。允许父母选择自己的第二意见的策略可能被证明是一个好策略，只要这个过程保持透明，不会导致拖延
It has never been all plain sailing in paediatrics and the process of making a wise treatment decision in the best interest of a sick child will, from time to time, result in a conflict of views between the health professionals and the parents. Paediatricians who lead healthcare teams will usually have developed strategies to reach consensual agreement in the great majority of these disputes, often after several days of discussion with the parents and different members of the team. It would be foolish for any health professional to think that an intractable dispute only happens when a less-experienced colleague is lacking the requisite communication skills. To say “this could never happen to me” is to bury your head in the sand.The most strongly expressed differences of view are likely to arise when there is a perceived rationing of resources or withdrawal or withholding of life-sustaining treatment, particularly when the issue concerns the likely duration and quality of the child’s life. Therefore the majority of serious disputes are encountered in the fields of neonatology, respiratory intensive care, oncology, transplantation and palliative care. However, an intractable impasse can arise in any area of paediatric practice. How should paediatricians behave if they sense that they are getting into one of these situations? To seek a second medical opinion is often helpful, but it may not always be viewed as completely independent and, should the second be in agreement with the first, it may be seen as collusion between consultants, or even a subtle form of coercion. The strategy of allowing parents to choose their own second opinion may prove to be a good one, as long as the process remains transparent and does not lead to prolonged