1
|
Li Q, Zhou J, Chen L. More exposure to medical injury news, better doctor-patient communication, but less doctors' professional identity: A moderated chain mediation model. Front Public Health 2022; 10:1045014. [PMID: 36620286 PMCID: PMC9814165 DOI: 10.3389/fpubh.2022.1045014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 12/05/2022] [Indexed: 12/24/2022] Open
Abstract
Objectives In recent years, news of medical malignant injury events has become common in China. However, it is unclear how exposure to this news affects medical staff. Methods The present study collected data from a sample of 311 medical staff in China. It explored the effect of exposure to such news on medical staff's communication and willingness to let their children be doctors, which was an attitude that reflects their professional identity well. In addition, this study also examined the mediating roles of outgroup attribution and anxiety, and the moderating role of social support. Results The results showed that exposure to news of medical injury could positively and directly predict the quality of doctor-patient communication, but negatively and indirectly predict medical staff's willingness to let their children become doctors. These effects existed through the mediating role of anxiety and the chain mediating role of both outgroup attribution and anxiety. In addition, social support could mitigate the negative correlation between news exposure and outgroup attribution. Conclusions These results suggest that news of medical malignant injury events may incentivize medical staff to improve the quality of communication in the short term, but it is not conducive to medical staff's long-term mental health. That is, exposure to news of medical injury is likely to lead to a negative influence on their professional identity, although social support can alleviate this negative influence.
Collapse
Affiliation(s)
- Qiwei Li
- Key Laboratory of Behavioral Science, Institute of Psychology, Chinese Academy of Sciences, Beijing, China,Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Jie Zhou
- Key Laboratory of Behavioral Science, Institute of Psychology, Chinese Academy of Sciences, Beijing, China,*Correspondence: Jie Zhou ✉
| | - Lei Chen
- Department of Ultrasound, Peking University First Hospital, Beijing, China
| |
Collapse
|
2
|
Baungaard N, Skovvang PL, Assing Hvidt E, Gerbild H, Kirstine Andersen M, Lykkegaard J. How defensive medicine is defined in European medical literature: a systematic review. BMJ Open 2022; 12:e057169. [PMID: 35058268 PMCID: PMC8783809 DOI: 10.1136/bmjopen-2021-057169] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 12/13/2021] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES Defensive medicine has originally been defined as motivated by fear of malpractice litigation. However, the term is frequently used in Europe where most countries have a no-fault malpractice system. The objectives of this systematic review were to explore the definition of the term 'defensive medicine' in European original medical literature and to identify the motives stated therein. DESIGN Systematic review. DATA SOURCES PubMed, Embase and Cochrane, 3 February 2020, with an updated search on 6 March 2021. METHODS Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, we reviewed all European original peer-reviewed studies fully or partially investigating 'defensive medicine'. RESULTS We identified a total of 50 studies. First, we divided these into two categories: the first category consisting of studies defining defensive medicine by using a narrow definition and the second category comprising studies in which defensive medicine was defined using a broad definition. In 23 of the studies(46%), defensive medicine was defined narrowly as: health professionals' deviation from sound medical practice motivated by a wish to reduce exposure to malpractice litigation. In 27 studies (54%), a broad definition was applied adding … or other self-protective motives. These self-protective motives, different from fear of malpractice litigation, were grouped into four categories: fear of patient dissatisfaction, fear of overlooking a severe diagnosis, fear of negative publicity and unconscious defensive medicine. Studies applying the narrow and broad definitions of defensive medicine did not differ regarding publication year, country, medical specialty, research quality or number of citations. CONCLUSIONS In European research, the narrow definition of defensive medicine as exclusively motivated by fear of litigation is often broadened to include other self-protective motives. In order to compare results pertaining to defensive medicine across countries, future studies are recommended to specify whether they are using the narrow or broad definition of defensive medicine. PROSPERO REGISTRATION NUMBER CRD42020167215.
Collapse
Affiliation(s)
- Nathalie Baungaard
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Pia Ladeby Skovvang
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Elisabeth Assing Hvidt
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
- Department for the Study of Culture, University of Southern Denmark, Odense, Denmark
| | - Helle Gerbild
- Health Sciences Research Centre, UCL University College, Odense, Denmark
- Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Merethe Kirstine Andersen
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Jesper Lykkegaard
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
3
|
Al-Azzawi R, Halvorsen PA, Risør T. Context and general practitioner decision-making - a scoping review of contextual influence on antibiotic prescribing. BMC FAMILY PRACTICE 2021; 22:225. [PMID: 34781877 PMCID: PMC8591810 DOI: 10.1186/s12875-021-01574-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 11/02/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND How contextual factors may influence GP decisions in real life practice is poorly understood. The authors have undertaken a scoping review of antibiotic prescribing in primary care, with a focus on the interaction between context and GP decision-making, and what it means for the decisions made. METHOD The authors searched Medline, Embase and Cinahl databases for English language articles published between 1946 and 2019, focusing on general practitioner prescribing of antibiotics. Articles discussing decision-making, reasoning, judgement, or uncertainty in relation to antibiotic prescribing were assessed. As no universal definition of context has been agreed, any papers discussing terms synonymous with context were reviewed. Terms encountered included contextual factors, non-medical factors, and non-clinical factors. RESULTS Three hundred seventy-seven full text articles were assessed for eligibility, resulting in the inclusion of 47. This article documented the experiences of general practitioners from over 18 countries, collected in 47 papers, over the course of 3 decades. Contextual factors fell under 7 themes that emerged in the process of analysis. These were space and place, time, stress and emotion, patient characteristics, therapeutic relationship, negotiating decisions and practice style, managing uncertainty, and clinical experience. Contextual presence was in every part of the consultation process, was vital to management, and often resulted in prescribing. CONCLUSION Context is essential in real life decision-making, and yet it does not feature in current representations of clinical decision-making. With an incomplete picture of how doctors make decisions in real life practice, we risk missing important opportunities to improve decision-making, such as antibiotic prescribing.
Collapse
Affiliation(s)
- Resha Al-Azzawi
- General Practice Research Unit, Department of Community Medicine, UiT The Arctic University of Norway, PO Box 6050, Langnes, N-9037, Tromsø, Norway.
| | - Peder A Halvorsen
- General Practice Research Unit, Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Torsten Risør
- General Practice Research Unit, Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
- Department of Public Health, Copenhagen University, Copenhagen, Denmark
| |
Collapse
|
4
|
Batteux E, Ferguson E, Tunney RJ. Do We Become More Cautious for Others When Large Amounts of Money Are at Stake? Exp Psychol 2021; 68:32-40. [PMID: 34109805 DOI: 10.1027/1618-3169/a000508] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
A considerable proportion of financial decisions are made by agents acting on behalf of other people. Although people are more cautious for others when making medical decisions, this does not seem to be the case for economic decisions. However, studies with large amounts of money are particularly absent from the literature, which precludes a clear comparison to studies in the medical domain. To address this gap, we investigated the effect of outcome magnitude in two experiments where participants made choices between safe and risky options. Decision-makers were not more cautious for others over large amounts. In fact, risk-taking was accentuated for large amounts in the gain domain. We did not find self-other differences in the loss domain for either outcome magnitude. This suggests that the caution observed in medical decisions does not replicate in financial decisions with large amounts, or at least not in the same way. These results echo the concerns that have been raised about excessive risk-taking by financial agents.
Collapse
Affiliation(s)
- Eleonore Batteux
- Centre for the Study of Decision-Making Uncertainty, University College London, UK
| | | | | |
Collapse
|
5
|
Vemulakonda VM, Kempe A, Hamer MK, Morris MA. Physician perspectives on discussions with parents of infants with suspected ureteropelvic junction obstruction. J Pediatr Surg 2021; 56:620-625. [PMID: 32467035 PMCID: PMC7606351 DOI: 10.1016/j.jpedsurg.2020.04.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 04/18/2020] [Accepted: 04/21/2020] [Indexed: 01/30/2023]
Abstract
INTRODUCTION The purpose of this study was to understand pediatric urologists' perceived role of patient characteristics on discussions about treatment of infants with suspected UPJ obstruction. METHODS We conducted semi-structured interviews with pediatric urologists from three geographically diverse sites. Interview domains included: clinical indications for surgery, discussions with parents, and consideration of parent socioeconomic factors. Transcribed data and field notes were analyzed using a team-based, inductive grounded theory approach. RESULTS Thirteen physicians were interviewed. Physicians reported a standardized approach to discussions to facilitate parental understanding. While they did not report overt consideration of demographics, they tailored discussions based on educational and cultural background and language barriers. Physicians also reported that concerns about risk of loss to follow up contributed to their treatment recommendations. Most physicians recognized that the lack of clear data often led to use of personal experience to guide recommendations. CONCLUSION Physicians recognize a gap in data to guide surgical decisions and utilize personal experience to augment this gap. They also recognize the influence of educational and language barriers on discussions with families and consider risk of loss to follow up when making recommendations, suggesting an implicit consideration of demographics. These findings suggest that development of evidence-based guidelines may reduce treatment variations. LEVEL OF EVIDENCE Not applicable (qualitative research study written in compliance with COREQ guidelines).
Collapse
Affiliation(s)
- Vijaya M. Vemulakonda
- Department of Pediatric Urology, Children’s Hospital Colorado; Division of Urology, Department of Surgery, University of Colorado School of Medicine
| | - Allison Kempe
- Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), University of Colorado Anschutz Medical Campus
| | - Mika K. Hamer
- Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), University of Colorado Anschutz Medical Campus
| | - Megan A. Morris
- Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), University of Colorado Anschutz Medical Campus
| |
Collapse
|
6
|
Dogan H, Aydin H. Effect of triage on physicians’ clinical decision: A prospective, observational, single-center and cross-sectional study. JOURNAL OF ACUTE DISEASE 2021. [DOI: 10.4103/2221-6189.330740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
7
|
Leis B, Bare I, Marshall K, Buschau E, Penner L, Keith C, De Villiers JS, Orvold J. Reducing Unnecessary Noninvasive Testing for Inpatients With Unstable Angina: The RUNIT Protocol. CJC Open 2020; 3:516-523. [PMID: 34027356 PMCID: PMC8129432 DOI: 10.1016/j.cjco.2020.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 12/05/2020] [Indexed: 11/16/2022] Open
Abstract
Background Routine inpatient transthoracic echocardiography (TTE) for patients with unstable angina is common, but it anecdotally adds little value to clinical care. A practice audit at our academic hospital demonstrated that 61.5% of patients with troponin-negative chest pain (TNCP) had normal left ventriculography (LVG) during coronary angiography and normal TTE on the same admission (duplicate testing). Methods We developed the Reducing Non-Invasive Testing (RUNIT) protocol, a clinical algorithm applied by clinical nurses to patient with TNCP. We performed a prospective assessment of rate of duplicate testing before and after intervention. If patients met certain simple clinical criteria, their TTE was cancelled (RUNIT positive). Patients then proceeded to have either coronary angiography with LVG or noninvasive risk stratification. We aimed to reduce duplicate testing by 25% over a 1-year period. Balancing measures included pathology on ordered TTEs, 30-day readmission, length of stay, and number of LVG. Results Among 254 patients admitted with TNCP over 12 months, we reduced duplicate testing from 61.5% (before intervention) to 34% (P = 0.001). There was no clinical difference in 30-day readmission (0.9% vs 0.7%), and length of stay was significantly shorter in RUNIT positive (3.48 vs 4.16 days, P = 0.02). The majority of duplicate TTEs did not reveal any management-informing pathology. RUNIT-positive patients underwent more LVG than RUNIT-negative patients (78.3% vs 62.8%, P = 0.008). Conclusion We achieved a sustained reduction in reflexive TTE ordering in patients with TNCP, and we discuss the potential of nursing-led interventions to address other areas of low value care in cardiology.
Collapse
Affiliation(s)
- Benjamin Leis
- Department of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Idris Bare
- Department of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Kirsten Marshall
- Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Elise Buschau
- Division of Cardiology, Saskatchewan Health Authority, Saskatoon, Saskatchewan, Canada
| | - Lori Penner
- Division of Cardiology, Saskatchewan Health Authority, Saskatoon, Saskatchewan, Canada
| | - Cassandra Keith
- Division of Cardiology, Saskatchewan Health Authority, Saskatoon, Saskatchewan, Canada
| | - J S De Villiers
- Department of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.,Division of Cardiology, Saskatchewan Health Authority, Saskatoon, Saskatchewan, Canada
| | - Jason Orvold
- Department of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.,Division of Cardiology, Saskatchewan Health Authority, Saskatoon, Saskatchewan, Canada
| |
Collapse
|
8
|
Batteux E, Ferguson E, Tunney RJ. A mixed methods investigation of end-of-life surrogate decisions among older adults. BMC Palliat Care 2020; 19:44. [PMID: 32241277 PMCID: PMC7119279 DOI: 10.1186/s12904-020-00553-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 03/23/2020] [Indexed: 11/15/2022] Open
Abstract
Background A large number of end-of-life decisions are made by a next-of-kin for a patient who has lost their decision-making capacity. This has given rise to investigations into how surrogates make these decisions. The experimental perspective has focused on examining how the decisions we make for others differ from our own, whereas the qualitative perspective has explored surrogate insights into making these decisions. Methods We conducted a mixed methods study to bring these two perspectives together. This is crucial to comparing decision outcomes to the decision process. We asked older adult partners to make end-of-life decisions for each other. They then took part in a semi-structured interview about their decision process. Transcripts were analysed using thematic analysis. Results 24 participants took part in the study. Surrogates were more likely to take a life-saving treatment at the risk of a diminished quality of life for their partner than for themselves. This was consistent with their transcripts which showed that they wanted to give their partner a better chance of living. Although there was evidence of surrogate inaccuracy in the decision task, participants overwhelmingly reported their intention to make a decision which aligns with the substituted judgment standard. However, uncertainty about their wishes pushed them to consider other factors. Conclusions Taking a mixed methods approach allowed us to make novel comparisons between decision outcome and process. We found that the intentions of surrogates broadly align with the expectations of the substituted judgment standard and that previous discussions with their partner helps them to make a decision.
Collapse
Affiliation(s)
- Eleonore Batteux
- Department of Clinical, Health and Educational Psychology, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK.
| | | | | |
Collapse
|
9
|
Baungaard N, Skovvang P, Assing Hvidt E, Gerbild H, Kirstine Andersen M, Lykkegaard J. How defensive medicine is defined and understood in European medical literature: protocol for a systematic review. BMJ Open 2020; 10:e034300. [PMID: 32114473 PMCID: PMC7050374 DOI: 10.1136/bmjopen-2019-034300] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 12/18/2019] [Accepted: 01/27/2020] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION The term defensive medicine, referring to actions motivated primarily by litigious concerns, originates from the USA and has been used in medical research literature since the late 1960s. Differences in medical legal systems between the US and most European countries with no tort legislation raise the question whether the US definition of defensive medicine holds true in Europe. AIM To present the protocol of a systematic review investigating variations in definitions and understandings of the term 'defensive medicine' in European research articles. METHODS AND ANALYSIS In concordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a systematic review of all medical research literature that investigate defensive medicine will be performed by two independent reviewers. The databases PubMed, Embase and Cochrane will be systematically searched on the basis of predetermined criteria. Data from all included European studies will systematically be extracted including the studies' definitions and understandings of defensive medicine, especially the motives for doing medical actions that the study regards as 'defensive'. ETHICS AND DISSEMINATION No ethics clearance is required as no primary data will be collected. The results of the systematic review will be published in a peer-reviewed, international journal. PROSPERO REGISTRATION NUMBER This review has been submitted to International Prospective Register of Systematic Reviews (PROSPERO) and is awaiting registration.
Collapse
Affiliation(s)
- Nathalie Baungaard
- Department of Public Health, Research Unit of General Practice, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Pia Skovvang
- Department of Public Health, Research Unit of General Practice, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Elisabeth Assing Hvidt
- Department of Public Health, Research Unit of General Practice, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
- Department for the Study of Culture, University of Southern Denmark, Odense, Denmark
| | - Helle Gerbild
- Center for Sexology Research, Department of Clinical Medicine, Aalborg Universitet, Aalborg, Denmark
- Health Sciences Research Centre University College, University College Lillebaelt, Campus Odense, Odense, Denmark
| | - Merethe Kirstine Andersen
- Department of Public Health, Research Unit of General Practice, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Jesper Lykkegaard
- Department of Public Health, Research Unit of General Practice, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
10
|
Batteux E, Ferguson E, Tunney RJ. On the Likelihood of Surrogates Conforming to the Substituted Judgment Standard When Making End-of-Life Decisions for Their Partner. Med Decis Making 2019; 39:651-660. [PMID: 31354033 PMCID: PMC6794635 DOI: 10.1177/0272989x19862800] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 06/14/2019] [Indexed: 11/16/2022]
Abstract
A considerable proportion of end-of-life decisions are made by the patient's next-of-kin, who can be asked to follow the substituted judgment standard and decide based on the patient's wishes. The question of whether these surrogate decision makers are actually able to do so has become an important issue. In this study, we examined how the likelihood of surrogates conforming to the substituted judgment standard varies with individual differences in mortality acceptance and confidence in their decision making. We recruited 153 participants in romantic relationships between 18 and 80 years old from the general population. We asked them to make hypothetical end-of-life decisions for themselves and on behalf of their partner, as well as predict what their partner would do, and complete a series of questionnaires. Participants predicted that their partner would make similar decisions to their own but were more likely to accept a life-saving treatment that could result in reduced quality of life on their partner's behalf than for themselves. Decisions made by older adults were more likely to conform to the substituted judgment standard, which is encouraging given that they are more likely to be confronted with these decisions in real life, although this was not due to differences in mortality acceptance. Older adults were also more likely to have had previous discussions with their partner and thereby know that person's wishes and feel confident that they made the right decision, but these factors did not affect their likelihood of conforming to the substituted judgment standard. This shows that encouraging discussions about end of life among families would ease the decision process, but more work is needed to ensure that surrogates can adhere to the substituted judgment standard.
Collapse
|
11
|
Cancer screening risk literacy of physicians in training: An experimental study. PLoS One 2019; 14:e0218821. [PMID: 31269051 PMCID: PMC6608976 DOI: 10.1371/journal.pone.0218821] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 06/10/2019] [Indexed: 12/29/2022] Open
Abstract
We investigated what factors may foster or hinder physicians' cancer screening risk literacy-specifically the ability to understand evidence regarding screening effectiveness and make evidence-based recommendations to patients. In an experiment, physicians in training (interns and residents) read statistical information about outcomes from screening for cancer, and had to decide whether to recommend it to a patient. We manipulated the effectiveness of the screening (effective vs. ineffective at reducing mortality) and the demand of the patient to get screened (demand vs. no demand). We assessed participants' comprehension of the presented evidence and recommendation to the patient, as well as a-priori screening beliefs (e.g., that screening is always a good choice), numeracy, science literacy, knowledge of screening statistics, statistical education, and demographics. Stronger positive a-priori screening beliefs, lower knowledge of screening statistics, and lower numeracy were related to worse comprehension of the evidence. Physicians recommended against the ineffective screening but only if they showed good comprehension of the evidence. Physicians' recommendations were further based on the perceived benefits from screening but not on perceived harms, nor the patient's demands. The current study demonstrates that comprehension of cancer screening statistics and the ability to infer the potential benefits for patients are essential for evidence-based recommendations. However, strong beliefs in favor of screening fostered by promotion campaigns may influence how physicians evaluate evidence about specific screenings. Fostering physician numeracy skills could help counteract such biases and provide evidence-based recommendations to patients.
Collapse
|
12
|
Assing Hvidt E, Bjørnskov Pedersen L, Lykkegaard J, Møller Pedersen K, Andersen MK. A colonized general practice? A critical habermasian analysis of how general practitioners experience defensive medicine in their everyday working life. Health (London) 2019; 25:141-158. [PMID: 31216878 DOI: 10.1177/1363459319857461] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aim of this article is to show how Jürgen Habermas' communicative action theory serves as a useful tool in analysing and interpreting empirical data on how Danish general practitioners experience defensive medicine in their everyday working life. Through six qualitative focus group interviews with a total of 28 general practitioners (14 men and 14 women), the general practitioners' understandings of and experiences with defensive medicine were unfolded and discussed. Traditionally, defensive medicine is understood as physicians' deviation from sound medical practice due to fears of liability claims or lawsuits. In this study, however, a broader understanding of defensive medicine emerged as unnecessary medical actions that are more substantiated by feelings of demands and pressures than meaningful clinical behaviour. As a first analytical step, the data are contextualized drawing on the medical sociological literature that has theorized recent changes within primary health care such as regulation, audit, standardization and consumerism. Using Habermas' theorization to further interpret the general practitioners' experiences, we argue that central areas of the general practitioners' clinical everyday work life can be seen as having become subject to the habermasian social and political processes of 'strategic action' and 'colonization'. It is furthermore shown that the general practitioners share an impulse to resist these colonizing processes, hereby pointing to a need for challenging the increasingly defensive medical culture that seems to pervade the organization of general practice today.
Collapse
|
13
|
Alexis Ruiz A, Wyszyńska PK, Laudanski K. Narrative Review of Decision-Making Processes in Critical Care. Anesth Analg 2019; 128:962-970. [DOI: 10.1213/ane.0000000000003683] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
|
14
|
Iriane I, Sajaratulnisah O, Farah ND. " The best interest of the adolescent " : Exploring doctors ' decision to proceed with treatment of sexual reproductive health without parental consent. MALAYSIAN FAMILY PHYSICIAN : THE OFFICIAL JOURNAL OF THE ACADEMY OF FAMILY PHYSICIANS OF MALAYSIA 2019; 14:35-41. [PMID: 31289631 PMCID: PMC6612278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Adolescents below the age of majority require parental consent for treatment or else the treating doctor may be liable for trespass and assault. This creates a dilemma for frontline doctors, as involving parents in the discussion could add yet another barrier to the existing barriers for adolescents in terms of access to healthcare services. AIM This paper seeks to explore doctors' treatment decisions made without parental consent when managing adolescents presenting with sexual and reproductive health issues. METHODS Based on a qualitative approach, in-depth interviews with 25 doctors throughout Malaysia were conducted. All audio-recorded interviews were transcribed verbatim and analyzed using a thematic approach. RESULTS Generally, doctors weigh any decision by examining the health risks and benefits involved. While fear of litigation influences treatment decisions, a strong adherence to the ethical duty of 'do no harm' outweighs other considerations. When all options are risky, choosing what is considered 'the lesser of two evils,' i.e., what is perceived to be in the best interest of the adolescent, is adopted. CONCLUSIONS The complexity of a medical decision related to adolescent SRH issues is increased further when legal requirements are not in synch with the ethical and personal values of doctors. The laws relating to parental consent should be promulgated with a provision allowing doctors to exercise discretion in terms of treating specific SRH issues without parental consent.
Collapse
Affiliation(s)
- I Iriane
- MBBS, MFamMed, PhD, Faculty of Medicine, University of Malaya, Kuala Lumpur Malaysia.,
| | - O Sajaratulnisah
- LLB, M.C.L, PhD, Magistrate's Court of Selayang Selangor, Malaysia.,
| | - N D Farah
- L.L.B, M.C.L, PhD, Faculty of Law, University of Malaya, Kuala Lumpur Malaysia.
| |
Collapse
|
15
|
Batteux E, Ferguson E, Tunney RJ. Exploring How Accountability Affects the Medical Decisions We Make for Other People. Front Psychol 2019; 10:79. [PMID: 30800081 PMCID: PMC6375882 DOI: 10.3389/fpsyg.2019.00079] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 01/11/2019] [Indexed: 11/18/2022] Open
Abstract
In the event that a patient has lost their decision-making capacity due to illness or injury, a surrogate is often appointed to do so on their behalf. Research has shown that people take less risk when making treatment decisions for other people than they do for themselves. This has been discussed as surrogates employing greater caution for others given the accountability they are faced with. We tested the prediction that making accountability salient reduces risk-taking for others relative to the self by manipulating the information shown to participants while they made treatment choices. One group was asked to focus on the consequences for the recipient’s family, another on the legal implications of their decisions, and another was not given additional information. Participants reduced their risk-taking for others compared to themselves, irrespective of the condition they were in. Although participants in each condition reported thinking about these factors to different extents, there were no clear differences in risk-taking between groups. However, we did find that, across all participants, thinking about legal consequences reduces risk-taking. We suggest that future research investigates how the effect of thinking about accountability on surrogate choices is mediated by feelings of accountability, in order to further examine the explanations suggested in the literature.
Collapse
Affiliation(s)
- Eleonore Batteux
- School of Psychology, University of Nottingham, Nottingham, United Kingdom
| | - Eamonn Ferguson
- School of Psychology, University of Nottingham, Nottingham, United Kingdom
| | - Richard J Tunney
- Department of Psychology, Aston University, Birmingham, United Kingdom
| |
Collapse
|
16
|
Popovic NF, Pachur T, Gaissmaier W. The gap between medical and monetary choices under risk persists in decisions for others. JOURNAL OF BEHAVIORAL DECISION MAKING 2019. [DOI: 10.1002/bdm.2121] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Nathalie F. Popovic
- Graduate School of Decision Sciences and ZukunftskollegUniversity of Konstanz Konstanz Germany
| | - Thorsten Pachur
- Center for Adaptive RationalityMax Planck Institute for Human Development Berlin Germany
| | | |
Collapse
|
17
|
Factors Related to Physician Clinical Decision-Making for African-American and Hispanic Patients: a Qualitative Meta-Synthesis. J Racial Ethn Health Disparities 2018; 5:1215-1229. [PMID: 29508374 DOI: 10.1007/s40615-018-0468-z] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 01/31/2018] [Accepted: 02/02/2018] [Indexed: 10/17/2022]
Abstract
Clinical decision-making may have a role in racial and ethnic disparities in healthcare but has not been evaluated systematically. The purpose of this study was to synthesize qualitative studies that explore various aspects of how a patient's African-American race or Hispanic ethnicity may factor into physician clinical decision-making. Using Ovid MEDLINE, Embase, and Cochrane Library, we identified 13 manuscripts that met inclusion criteria of usage of qualitative methods; addressed US physician clinical decision-making factors when caring for African-American, Hispanic, or Caucasian patients; and published between 2000 and 2017. We derived six fundamental themes that detail the role of patient race and ethnicity on physician decision-making, including importance of race, patient-level issues, system-level issues, bias and racism, patient values, and communication. In conclusion, a non-hierarchical system of intertwining themes influenced clinical decision-making among racial and ethnic minority patients. Future study should systematically intervene upon each theme in order to promote equitable clinical decision-making among diverse racial/ethnic patients.
Collapse
|
18
|
Hollander M, Holten L, Leusink A, van Dillen J, de Miranda E. Less or more? Maternal requests that go against medical advice. Women Birth 2018; 31:505-512. [PMID: 29439923 DOI: 10.1016/j.wombi.2018.01.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 01/06/2018] [Accepted: 01/31/2018] [Indexed: 11/28/2022]
Abstract
PROBLEM AND BACKGROUND This study explores the experiences of Dutch midwives and gynaecologists with pregnant women who request more, less or no care during pregnancy and/or childbirth. METHODS All Dutch midwives and (trainee) gynaecologists were invited to fill out a questionnaire specifically designed for the purposes of this study. Holistic midwives were analysed separately from regular community midwives. FINDINGS Most maternity care providers in the Netherlands receive requests for less care than recommended at least once a year. The most frequently maternal requests were declining testing for gestational diabetes (66.3%), opting for a home birth in case of a high risk pregnancy (65.3%), and declining foetal monitoring during labour (39.6%). Holistic midwives are more convinced of an increasing demand for less care than community midwives (73.1% vs. 35.2%, p=<0.001). More community midwives than hospital staff reported to have declined one or more request for less care than recommended (48.6% vs. 27.9%, p=<0.001). The majority of hospital staff also receive at least one request for an elective caesarean section every year. DISCUSSION AND CONCLUSION Requests for more and less care than indicated during pregnancy and childbirth are equally prevalent in this study. However, a request for less care is more likely to be declined than a request for more care. Counselling women who disagree with their care provider demands time. In case of requests for less care, second best care should be considered.
Collapse
Affiliation(s)
- Martine Hollander
- Radboud University Medical Centre, Department of Obstetrics and Gynaecology, Geert Grooteplein-Zuid 10, 6525 GA Nijmegen, The Netherlands.
| | - Lianne Holten
- Midwifery Science, AVAG, Amsterdam Public Health Research Institute, VU University Medical Center, Vlaardingenlaan 1, 1059 GL Amsterdam, The Netherlands.
| | - Annemieke Leusink
- Radboud University Medical Centre, Department of Obstetrics and Gynaecology, Geert Grooteplein-Zuid 10, 6525 GA Nijmegen, The Netherlands.
| | - Jeroen van Dillen
- Radboud University Medical Centre, Department of Obstetrics and Gynaecology, Geert Grooteplein-Zuid 10, 6525 GA Nijmegen, The Netherlands.
| | - Esteriek de Miranda
- Department of Obstetrics, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
| |
Collapse
|
19
|
Galizzi MM, Miraldo M, Stavropoulou C, van der Pol M. Doctor-patient differences in risk and time preferences: A field experiment. JOURNAL OF HEALTH ECONOMICS 2016; 50:171-182. [PMID: 27792903 DOI: 10.1016/j.jhealeco.2016.10.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2015] [Revised: 10/04/2016] [Accepted: 10/07/2016] [Indexed: 06/06/2023]
Abstract
We conduct a framed field experiment among patients and doctors to test whether the two groups have similar risk and time preferences. We elicit risk and time preferences using multiple price list tests and their adaptations to the healthcare context. Risk and time preferences are compared in terms of switching points in the tests and the structurally estimated behavioural parameters. We find that doctors and patients significantly differ in their time preferences: doctors discount future outcomes less heavily than patients. We find no evidence that doctors and patients systematically differ in their risk preferences in the healthcare domain.
Collapse
Affiliation(s)
- Matteo M Galizzi
- Department of Social Policy, Behavioural Research Lab, LSE Health, London School of Economics, Old 2.35 Old Building, Houghton Street, London WC2A 2AE, UK; École d'Économie de Paris, Hospinnomics, Paris School of Economics, Hôtel-Dieu, 1, Parvis de Notre-Dame, Bâtiment B1, 5° étage, 75004 Paris, France.
| | - Marisa Miraldo
- École d'Économie de Paris, Hospinnomics, Paris School of Economics, Hôtel-Dieu, 1, Parvis de Notre-Dame, Bâtiment B1, 5° étage, 75004 Paris, France; Management Group, Imperial College Business School, South Kensington Campus, London SW7 2AZ, UK.
| | - Charitini Stavropoulou
- School of Health Sciences, City, University of London, Northampton Square, London EC1V 0HB, UK.
| | - Marjon van der Pol
- Health Economics Research Unit, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen AB25 2ZD, UK.
| |
Collapse
|
20
|
What Factors Moderate Self-Other Discrepancies in Decision Making? Results from a Vaccination Scenario. THE SPANISH JOURNAL OF PSYCHOLOGY 2016; 19:E52. [PMID: 27646872 DOI: 10.1017/sjp.2016.50] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
When we make risky decisions for others, we tend to follow social norms about risks. This often results in making different decisions for others than we would make for ourselves in a similar situation (i.e., self-other discrepancies). In an experiment, we investigated self-other discrepancies in young adults' decisions to purchase a vaccine against a sexually-transmitted virus for themselves or for another person (i.e., the target of the decision). When the target's preferences were in line with social norms, surrogates showed large self-other discrepancies in line with these norms. When the target's preferences were contrary to social norms, surrogates did not show self-other discrepancies in line with these preferences; instead they still followed social norms, F(1, 140) = 21.45, p < .001, η p 2 = .13. Surrogates with lower numeracy, F(2, 128) = 3.44, p = .035, η p 2 = .05, and higher empathy, F(2, 128) = 3.72, p = .027, η p 2 = .06, showed self-other discrepancies more in line with the target's preferences, even when these were contrary to the norm. Surrogates whose own risk attitudes were contrary to social norms showed larger self-other discrepancies, F(1, 128) = 5.38, p = .022, η p 2 = .04. These results demonstrate that perceived social norms about risk can predict self-other discrepancies in risky decisions, even when the target's preferences are known and at odds with the social norm. Further, the surrogates' numeracy, empathy, and propensity to take risks influence the extent to which risky decisions for others resemble risky decisions for oneself.
Collapse
|
21
|
Barber A, Puryer J, Leary S, McNally L, O'Sullivan D. Attitudes towards Prosthodontic Clinical Decision-Making for Edentulous Patients among South West Deanery Dental Foundation Year One Dentists. Dent J (Basel) 2016; 4:dj4020012. [PMID: 29563454 PMCID: PMC5851257 DOI: 10.3390/dj4020012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 04/27/2016] [Accepted: 05/05/2016] [Indexed: 11/20/2022] Open
Abstract
The aim of this study was to describe Dental Foundation year one dentists’ attitudes towards prosthodontic decision making for edentulous patients, and identify whether there are gender differences in these attitudes. All South West Deanery trainees were invited to take part in the study between May and June 2011 and a previously piloted questionnaire was administered to the trainees by their training programme directors. The questionnaire posed questions based upon a clinical scenario of discussing treatment options with patients. Seventy-two questionnaires were used in the analysis (91% overall response rate). Trainees perceived their own values to be less important than the patient’s values (p < 0.001) in decision making, but similar to the patient’s friend’s/relative’s values (p = 0.1). In addition, the trainees perceived the patient’s values to be less important than their friend’s/relatives (p < 0.001). Sixty-six per cent of trainees acknowledged an influence from their own personal values on their presentation of material to patients who are in the process of choosing among different treatment options, and 87% thought their edentulous patients were satisfied with the decision making process when choosing among different treatment options. Fifty-eight per cent of trainees supported a strategy of negotiation between patients and clinicians (shared decision making). There was no strong evidence to suggest gender had an influence on the attitudes towards decision making. The finding of a consensus towards shared decision making in the attitudes of trainees, and no gender differences is encouraging and is supportive of UK dental schools’ ability to foster ethical and professional values among dentists.
Collapse
Affiliation(s)
- Andrew Barber
- Cambridge University Hospital, Cambridge Biomedical Campus, Hills Road, Cambridge CB2 0QQ, UK.
| | - James Puryer
- School of Oral and Dental Sciences, Bristol Dental Hospital, Lower Maudlin Street, Bristol BS1 2LY, UK.
| | - Sam Leary
- Bristol Nutrition (Biomedical Research Unit), School of Oral and Dental Sciences, Bristol Dental Hospital, Lower Maudlin Street, Bristol BS1 2LY, UK.
| | - Lisa McNally
- School of Oral and Dental Sciences, Bristol Dental Hospital, Lower Maudlin Street, Bristol BS1 2LY, UK.
| | - Dominic O'Sullivan
- School of Oral and Dental Sciences, Bristol Dental Hospital, Lower Maudlin Street, Bristol BS1 2LY, UK.
| |
Collapse
|
22
|
Clemow DB, Dewulf L, Koren G, Mikita JS, Nolan MR, Michaels DL, Cantrell SA, Kogelnik AM. Clinical Data for Informed Medication Use in Pregnancy: Strengths, Limitations, Gaps, and a Need to Continue Moving Forward. Ther Innov Regul Sci 2014; 48:134-144. [PMID: 30227507 DOI: 10.1177/2168479014523006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The objective of this paper is to explore the strengths, weaknesses, gaps, and needs in research on medication use in pregnancy, where opportunities have been bypassed to develop standards and collaborations for collecting data to better understand how medications can impact clinical outcomes in pregnant women and developing fetuses. The availability of existing data and the methods of its capture are reviewed, including registries, claims and health record databases, and meta-analyses. The paper focuses on why these efforts have not fundamentally provided benefit-risk information and clinical treatment algorithms for medication use in pregnant women. Methodological issues, such as lack of standardization and central data collection, are discussed. Common barriers are examined, including a lack of awareness and education, cultural hurdles, collaboration deficiency, and an insufficient development of new data collection methods.
Collapse
Affiliation(s)
| | | | - Gideon Koren
- 3 The Hospital for Sick Children, Toronto, ON, Canada.,4 The University of Toronto, Toronto, ON, Canada.,5 The University of Western Ontario, Toronto, ON, Canada
| | | | - Martha R Nolan
- 7 Society for Women's Health Research, Washington, DC, USA
| | | | | | | |
Collapse
|