Jain A, Ogden J
Department of General Practice, Guy's, Kings and St Thomas's Medical Schools, Kings College London SE11 6SP.
BMJ. 1999 Jun 12;318(7198):1596-9. doi: 10.1136/bmj.318.7198.1596.
To examine how general practitioners experience patients' complaints.
General practices in Lambeth, Southwark, and Lewisham health authority.
Representative sample of 30 general practitioners who had had complaints made against them under either the old or new complaints system.
Qualitative study with detailed interviews.
Participants described their experiences of patients' complaints in three stages: initial impact, conflict, and resolution. The first stage described being out of control, feelings of shock and panic, and a sense of indignation towards patients generally. The second stage described the many conflicts generated by the complaint: emotional conflicts such as feelings of anger, depression, and even suicide, conflicts around aspects of professional identity including doubts about clinical competence, conflicts with family and colleagues, and conflicts arising from the management of the complaint. The third stage described a sense of resolution. For many this meant practising defensively, for others it meant planning to leave general practice, and for a minority no resolution was achieved. Not all participants, however, reported such a negative experience. Some described how they had become immune to complaints, and a small minority described the complaint as a learning experience.
The initial impact stage and conflict stage may be necessary aspects of the experience that general practitioners endure when they have a complaint made against them. Support structures should, however, be in place to help general practitioners through these stages.
探讨全科医生如何看待患者的投诉。
伦敦兰贝斯区、南华克区和刘易舍姆区卫生当局的全科医疗诊所。
从30名全科医生中选取的代表性样本,这些医生曾在旧的或新的投诉系统下收到针对他们的投诉。
采用详细访谈的定性研究。
参与者将他们对患者投诉的经历描述为三个阶段:初始影响、冲突和解决。第一阶段描述了失控感、震惊和恐慌情绪,以及对患者普遍的愤慨感。第二阶段描述了投诉引发的诸多冲突:情绪冲突,如愤怒、沮丧甚至自杀情绪;围绕职业身份方面的冲突,包括对临床能力的怀疑;与家人和同事的冲突;以及投诉管理引发的冲突。第三阶段描述了一种解决感。对许多人来说,这意味着采取防御性做法;对另一些人来说,这意味着计划离开全科医疗行业;而少数人则没有实现解决。然而,并非所有参与者都报告了如此负面的经历。一些人描述了他们如何对投诉变得免疫,少数人将投诉描述为一次学习经历。
初始影响阶段和冲突阶段可能是全科医生在收到针对他们的投诉时所经历的必要阶段。然而,应该建立支持结构来帮助全科医生度过这些阶段。