Mutual mistrust in the medical care of drug users - The keys to the ''narc'' cabinet
Mutual mistrust in the medical care of drug users - The keys to the ''narc'' cabinet
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DOI：
10.1046/j.1525-1497.2002.10625.x
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发表时间：
2002-05-01
影响因子：
5.7
通讯作者：
Bradley, KA
中科院分区：
文献类型：
--
作者：
Merrill, J;Rhodes, LA;Bradley, KA
目的：照顾活跃的吸毒者是具有挑战性的。为了更好地了解非法药物使用患者和他们的医生之间的关系往往很困难，我们试图找出主要问题，出现在他们的互动在教学hospital.Design：探索性定性分析的数据，从直接观察病人护理的相互作用和采访的药物使用患者和他们的医生。19例最近活跃的药物使用，主要是阿片类药物的使用，和他们的8个医生teams.Results：出现了四个主要的主题。首先，医生害怕被吸毒的病人欺骗。特别是，他们质疑患者要求阿片类药物治疗疼痛或戒断是否可能是由于成瘾行为，而不是“医学指示”的需要。其次，他们缺乏一个标准的方法来解决常见的临床问题，特别是评估和治疗疼痛和阿片类药物戒断。由于病人的主观症状报告是可疑的，医生努力寻找适当的阿片类药物处方的标准。第三，医生避免让患者参与关键投诉，并表示他们对这些患者的态度感到不适和不确定。第四，吸毒患者敏感的可能性差的医疗保健，往往解释医生的不一致或医院效率低下的迹象故意abraftment.CONCLUSION：医生和吸毒患者在教学医院设置显示相互不信任，特别是关于阿片类药物处方。医生对欺骗、前后矛盾和回避的恐惧与病人对他们受到虐待和侮辱的担忧相互作用。医学教育应该更加关注成瘾医学和疼痛管理。
OBJECTIVE: Caring for patients who are active drug users is challenging. To better understand the often difficult relationships between Illicit drug-using patients and their physicians, we sought to identify major issues that emerge during their interactions in a teaching hospital.DESIGN: Exploratory qualitative analysis of data from direct observation of patient care interactions and interviews with drug-using patients and their physicians.SETTING: The inpatient internal medicine service of an urban public teaching hospital.PARTICIPANTS: Nineteen patients with recent active drug use, primarily opiate use, and their 8 physician teams.RESULTS: Four major themes emerged. First, physicians feared being deceived by drug-using patients. In particular, they questioned whether patients' requests for opiates to treat pain or withdrawal might result from addictive behavior rather than from "medically indicated" need. Second, they lacked a standard approach to commonly encountered clinical issues, especially the assessment and treatment of pain and opiate withdrawal. Because patients' subjective report of symptoms Is suspect, physicians struggled to find criteria for appropriate opiate prescription. Third, physicians avoided engaging patients regarding key complaints, and expressed discomfort and uncertainty in their approach to these patients. Fourth, drug-using patients were sensitive to the possibility of poor medical care, often interpreting physician inconsistency or hospital Inefficiency as signs of intentional mistreatment.CONCLUSION: Physicians and drug-using patients in the teaching hospital setting display mutual mistrust, especially concerning opiate prescription. Physicians' fear of deception, inconsistency and avoidance interacts with patients' concern that they are mistreated and stigmatized. Medical education should focus greater attention on addiction medicine and pain management.