Wu A W, Folkman S, McPhee S J, Lo B
Department of Health Policy and Management, School of Hygiene and Public Health, Johns Hopkins University, Baltimore, Maryland 21205.
West J Med. 1993 Nov;159(5):565-9.
We examined how house officers coped with serious medical mistakes to gain insight into how medical educators should handle these situations. An anonymous questionnaire was mailed to 254 house officers in internal medicine asking them to describe their most important mistake and their response to it; 45% (N = 114) reported a mistake and completed the questionnaire. House officers experienced considerable emotional distress in response to their mistakes and used a variety of strategies to cope. In multivariate analysis, those who coped by accepting responsibility were more likely to make constructive changes in practice, but to experience more emotional distress. House officers who coped by escape-avoidance were more likely to report defensive changes in practice. For house officers who have made a mistake, we suggest that medical educators provide specific advice about preventing a recurrence of the mistake, provide emotional support, and help them understand that distress is an expected concomitant of learning from the experience.
我们研究了住院医生如何应对严重的医疗失误，以深入了解医学教育工作者应如何处理这些情况。向254名内科住院医生邮寄了一份匿名问卷，要求他们描述自己最重要的失误以及对此的反应；45%（N = 114）报告了失误并完成了问卷。住院医生因失误而经历了相当大的情绪困扰，并采用了多种应对策略。在多变量分析中，那些通过承担责任来应对的人更有可能在实践中做出建设性的改变，但会经历更多的情绪困扰。通过逃避来应对的住院医生更有可能报告在实践中做出防御性的改变。对于已经犯错的住院医生，我们建议医学教育工作者提供关于防止失误再次发生的具体建议，提供情感支持，并帮助他们明白痛苦是从这次经历中学习的预期伴随物。
