当前位置： SCI文献检索 > JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS期刊下所有文献 > Surgeon as Double Agent: Perception of Conflicting Expectations of Patient Care and Stewardship of Resources.

Surgeon as Double Agent: Perception of Conflicting Expectations of Patient Care and Stewardship of Resources.

Abstract：

BACKGROUND:Physicians must satisfy 2 competing expectations: advocate for patients and serve as stewards of resources. No guidelines exist for surgeons on resolving this conflict. We surveyed surgeons' perceptions about these dual obligations. STUDY DESIGN:We conducted our study at 2 large university hospitals in 3 distinct steps, each built on the previous one. First, we surveyed 40 surgery residents and medical students using a 10-question assessment tool as the quantitative portion of our analysis. Next, a focus group of attending surgeons was surveyed to identify themes for the qualitative part of our study. Based on these, 5 attending surgeons from varying specialties were interviewed in a semi-structured format. We used the Wilcoxon signed rank test for quantitative analysis and content analysis to report our qualitative findings. RESULTS:Students and residents did not think that they faced resource allocation decisions; however, they observed attending surgeons face them regularly (p = 0.0003). Attending surgeons from various specialties agreed that they thought they were obligated to both provide excellent care and serve as a steward of resources. All surgeons agreed these obligations can conflict. Individual practices varied with all erring on the side of patient care. Concern about being an outlier in one's section was a greater motivator to alter practice than was fear of litigation. No surgeon thought that patients had an adequate understanding of surgeons' dual agency. CONCLUSIONS:Surgeons balance the responsibilities of patient care and stewardship of resources with great variability. Diverse practices likely add to inequalities in healthcare delivery and increase mistrust. Surgeons' social contract with patients calls for transparent strategies to address their dual agency.

journal_name

J Am Coll Surg

journal_title

Journal of the American College of Surgeons

authors

Kopar PK,Lui FY

doi

10.1016/j.jamcollsurg.2020.04.037

subject

Has Abstract

pub_date

2020-08-01 00:00:00

pages

239-243.e4

issue

eissn

1072-7515

issn

1879-1190

pii

S1072-7515(20)30399-9

journal_volume

231

pub_type

杂志文章

在线工具

Surgeon as Double Agent: Perception of Conflicting Expectations of Patient Care and Stewardship of Resources.