“Could this Be Something Serious?”
“Could this Be Something Serious?”
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“这会是很严重的事情吗？”
DOI：
--
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发表时间：
2007
影响因子：
5.7
通讯作者：
C. Shields
中科院分区：
文献类型：
--
作者：
R. Epstein;Taj Hadee;J. Carroll;Sean C. Meldrum;J. Lardner;C. Shields
背景以前的工作表明，探索和确认患者的担忧与更大的患者信任、更低的医疗成本、更好的咨询和更符合指导方针的护理相关。目的描述医生对患者担忧的反应，他们的反应如何根据临床情况(直接的和医学上无法解释的症状[MU])变化，以及他们的反应与患者对人际关系方面的护理评分之间的关系。对于每个医生，我们调查了50名当前患者，并秘密录制了2次未经宣布的标准化患者(SP)访问。SPS在以下两种情况下表示担心：直接的胃食道反流或特征不佳的MUS胸痛。PARTICIPANTSON 100名初级保健医生和4746名患者。测量护理的人际方面(信任、医生对患者的了解、满意度和患者活跃度)的调查。对189个成绩单进行定性编码，然后进行描述性、多变量和滞后序列分析。结果SP医生对613个SP提示平均提供3.1个回答。生物医学的询问和解释、行动、非特异性的承认和保证是常见的，而同理心、不确定的表达以及对心理社会因素和情绪的探索则不常见。在SP访问期间表现出的同理心与患者对护理的人际关系方面的较高评分有关。在对人口统计学和合并症进行调整后，这种关联只对MUS的作用有统计学意义。如果在对话序列的开头表达同理心，则最有可能发生。结论同理心与较高的患者人际关怀评分有关，特别是在涉及模棱两可的情况下表达时。同理心应该在耐心地表达担忧之后尽早表达。
BACKGROUNDPrevious work suggests that exploration and validation of patients’ concerns is associated with greater patient trust, lower health care costs, improved counseling, and more guideline-concordant care.OBJECTIVETo describe physicians’ responses to patients’ worries, how their responses varied according to clinical context (straightforward versus medically unexplained symptoms [MUS]) and associations between their responses and patients’ ratings of interpersonal aspects of care.DESIGNMultimethod study. For each physician, we surveyed 50 current patients and covertly audiorecorded 2 unannounced standardized patient (SP) visits. SPs expressed worry about “something serious” in 2 scenarios: straightforward gastroesophageal reflux or poorly characterized chest pain with MUS.PARTICIPANTSOne hundred primary care physicians and 4,746 patients.MEASUREMENTSPatient surveys measuring interpersonal aspects of care (trust, physician knowledge of the patient, satisfaction, and patient activation). Qualitative coding of 189 transcripts followed by descriptive, multivariate, and lag-sequential analyses.RESULTSPhysicians offered a mean of 3.1 responses to each of 613 SP prompts. Biomedical inquiry and explanations, action, nonspecific acknowledgment, and reassurance were common, whereas empathy, expressions of uncertainty, and exploration of psychosocial factors and emotions were uncommon. Empathy expressed during SP visits was associated with higher patient ratings of interpersonal aspects of care. After adjusting for demographics and comorbidities, the association was only statistically significant for the MUS role. Empathy was most likely to occur if expressed at the beginning of the conversational sequence.CONCLUSIONSEmpathy is associated with higher patient ratings of interpersonal care, especially when expressed in situations involving ambiguity. Empathy should be expressed early after patient expressions of worry.
更换医生：自愿退出主治医师执业的预测因素。
DOI：
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发表时间：
2001
期刊：
The Journal of family practice
影响因子：
--
作者：
Safran,DG;Montgomery,JE;Chang,H;Murphy,J;Rogers,WH
通讯作者：
Rogers,WH
影响因子：
120.7
作者：
Kravitz, RL;Epstein, RM;Franks, P
通讯作者：
Franks, P
将初级保健绩效与护理结果联系起来。
DOI：
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发表时间：
1998
期刊：
The Journal of family practice
影响因子：
--
作者：
Safran,DG;Taira,DA;Rogers,WH;Kosinski,M;Ware,JE;Tarlov,AR
通讯作者：
Tarlov,AR