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基层医疗中的医疗差错与不确定性:年轻与经验丰富的全科医生应对策略的比较研究

Medical errors and uncertainty in primary healthcare: a comparative study of coping strategies among young and experienced GPs.

作者信息

Nevalainen Maarit, Kuikka Liisa, Pitkälä Kaisu

机构信息

Department of General Practice, University of Helsinki , Helsinki , Finland.

出版信息

Scand J Prim Health Care. 2014 Jun;32(2):84-9. doi: 10.3109/02813432.2014.929820. Epub 2014 Jun 10.

Abstract

OBJECTIVE

To study coping differences between young and experienced GPs in primary care who experience medical errors and uncertainty.

DESIGN

Questionnaire-based survey (self-assessment) conducted in 2011.

SETTING

Finnish primary practice offices in Southern Finland.

SUBJECTS

Finnish GPs engaged in primary health care from two different respondent groups: young (working experience ≤ 5 years, n = 85) and experienced (working experience > 5 years, n = 80).

MAIN OUTCOME MEASURES

Outcome measures included experiences and attitudes expressed by the included participants towards medical errors and tolerance of uncertainty, their coping strategies, and factors that may influence (positively or negatively) sources of errors.

RESULTS

In total, 165/244 GPs responded (response rate: 68%). Young GPs expressed significantly more often fear of committing a medical error (70.2% vs. 48.1%, p = 0.004) and admitted more often than experienced GPs that they had committed a medical error during the past year (83.5% vs. 68.8%, p = 0.026). Young GPs were less prone to apologize to a patient for an error (44.7% vs. 65.0%, p = 0.009) and found, more often than their more experienced colleagues, on-site consultations and electronic databases useful for avoiding mistakes.

CONCLUSION

Experienced GPs seem to better tolerate uncertainty and also seem to fear medical errors less than their young colleagues. Young and more experienced GPs use different coping strategies for dealing with medical errors.

IMPLICATIONS

When GPs become more experienced, they seem to get better at coping with medical errors. Means to support these skills should be studied in future research.

摘要

目的

研究基层医疗中经历过医疗差错和不确定性的年轻全科医生与经验丰富的全科医生在应对方式上的差异。

设计

2011年进行的基于问卷的调查(自我评估)。

地点

芬兰南部的基层医疗诊所。

研究对象

来自两个不同应答组的从事基层医疗的芬兰全科医生:年轻组(工作经验≤5年,n = 85)和经验丰富组(工作经验>5年,n = 80)。

主要观察指标

观察指标包括纳入的参与者对医疗差错的经历和态度、对不确定性的容忍度、他们的应对策略,以及可能(正面或负面)影响差错来源的因素。

结果

总共244名全科医生中有165名做出了回应(回应率:68%)。年轻全科医生比经验丰富的全科医生更频繁地表示害怕犯医疗差错(70.2%对48.1%,p = 0.004),并且比经验丰富的全科医生更频繁地承认在过去一年中犯过医疗差错(83.5%对68.8%,p = 0.026)。年轻全科医生较少倾向于因差错向患者道歉(44.7%对65.0%,p = 0.009),并且比经验更丰富的同事更频繁地发现现场会诊和电子数据库对避免错误有用。

结论

经验丰富的全科医生似乎比年轻同事更能容忍不确定性,并且似乎对医疗差错的恐惧也更小。年轻和经验更丰富的全科医生在应对医疗差错时使用不同的策略。

启示

当全科医生经验更丰富时,他们似乎在应对医疗差错方面做得更好。未来的研究应探讨支持这些技能的方法。

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