THE HEART OF DARKNESS - THE IMPACT OF PERCEIVED MISTAKES ON PHYSICIANS
THE HEART OF DARKNESS - THE IMPACT OF PERCEIVED MISTAKES ON PHYSICIANS
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DOI：
10.1007/bf02599161
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发表时间：
1992-07-01
影响因子：
5.7
通讯作者：
DUNN, PM
中科院分区：
文献类型：
--
作者：
CHRISTENSEN, JF;LEVINSON, W;DUNN, PM
目的：描述医生如何思考和感受他们感知到的错误，检查医生先前的信念和处理错误的方式如何影响他们的情绪反应，并促进医学界对这一敏感问题的进一步讨论。设计：对医生进行录音的深入访谈，每位医生讨论之前的错误及其对他或她生活的影响。对访谈记录进行定性分析，并将数据组织为五个主题领域：错误的性质、医生对错误的信念、错误后的情绪体验、医生应对错误的方式以及由于错误而导致的医生实践的变化。参与者和环境：在俄勒冈州一家社区大学附属医院执业的11名普通内科医生和医学专科医生。结果：访谈分析得出的主题是临床实践中普遍存在的错误；很少向同事、家人和朋友自我披露错误；缺乏同事之间的支持；对医生的情感影响的程度，以至于一些错误甚至在几年后仍被详细地记得；以及医生的职业控制点对后续情绪的影响。结论：对犯错的认知对执业医师造成了显著的情绪困扰。这种痛苦的严重程度可能受到诸如先前信念和完美主义等因素的影响。医生与同事分担这种痛苦的程度可能受到医疗培训所产生的竞争程度的影响。在医疗培训和实践中，应更加突出对错误的公开讨论，并应继续研究这一主题。
Objectives: To describe how Physicians think and feel about their perceived mistakes, to examine bow physicians' prior beliefs and manners of coping with mistakes may influence their emotional a responses, and to promote further discussion in the medical community about this sensitive issue.Design: Audiotaped, in-depth interviews with physicians in which each physician discussed a previous mistake and its impact on his or her life. Transcripts of the interviews were analyzed qualitatively and the data organized into five topic areas: the nature of the mistake, the physician's beliefs about the mistake, the emotions experienced in the aftermath of the mistake, the physician's way of coping with the mistake, and changes in the Physician's Practice as a result of the mistake.Participants and setting: Eleven general internists and medical subspecialists practicing at a community, university-affiliated hospital in Oregon.Results: Themes emerging from analysis of the interviews were the ubiquity of mistakes in clinical practice; the infrequency of self-disclosure about mistakes to colleagues, family, and friends; the lack of support among colleagues; the degree of emotional impact on the physician so that some mistakes were remembered in great detail even after several years; and the influence of the Physician's professional locus of control on subsequent emotions.Conclusions: The perception of having made a mistake creates significant emotional distress for practicing physicians. The severity of this distress may be influenced by factors such as prior beliefs and perfectionism. The extent to which physicians share this distress with colleagues may be influenced by the degree of competitiveness engendered by medical training. Open discussion of mistakes should be more prominent in medical training and practice, and there should be continued research on this topic.