Hospitalists' perspectives on challenging patient encounters and physician well-being: A qualitative study
Hospitalists' perspectives on challenging patient encounters and physician well-being: A qualitative study
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DOI：
10.1016/j.pec.2021.08.023
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发表时间：
2022-05-16
影响因子：
3.5
通讯作者：
Patel, Hemali
中科院分区：
文献类型：
--
作者：
Fosnot, Lisa;Jones, Christine D.;Patel, Hemali
目的：病人的遭遇会导致医生的倦怠，尽管很少有人知道这些具体如何影响住院医生。本研究探讨了住院医师如何表征具有挑战性的患者遭遇及其对住院医师幸福感的影响，以告知组织努力。方法：我们对两个地点的15名医生住院医师教师进行了定性，描述性研究，一所三级学术和安全网医院，利用基于斯坦福大学健康框架的概念框架，围绕具有挑战性的患者遭遇进行医生弹性。结果：出现了两个主题：无助感和耗时的遭遇。无助感与系统问题、患者/提供者目标不一致和暴力有关。耗时的遭遇是由于系统问题，需要长时间对话的目标不一致，以及耐心因素。这些因素被发现对住院医生的幸福感产生负面影响。弹性策略包括发展和教学的同理心，并寻求专家/同事的意见，通过汇报，同行互动，和external resources.Conclusions：组织战略，以支持住院医生在具有挑战性的患者遭遇的背景下，需要一个多方面的方法：改进系统流程，培养当地的同理心建设文化，并支持同行关系和汇报机制。除了沟通技巧和正念之外，围绕系统流程改进和健康文化加强沟通，可以改善住院医生的健康状况。(C)2021爱思唯尔有限公司版权所有。
Objective: Challenging patient encounters contribute to physician burnout, though little is known about how these impact hospitalists specifically. This study explores how hospitalists characterize challenging patient encounters and their impact on hospitalist well-being to inform organizational efforts.Methods: We conducted a qualitative, descriptive study with 15 physician hospitalist faculty at two locations, a tertiary academic and safety-net hospital, utilizing a conceptual framework based on the Stanford Wellness Framework for physician resilience around challenging patient encounters.Results: Two themes emerged: feelings of helplessness and time-consuming encounters. Helplessness was associated with systems issues, misaligned patient/provider goals, and violence. Time-consuming encounters were due to systems issues, misaligned goals requiring prolonged conversations, and patient factors. These factors were found to negatively impact hospitalist well-being. Resilience strategies included developing and teaching empathy and seeking expert/colleague opinion through debriefing, peer-to-peer interactions, and external resources.Conclusions: Organizational strategies to support hospitalists in the context of challenging patient encounters require a multifaceted approach: improved system processes, fostering a local culture of empathy-building, and supporting peer-to-peer relationships and debriefing mechanisms.Practice implications: Enhanced communication around system process improvements and culture of wellness, in addition to communication skills and mindfulness, could improve hospitalist well-being. (C) 2021 Elsevier B.V. All rights reserved.