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Physician Management of Patients With Adverse Outcomes

Physician Management of Patients With Adverse Outcomes Abstract • The incidence of iatrogenic complications of medical or surgical care is increasing. Such adverse events may severely strain the patient/physician relationship. The nature of the underlying patient/physician relationship in terms of the style of interaction and the handling of uncertainty and decision making may influence the impact of adverse events on the relationship. Physicians may manage these situations poorly because of perceived threats to their self-image or sense of control, or because of fear of malpractice suits. Patients may consciously or subconsciously blame the physician, fail to express their concerns, or exaggerate their complaints. If possible, continuity of the patient/physician relationship should be maintained through full disclosure of all medical facts, frank and open communication, and a renewed commitment to the therapeutic relationship. (Arch Intern Med 1986;146:2249-2252) References 1. Moser RH: Diseases of Medical Progress: A Study of Iatrogenic Disease . Springfield, Ill, Charles C Thomas Publishers, 1979. 2. D'Arcy PF, Griffin JP: Iatrogenic Disease . New York, Oxford University Press Inc, 1972. 3. Steele K, Gertman PM, Crescenzi C, et al: Iatrogenic illness on a general medical service at a university hospital. N Engl J Med 1981;304: 638-642.Crossref 4. Press I: Predisposition to file claims. Law, Medicine, and Health Care 1984;12:53-62. 5. Richards EP, Rathburn KC: Medical Risk Management . Rockville, Md, Aspen Systems Corp, 1983. 6. Peterson JL: Consumer's knowledge and attitudes toward medical malpractice , in Report to the Secretary's Commission on Medical Malpractice , US Dept Health, Education, and Welfare Publication No. 73-88, 73-89. Government Printing Office, 1973, pp 658-757. 7. Blum RH, Saduch J, Waterson R: Management of the Doctor-Patient Relationship . New York, McGraw-Hill International Book Co, 1960. 8. Szasz TS, Hollender MH: The doctor-patient relationship. Arch Intern Med 1956;97:585-592.Crossref 9. Guthiel TG, Bursztajn H, Brodsky A: Malpractice prevention through the sharing of uncertainty. N Engl J Med 1984;31:49-51.Crossref 10. Bursztajn H, Feinbloom RI, Hamm RM, et al: Medical Choices, Medical Chances . New York, Delacorte Press, 1981. 11. Mechanic D: Medical Sociology , ed 2. New York, Free Press, 1978, pp 495-570. 12. Katz J: Why doctors don't disclose uncertainty. Hastings Center Rep 1984;14:35-44.Crossref 13. Lazare A, Eisenthal S, Frank A, et al: Studies on a negotiated approach to patienthood , in The Doctor-Patient Relationship in the Changing Health Scene, Proceedings of the Fogarty Center International Conference , US Dept Health, Education, and Welfare Publication No. 78-183. Government Printing Office, 1976. 14. Korsch BM, Gozzi EK, Francis V: Gaps in doctor-patient communication: I. Doctor-patient interaction and patient satisfaction. Pediatrics 1978;42:855-871. 15. Ware JE, Snyder MK: Dimensions of patient attitudes regarding doctors and medical care services. Med Care 1975;23:669-682.Crossref 16. Cousins N: How patients appraise physicians. N Engl J Med 1985;313: 1422-1424.Crossref 17. Woolley FR: The effects of doctor-patient communication on satisfaction and outcome of care. Soc Sci Med 1978;12:123-127. 18. Shapiro EC, Lowenstein LM: Becoming a Physician: Development of Values and Attitudes in Medicine . Cambridge, Mass, Ballinger, 1979. 19. Fox R: Experiment Perilous: Physicians and Patients Facing the Unknown . Glencoe, Ill, Free Press, 1959. 20. Kushner HS: When Bad Things Happen to Good People . Boston, GK Hall & Co, 1982. 21. Waitzkin H, Stoeckel J: Information control and the micropolitics of health care. Soc Sci Med 1976;10:263-264.Crossref 22. Gabbard GO: The role of compulsiveness in the normal physician. JAMA 1985;254:2926-2929.Crossref 23. Pellegrino ED: Toward a reconstruction of medical morality. J Med Philos 1979;4:32-56.Crossref 24. Cowles J: Informed consent . New York, Coward, McCann, and Geoghegan, 1976. 25. Childress JF: Who Should Decide? New York, Oxford University Press Inc, 1982, p 127. 26. Radovsky SS: Bearing the news. N Engl J Med 1985;313:586-588.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Physician Management of Patients With Adverse Outcomes

Applegate, William B.
Archives of Internal Medicine , Volume 146 (11) – Nov 1, 1986
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References (29)

Publisher
American Medical Association
Copyright
Copyright © 1986 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1986.00360230189027
Publisher site
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Abstract

Abstract • The incidence of iatrogenic complications of medical or surgical care is increasing. Such adverse events may severely strain the patient/physician relationship. The nature of the underlying patient/physician relationship in terms of the style of interaction and the handling of uncertainty and decision making may influence the impact of adverse events on the relationship. Physicians may manage these situations poorly because of perceived threats to their self-image or sense of control, or because of fear of malpractice suits. Patients may consciously or subconsciously blame the physician, fail to express their concerns, or exaggerate their complaints. If possible, continuity of the patient/physician relationship should be maintained through full disclosure of all medical facts, frank and open communication, and a renewed commitment to the therapeutic relationship. (Arch Intern Med 1986;146:2249-2252) References 1. Moser RH: Diseases of Medical Progress: A Study of Iatrogenic Disease . Springfield, Ill, Charles C Thomas Publishers, 1979. 2. D'Arcy PF, Griffin JP: Iatrogenic Disease . New York, Oxford University Press Inc, 1972. 3. Steele K, Gertman PM, Crescenzi C, et al: Iatrogenic illness on a general medical service at a university hospital. N Engl J Med 1981;304: 638-642.Crossref 4. Press I: Predisposition to file claims. Law, Medicine, and Health Care 1984;12:53-62. 5. Richards EP, Rathburn KC: Medical Risk Management . Rockville, Md, Aspen Systems Corp, 1983. 6. Peterson JL: Consumer's knowledge and attitudes toward medical malpractice , in Report to the Secretary's Commission on Medical Malpractice , US Dept Health, Education, and Welfare Publication No. 73-88, 73-89. Government Printing Office, 1973, pp 658-757. 7. Blum RH, Saduch J, Waterson R: Management of the Doctor-Patient Relationship . New York, McGraw-Hill International Book Co, 1960. 8. Szasz TS, Hollender MH: The doctor-patient relationship. Arch Intern Med 1956;97:585-592.Crossref 9. Guthiel TG, Bursztajn H, Brodsky A: Malpractice prevention through the sharing of uncertainty. N Engl J Med 1984;31:49-51.Crossref 10. Bursztajn H, Feinbloom RI, Hamm RM, et al: Medical Choices, Medical Chances . New York, Delacorte Press, 1981. 11. Mechanic D: Medical Sociology , ed 2. New York, Free Press, 1978, pp 495-570. 12. Katz J: Why doctors don't disclose uncertainty. Hastings Center Rep 1984;14:35-44.Crossref 13. Lazare A, Eisenthal S, Frank A, et al: Studies on a negotiated approach to patienthood , in The Doctor-Patient Relationship in the Changing Health Scene, Proceedings of the Fogarty Center International Conference , US Dept Health, Education, and Welfare Publication No. 78-183. Government Printing Office, 1976. 14. Korsch BM, Gozzi EK, Francis V: Gaps in doctor-patient communication: I. Doctor-patient interaction and patient satisfaction. Pediatrics 1978;42:855-871. 15. Ware JE, Snyder MK: Dimensions of patient attitudes regarding doctors and medical care services. Med Care 1975;23:669-682.Crossref 16. Cousins N: How patients appraise physicians. N Engl J Med 1985;313: 1422-1424.Crossref 17. Woolley FR: The effects of doctor-patient communication on satisfaction and outcome of care. Soc Sci Med 1978;12:123-127. 18. Shapiro EC, Lowenstein LM: Becoming a Physician: Development of Values and Attitudes in Medicine . Cambridge, Mass, Ballinger, 1979. 19. Fox R: Experiment Perilous: Physicians and Patients Facing the Unknown . Glencoe, Ill, Free Press, 1959. 20. Kushner HS: When Bad Things Happen to Good People . Boston, GK Hall & Co, 1982. 21. Waitzkin H, Stoeckel J: Information control and the micropolitics of health care. Soc Sci Med 1976;10:263-264.Crossref 22. Gabbard GO: The role of compulsiveness in the normal physician. JAMA 1985;254:2926-2929.Crossref 23. Pellegrino ED: Toward a reconstruction of medical morality. J Med Philos 1979;4:32-56.Crossref 24. Cowles J: Informed consent . New York, Coward, McCann, and Geoghegan, 1976. 25. Childress JF: Who Should Decide? New York, Oxford University Press Inc, 1982, p 127. 26. Radovsky SS: Bearing the news. N Engl J Med 1985;313:586-588.Crossref

Journal

Archives of Internal Medicine – American Medical Association

Published: Nov 1, 1986

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