M.E. Kiger is assistant professor, Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland. H.S. Meyer is assistant professor, Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland. C. Hammond is clinical instructor, Department of Pediatrics, Wright State University, Dayton, Ohio. K.M. Miller is resident physician, Wright State University School of Medicine, Dayton, Ohio. K.J. Dickey is resident physician, Wright State University School of Medicine, Dayton, Ohio. D.V. Hammond is pediatrician, Keesler Medical Center, Biloxi, Mississippi. L. Varpio is professor, Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland.
Acad Med. 2019 Nov;94(11S Association of American Medical Colleges Learn Serve Lead: Proceedings of the 58th Annual Research in Medical Education Sessions):S95-S104. doi: 10.1097/ACM.0000000000002920.
The scope of physicians' responsibility toward patients is becoming increasingly complicated to delimit as interdisciplinary care delivery and degrees of subspecialization increase. Patients can easily be lost across multiple transitions involved in care. Preparing learners to engage in safe and responsible patient care requires that we be clear about parameters of patient ownership. This scoping review (1) explores and synthesizes definitions of patient ownership and (2) describes the factors that influence patient ownership.
Searching PubMed, Embase, and PsycINFO, the authors sought out publications of any format (i.e., original research papers, review articles, commentaries, editorials, and author discussions) that (1) addressed patient ownership directly or a closely related concept that explicitly affected patient ownership, (2) included medical care providers (attending/faculty physicians, medical residents, and/or medical students), and (3) were published in English. The authors analyzed findings to construct common themes and categorize findings.
Of 411 papers screened, 82 met our inclusion criteria. Twenty-three papers defined patient ownership in highly variable ways. Common themes across definitions included responsibility for patient care, personally carrying out patient care tasks, knowledge of patients' medical information, independent decision making, and putting patients' needs above one's own. Factors influencing patient ownership were (1) logistical concerns, (2) personal attributes, and (3) socially or organizationally constructed expectations.
A new definition of patient ownership is proposed encompassing findings from the review, while also respecting the shift from individual to a team-based patient care, and without removing the centrality of an individual provider's commitment to patients.
随着跨学科医疗服务和亚专科程度的提高，医生对患者的责任范围越来越难以界定。患者在多个护理环节中很容易被忽视。要让学习者为安全、尽责地照顾患者做好准备，我们就必须明确患者所有权的参数。本范围综述（1）探讨和综合了患者所有权的定义，（2）描述了影响患者所有权的因素。
作者在 PubMed、Embase 和 PsycINFO 上搜索了任何格式（即原始研究论文、综述文章、评论、社论和作者讨论）的出版物，（1）直接涉及患者所有权或明确影响患者所有权的密切相关概念，（2）包括医疗保健提供者（主治医生/教授医师、住院医师和/或医学生），以及（3）以英文发表。作者对研究结果进行了分析，以构建共同主题并对研究结果进行分类。
在筛选出的 411 篇论文中，有 82 篇符合我们的纳入标准。23 篇论文以非常不同的方式定义了患者所有权。定义中常见的主题包括对患者护理的责任、亲自执行患者护理任务、了解患者的医疗信息、独立决策以及将患者的需求置于自己的需求之上。影响患者所有权的因素有（1）后勤问题，（2）个人属性，和（3）社会或组织构建的期望。
提出了一个新的患者所有权定义，该定义综合了综述的研究结果，同时尊重从个体向团队为基础的患者护理的转变，且不消除个体提供者对患者的核心承诺。
