Stokes Tim, Dixon-Woods Mary, McKinley Robert K
Department of General Practice and Primary Health Care, University of Leicester, Leicester General Hospital, Leicester LE5 4PW, UK.
Fam Pract. 2003 Dec;20(6):628-34. doi: 10.1093/fampra/cmg602.
The aim of this study was to understand why GPs choose to end their relationship with patients by removing them from their lists.
Semi-structured interviews were carried out with 25 GPs from 22 general practices in Leicestershire. Qualitative analysis was performed using the constant comparative method. The main outcome measures were participants' accounts of removing patients from their lists.
GPs use removal as a means of ending their professional relationships with problematic patients. All of the doctors indicated that they wished to retain the right to remove patients and stressed that removal is a rare event which they only use as a "last resort". There are two distinct but overlapping types of patients who are most likely to become eligible for removal: "bad" patients, who break the rules of the doctor-patient or practice-patient relationship, and "difficult" patients, with whom the doctor-patient relationship is so strained that doctors feel they can no longer care for them. The doctors may choose to remove a patient without warning or else to write a short letter giving "relationship breakdown" as the reason. They find it hard to confront the patient openly about the difficulties in the relationship.
The ability to remove patients is a right that GPs value. They report that it is rare for them to seek to end their relationships with patients and, when they do, it is for reasons that are important in the maintenance of professional boundaries or fulfilling professional responsibilities.
本研究旨在了解全科医生（GPs）为何选择通过将患者从其名单中移除来结束与患者的关系。
对来自莱斯特郡22家普通诊所的25名全科医生进行了半结构化访谈。采用持续比较法进行定性分析。主要观察指标是参与者关于将患者从其名单中移除的描述。
全科医生将移除作为结束与有问题患者专业关系的一种手段。所有医生都表示希望保留移除患者的权利，并强调移除是一种罕见的情况，他们仅将其作为“最后手段”使用。有两种不同但重叠的患者类型最有可能被移除：“不良”患者，即违反医患或诊所与患者关系规则的患者；以及“难相处”患者，医患关系紧张到医生觉得无法再为其提供治疗。医生可能会选择在没有警告的情况下移除患者，或者写一封简短的信，以“关系破裂”作为理由。他们发现很难就关系中的困难与患者公开对峙。
移除患者的能力是全科医生重视的一项权利。他们报告说，他们很少寻求结束与患者的关系，而当他们这样做时，是出于维护专业界限或履行专业职责方面重要的原因。
