Nortvedt P, Pedersen R, Grøthe K H, Nordhaug M, Kirkevold M, Slettebø A, Brinchmann B S, Andersen B
Department of General Practice and Community Medicine, Section for Medical Ethics, University of Oslo, PO Box 1130 Blindern, NO-0318 Oslo, Norway.
J Med Ethics. 2008 May;34(5):332-5. doi: 10.1136/jme.2007.020693.
Although fair distribution of healthcare services for older patients is an important challenge, qualitative research exploring clinicians' considerations in clinical prioritisation within this field is scarce.
To explore how clinicians understand their professional role in clinical prioritisations in healthcare services for old patients.
A semi-structured interview-guide was employed to interview 45 clinicians working with older patients. The interviews were analysed qualitatively using hermeneutical content analysis.
20 physicians and 25 nurses working in public hospitals and nursing homes in different parts of Norway.
The clinicians struggle with not being able to attend to the comprehensive needs of older patients, and being unfaithful to professional ideals and expectations. There is a tendency towards lowering the standards and narrowing the role of the clinician. This is done in order to secure the vital needs of the patient, but is at the expense of good practice and holistic role modelling. Increased specialisation, advances and increase in medical interventions, economical incentives, organisational structures, and biomedical paradigms, may all contribute to a narrowing of the clinicians' role.
Distributing healthcare services in a fair way is generally not described as integral to the clinicians' role in clinical prioritisations. If considerations of justice are not included in clinicians' role, it is likely that others will shape major parts of their roles and responsibilities in clinical prioritisations. Fair distribution of healthcare services for older patients is possible only if clinicians accept responsibility in these questions.
尽管为老年患者公平分配医疗服务是一项重大挑战，但在该领域探索临床医生在临床优先级考量方面的定性研究却很匮乏。
探讨临床医生如何理解他们在老年患者医疗服务临床优先级确定中的专业角色。
采用半结构化访谈指南对45名从事老年患者工作的临床医生进行访谈。运用诠释学内容分析法对访谈进行定性分析。
挪威不同地区公立医院和养老院的20名医生和25名护士。
临床医生因无法满足老年患者的全面需求以及违背专业理想和期望而感到困扰。存在降低标准和缩小临床医生角色的趋势。这样做是为了确保患者的关键需求，但却以良好的医疗实践和整体角色示范为代价。专业化程度的提高、医疗干预的进步和增加、经济激励、组织结构以及生物医学范式，都可能导致临床医生角色的缩小。
公平分配医疗服务通常未被描述为临床医生在临床优先级确定中角色的组成部分。如果临床医生的角色中不包含对公平的考量，那么很可能其他人会塑造他们在临床优先级确定中角色和责任的主要部分。只有临床医生在这些问题上承担责任，才有可能为老年患者公平分配医疗服务。
