Daugird A, Spencer D
Department of Family and Community Medicine, University of Missouri at Columbia, USA.
Arch Fam Med. 1996 Oct;5(9):497-500; discussion 501. doi: 10.1001/archfami.5.9.497.
The American health care reform revolution has brought about major changes in the practice of medicine. As integral components of the health care system, physicians have felt the full impact of most of these changes. Change often involves losses for those affected, and, in this case, physicians are no exception. Many physicians have experienced losses of financial security, social status, independent clinical decision making and resource utilization, the practice option of independent private practice, hospital governance power, freedom of choice in specialty selection and geographic practice location, physician collegiality, continuity of patient relationships, and autonomy. We use Kübler-Ross' grieving model to help understand physician responses to their losses inherent in health care system reform. The grieving stages of denial, anger, bargaining, depression, and acceptance are applied to these physician responses and suggestions given to help physicians through this grieving process.
美国医疗保健改革革命给医学实践带来了重大变革。作为医疗保健系统的组成部分，医生们充分感受到了这些变革中的大部分影响。变革往往会给受影响者带来损失，在这种情况下，医生也不例外。许多医生经历了经济保障、社会地位、独立临床决策和资源利用、独立私人执业的实践选择、医院治理权、专业选择和地理执业地点的选择自由、医生同行关系、患者关系的连续性以及自主权等方面的损失。我们运用库伯勒 - 罗斯的悲伤模型来帮助理解医生对医疗保健系统改革中固有损失的反应。否认、愤怒、讨价还价、抑郁和接受这几个悲伤阶段被应用于这些医生的反应，并给出了帮助医生度过这个悲伤过程的建议。
