Department of Family Medicine, Maastricht University, CAPHRI Care and Public Health Research Institute, Maastricht, The Netherlands
Department of Educational Development and Research, Maastricht University, School of Health Professions Education (SHE), Maastricht, The Netherlands.
Ann Fam Med. 2018 Jan;16(1):45-51. doi: 10.1370/afm.2152.
Although guidelines generally state that physicians should not treat their family members or friends (nonpatients), physicians regularly receive medical requests from nonpatients. We aimed to explore junior and senior family physicians' experiences with and attitudes toward managing medical requests from nonpatients.
We conducted a qualitative study with 7 focus groups with junior and senior physicians. We performed a thematic analysis during an iterative cycle of data collection and analysis.
When confronted with a medical request from a nonpatient, physicians first oriented themselves to the situation: who is this person, what is he or she asking of me, and where are we? Physicians next considered the following interrelated factors: (1) nature/strength of the relationship with the nonpatient, (2) amount of trust in his/her own knowledge and skills, (3) expected consequences of making mistakes, (4) importance of work-life balance, and (5) risk of disturbing the physician-patient process. Senior physicians applied more nuanced considerations when deciding whether to respond, whereas junior physicians experienced more difficulties dealing with these requests, were less inclined to respond, and were more concerned about disturbing the existing relationship that a person had with his/her own physician.
This study provides insight into the complexity that physicians face when managing medical questions and requests from nonpatients. Facilitated group discussions during which experiences are shared can help junior physicians become more confident in dealing with these complex issues as they formulate their own personal strategy regarding provision of medical advice or treatment to family and friends.
尽管指南通常规定医生不应治疗其家庭成员或朋友（非患者），但医生经常收到非患者的医疗请求。我们旨在探讨初级和高级家庭医生处理和对待非患者医疗请求的经验和态度。
我们对初级和高级医生进行了 7 个焦点小组的定性研究。我们在数据收集和分析的迭代循环中进行了主题分析。
当面对非患者的医疗请求时，医生首先对情况进行定位：这个人是谁，他或她要求我做什么，我们在哪里？医生接下来考虑了以下相互关联的因素：（1）与非患者的关系性质/强度，（2）对自己知识和技能的信任程度，（3）犯错的预期后果，（4）工作与生活平衡的重要性，以及（5）扰乱医患过程的风险。资深医生在决定是否回应时会考虑更多细微差别，而初级医生在处理这些请求时遇到更多困难，不太倾向于回应，并且更担心扰乱一个人与自己医生之间的现有关系。
这项研究深入了解了医生在处理非患者的医疗问题和请求时所面临的复杂性。促进小组讨论可以帮助初级医生在制定自己为家人和朋友提供医疗建议或治疗的个人策略时，更有信心地处理这些复杂问题。
