Physicians with multiple patient complaints: ending our silence.
Physicians with multiple patient complaints: ending our silence.
复制标题
面对多个患者投诉的医生：结束我们的沉默。
DOI：
10.1136/bmjqs-2013-001880
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发表时间：
2013
影响因子：
5.4
通讯作者：
Levinson,Wendy
中科院分区：
文献类型：
--
作者：
Gallagher,ThomasH;Levinson,Wendy
患者通常对他们的私人医生感到满意，并欣赏与他们的积极关系。在最近对美国近4000家医院的患者进行的医疗保健提供者和系统医院消费者评估（HCAHPS）调查中，81%的患者对与医生的沟通给予了最高分。[1]然而，一些医生很难与患者进行有效的互动。大多数有问题的患者与提供者的互动都被忽视了，除了患者。医生没有收到反馈，可能不知道他们的病人不满意。有时，与医生互动不良的患者会向医疗机构或州医学委员会等监管机构提出投诉。之前的研究，沿着Bismark及其同事在本期的研究，2强调了少数医生如何对大多数患者的投诉负责。[3]类似的研究结果以前也被证明是有问题的患者-提供者互动的其他标志，例如医疗事故索赔，当少数医生对大多数诉讼负责时。4 5鉴于许多患者对与医生的沟通感到不满，因此不愿投诉，目前关于患者投诉流行率的数据只是冰山一角。6一些组织正在系统地审查病人的投诉，以了解和改善提供者的沟通技巧和病人的满意度。3此外，患者投诉与其他衡量护理质量差距的指标相关。然而，从历史上看，医疗行业并没有特别认真地对待病人的投诉。在监管机构进行调查之前，通常需要多个正式的患者投诉或对单个医生的恶劣行为的指控。Bismark及其同事的严格研究记录了医生反复出现患者投诉的问题是多么普遍和令人担忧。2 3%的澳大利亚医生占患者投诉的49%，1%占患者投诉的25%。累积多次既往投诉的医生极有可能在未来发生投诉。与先前的研究一样，产生投诉的问题包括患者对临床护理和沟通障碍的担忧。6 8 9虽然这项研究是在澳大利亚进行的，但很可能在北美、英国和其他地方也会有类似的发现。
Patients are generally pleased with their personal physicians and appreciate positive relationships with them. In the recent Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey of patients in nearly 4000 US hospitals, 81% of patients gave the highest marks possible to their communication with their physicians. 1 Yet some physicians struggle to interact effectively with patients. The majority of problematic patient–provider interactions go unnoticed, except by the patient. The physicians do not receive feedback and may be unaware that their patients are dissatisfied. Sometimes patients who have had a poor interaction with their physician file a complaint, either with the healthcare institution or with a regulator such as a state Board of Medicine. Prior research, along with the study by Bismark and colleagues in this issue, 2 highlight how a small number of physicians are responsible for the majority of patient complaints. 3 Similar findings have been demonstrated previously for other markers of problematic patient–provider interactions such as malpractice claims, when a small minority of physicians are responsible for the majority of lawsuits. 4 5 Given the fact that many patients who are unhappy with the communication with their physicians hesitate to complain, the current data on the prevalence of patient complaints represent the tip of the iceberg. 6 Some organisations are systematically examining patient complaints to understand and improve providers’ communication skills and patient satisfaction. 3 Furthermore, patient complaints are associated with other measures of gaps in quality of care. 7 However, historically the medical profession has not taken patient complaints especially seriously. Multiple formal patient complaints or allegations of egregious behaviour about an individual physician are often required before regulators investigate.The rigorous study by Bismark and colleagues documents just how pervasive and concerning the problem of physicians with recurrent patient complaints is. 2 Three percent of Australian physicians accounted for 49% of patient complaints, and 1% accounted for 25% of patient complaints. Physicians who accumulated multiple prior complaints were highly likely to experience future complaints. As with prior studies, the problems that generated the complaints included a mixture of patient concerns about clinical care and communication breakdowns. 6 8 9 While the study was conducted in Australia, it is very likely that the findings would be similar in North America, the UK and elsewhere.