Time and the patient-physician relationship
Time and the patient-physician relationship
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DOI：
10.1046/j.1525-1497.1999.00263.x
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发表时间：
1999-01-01
影响因子：
5.7
通讯作者：
Pantilat, SZ
中科院分区：
文献类型：
--
作者：
Dugdale, DC;Epstein, R;Pantilat, SZ
当一名医生一直是一份忙碌的工作。对于初级保健医生来说尤其如此，他们把为病人提供和协调全面护理作为他们的目标。要实现这一目标，需要具备广泛的医学知识，有效利用当地卫生保健系统，并关注病人生活和健康的“大局”和细节。对提供保健服务的技术资源进行了广泛的研究。重大进展经常出现在诊断检测、治疗和制药领域。现代信息传输技术使医生能够更容易地获取有关这些进步的信息，并有助于患者更好地了解医疗保健许多方面的变化。与此同时，医生可能会被要求将卫生保健资源的使用限制在被判断为“医疗必要”的服务上。将医生的时间作为一种资源的研究相对较少。1然而，无论是作为保健费用的贡献，还是作为医患关系中的一个关键因素，都有理由相信它应该得到更多的关注。此外，随着人们越来越重视医疗服务的价值和效率，医生和患者之间的优质时间是一种越来越宝贵的资源。医生花时间与患者面对面接触，收集信息，发展关系，做与就诊相关的行政工作，并维护他们的知识库。重要的是，时间总是有限的：无论医生面对什么要求，一天只有24小时。在目前的执业环境中，医生面临着越来越多的时间要求。不断增加的医疗保健交付管理要求(例如，服务和授权请求、利用情况审查流程)侵占了与患者相处的时间。1995年联邦基金的调查发现，41%的医生注意到1992年至1995年期间与病人相处的时间减少，43%的医生注意到与同事相处的时间减少。2由于医生队伍的社会和人口结构变化，许多医生有家庭责任，这减少了他们可用于工作的时间。这些因素已经把医生在执业和生活中的时间管理作为一个关键问题推到了前列。在这篇文章中，我们考察了限制时间对医患关系的影响。我们回顾了可归因于管理型医疗的影响。最后，我们提供了教授医学生和住院医生技能的建议，这些技能将有助于在面临时间压力的情况下建立和维持他们的医患关系。
Being a physician always has been a busy job. This is especially true for primary care physicians who set as their goal the delivery and coordination of comprehensive care for patients. Achieving such a goal requires availability, a broad spectrum of medical knowledge, effective use of the local health care system, and attention to both the “big picture” and the details of a patient’s life and health. The technical resources that go into the delivery of health care have been studied extensively. Major advances are frequent in the arenas of diagnostic testing, therapeutics, and pharmaceuticals. Modern information transfer technology has made physicians’ ability to access information about these advances easier and contributed to patients being more aware of changes in many aspects of health care. At the same time, physicians may be called on to limit utilization of health care resources to services that are judged to be “medically necessary.” There has been relatively little study of physician time as a resource. 1 Yet both as a contribution to health care costs and as a key element in patient-doctor relationships, there is reason to believe that it deserves more attention. Furthermore, with an increasing emphasis on value and efficiency in health care delivery, quality time between physician and patient is an increasingly valuable resource. Physicians spend time in face-to-face contact with patients gathering information, and developing a relationship, doing administrative work related to visits, and maintaining their knowledge base. Importantly, time is always finite: no matter what demands a physician faces, there are only 24 hours in a day. In the current practice environment, physicians face mounting demands on their time. Increasing administrative requirements for health care delivery (eg, service and authorization requests, utilization review processes) encroach on time spent with patients. The 1995 Commonwealth Fund survey found that 41% of physicians noted a decline in the amount of time spent with patients and 43% noted a decline in the amount of time spent with colleagues between 1992 and 1995. 2 Because of social and demographic changes in the physician workforce, many physicians have family responsibilities that reduce their time available for work. These factors have moved time management for physicians, in their practices and in their lives, to the forefront as a critical issue. In this article we examine the effects of limiting time on the patient-doctor relationship. We review the effects that are attributable to managed care. Finally, we offer recommendations for teaching medical students and residents skills that will help establish and maintain their patient-doctor relationships in the face of time pressure.