Can patients tell when they are unwanted? "Turfing" in residency training
Can patients tell when they are unwanted? "Turfing" in residency training
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DOI：
10.1016/j.pec.2003.12.014
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发表时间：
2005-01-01
影响因子：
3.5
通讯作者：
Frankel, RM
中科院分区：
文献类型：
--
作者：
Caldicott, CV;Dunn, KA;Frankel, RM
目的：当医生认为照顾病人的麻烦大于回报时，他或她可以转移——“地盘”，不受欢迎的病人从他或她自己的地盘转移到另一个医生的地盘。接受这类病人的医生会对照顾那些被其他医生“圈地”给他们的病人感到负担和怨恨，然而这种“圈地之争”对病人护理的影响却知之甚少。本研究的目的是发现如果“turf”患者（TPs）体验他们的住院不同的病人入院被他们的医生认为更有利。设计：半结构化、深度访谈。人口：26名讲英语的患者在三级大学医院接受医疗服务。结果：基于访谈录音带和笔录的定性专题分析的住院经验。结果：被认为是“草皮”的患者的经历与被认为更合适的患者在两个方面有所不同：入院方式和访谈主题的语气。TPs通过急诊科或院内转院入院；不像“合适的”病人（APs），没有一个来自医院外。尽管两组患者表达了许多相似的主题，但几乎所有的TP访谈主题都是不利的。相比之下，美联社的受访者表达了有利和不利的主题。TPs直接而明确地表达了他们的愤怒和沮丧，而ap则将幽默与抱怨混合在一起。结论：“草包”患者可能与那些被认为适合医疗服务的患者有不同的护理经历。跨专业障碍的合作和以关系为中心的护理塑造了医生对患者适当性和可取性的看法，值得进一步的大规模探索。2004爱思唯尔爱尔兰有限公司版权所有。
Objectives: When a physician believes that the troubles of caring for a patient outweigh the rewards, he or she can move-"turf", the unwanted patient from his or her own to another physician's territory. Physicians receiving such patients can feel burdened by, and resentful about, caring for those who are "turfed" to them by other physicians, yet little is known about the effects such "turf battles" have on patient care. This study aims to discover if "turfed" patients (TPs) experience their hospitalizations differently from patients whose admissions are perceived more favorably by their physicians. Design: Semi-structured, in-depth interviews. Population: Twenty Six English-speaking patients on a medical service in a tertiary care university hospital. Outcomes: Hospitalization experiences based on qualitative thematic analysis of interview audiotapes and transcripts. Results: The experience of patients perceived as "turfs" differed from patients deemed more appropriately admitted in two areas: mode of admission and tone of interview themes. TPs were admitted via the emergency department or intra-hospital transfer; unlike the "appropriate" patients (APs), none came from outside hospitals. Although patients in both groups voiced many similar themes, nearly all TP interview themes were unfavorable. AP interviewees, by comparison expressed both favorable and unfavorable themes. TPs were direct and explicit about their anger and frustration, while APs mixed humor with complaints. Conclusions: "Turfed" patients may have different care experiences from those of patients deemed appropriate for a medical service. Inter-specialty barriers to collegiality and relationship-centered care shape physicians' perceptions of patient appropriateness and desirability and merit further large-scale exploration. (C) 2004 Elsevier Ireland Ltd. All rights reserved.