McMichael Lachlan C, Zambrano Sofia C, Crawford Gregory B
Central Adelaide Local Health Network, Adelaide, SA, Australia.
School of Psychology, University of Adelaide, Adelaide, SA, Australia.
Palliat Med. 2016 Oct;30(9):889-92. doi: 10.1177/0269216316639774. Epub 2016 Mar 24.
Dying physicians may present unique challenges to palliative care teams. Studies of dying physicians are scarce, but those that exist suggest a potential absence of a coordinating clinician, prolongation of curative treatments, resistance to palliative care input and barriers to discussing psychosocial needs.
The aim was to describe and examine the care provided to physician-patients referred to an Australian palliative care service, and to identify issues faced by the physician-patient and by the treating team.
A retrospective case-note audit of the case notes of medical practitioners referred for palliative care and dying between January 2007 and April 2013 was conducted.
There was evidence of medically qualified friends or family members initiating referrals and directing treatment decisions. There was some evidence of increased consultant-led decision-making and bypassing of usual referral pathways and systems for providing after-hours advice and calling consultants directly. There also appeared to be some reluctance by junior doctors to make decisions, because of the patient's desire for consultant-level advice only.
This study adds to the growing body of literature that identifies the potential difficulties associated with caring for medical practitioners. By understanding some of the complexity of this particular doctor-patient relationship, clinicians can approach the management of physician-patients facing the end of their lives with a more sound understanding of their particular care needs.
临终医生可能给姑息治疗团队带来独特的挑战。关于临终医生的研究很少，但现有研究表明可能缺乏协调的临床医生、延长了治愈性治疗、对姑息治疗的抵触以及在讨论心理社会需求方面存在障碍。
目的是描述和检查为转介至澳大利亚姑息治疗服务机构的医生患者提供的护理，并确定医生患者和治疗团队面临的问题。
对2007年1月至2013年4月期间转介接受姑息治疗并临终的医生的病历进行了回顾性病例记录审核。
有证据表明医学资格的朋友或家庭成员发起转介并指导治疗决策。有一些证据表明增加了由顾问主导的决策，绕过了通常的转介途径和提供非工作时间建议及直接联系顾问的系统。由于患者只希望获得顾问级别的建议，初级医生似乎也有些不愿意做出决策。
本研究增加了越来越多的文献，这些文献指出了照顾医生患者可能存在的潜在困难。通过了解这种特殊医患关系的一些复杂性，临床医生可以在更全面理解其特殊护理需求的基础上，对面临生命末期的医生患者进行管理。
