Veldhuis M, Wigersma L, Okkes I
Department of General Practice, Academic Medical Centre, Amsterdam.
Br J Gen Pract. 1998 Dec;48(437):1833-6.
When general practitioners (GPs) act contrary to their own standards of good practice, they usually cite patient demands as the main reason. However, up until now, studies have relied on doctors' recollections of departures from their own norms, which may be unreliable.
To systematically explore GPs' motives for deliberate departures from their own conception of good practice.
Forty-nine GPs, over five days, registered to what extent they had deviated from their own norms, and recorded the motives underlying any deviation.
Of the 6087 consultations registered, 10% contained some departure from 'good' general practice, the majority (75%) of which was perceived by the doctor concerned as 'slight'. Doctors underpinned their departures mostly by referring to the doctor-patient relationship: the wish to be nice was used, on average, in 42% of deviations, and the wish to prevent a conflict in 30%. The most important non-relational motive was clinical uncertainty, which doctors used in 11% of their cases.
Contrary to common belief, GPs often comply with patient requests because they wish to, and not because they feel forced to. Whether or not this behaviour affects the quality of care is largely dependent on the model of 'good' general practice used.
当全科医生的行为违背其自身的良好医疗规范时，他们通常将患者的要求作为主要原因。然而，到目前为止，研究一直依赖于医生对偏离自身规范情况的回忆，而这可能并不可靠。
系统地探究全科医生故意偏离其自身良好医疗观念的动机。
49名全科医生在五天时间里记录了他们偏离自身规范的程度，并记录了任何偏离行为背后的动机。
在记录的6087次诊疗中，10%在一定程度上偏离了“良好”的全科医疗规范，其中大多数（75%）被相关医生认为是“轻微”的。医生们偏离规范的主要依据是医患关系：平均而言，42%的偏离行为是出于“想表现友善”的愿望，30%是出于“想避免冲突”的愿望。最重要的非关系性动机是临床不确定性，医生在11%的病例中提到了这一点。
与普遍看法相反，全科医生经常遵从患者的要求是因为他们愿意，而不是因为他们感到被迫。这种行为是否会影响医疗质量在很大程度上取决于所采用的“良好”全科医疗模式。
