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INDIANAPOLIS – Although the importance of trusting relationships between patients and their physicians is taken for granted, little attention has been given to relationships between physicians themselves. However, interactions between, for example, the primary care physician and the patient's cardiologist or between the patient's pediatrician and an oncology team, are critical to the safety and quality of patient care and to the resilience of physicians and other health professionals.
In a Viewpoint article, "Doctors Trust Each Other," published online March 22 and in the print edition of April 9 JAMA, authors Richard M. Frankel, Ph.D. Regenstrief Institute; Virginia P. Tilden, Ph.D. of Oregon Health & Science University and Anthony Suchman, MD of the University of Rochester, write that although confidence in the doctor-to-physician relationship has not been closely scrutinized it seems more and more threatened.
"If doctors do not value themselves and trust each other, the safety and quality of patient care may be compromised," said Dr. Frankel, a health services researcher and sociologist. medical, first author of the article. "Trust is important for any system that works properly and we know that for the health system to work properly, trust must be invested at all levels of this system."
Where does this apparent lack of trust come from? Dr. Frankel examines the competitiveness of the Faculty of Medicine and, at the end, the residency competition. Do those who engage in the most selective specialties (and in the United States, the best paid) scorn their primary care colleagues? Do specialists have a lack of confidence in the judgment of their primary care peers simply because they have chosen a less specialized medical career such as pediatrics or family medicine?
Noting that the use of electronic medical records and the development of specialties such as hospital medicine have eliminated much of the interpersonal interactions that existed between primary care physicians and specialists – the phone call to discuss A case or corridor update – Dr. Frankel worries that lack of interpersonal interaction, in addition to having a potentially negative impact on patient care, could also contribute to the increase in physician burnout and the decrease in their resiliency.
"Diversity of opinions, critical thinking and skepticism are all good for you and allow you to provide good care and detect potential errors," said Dr. Frankel. "But if a doctor does not trust his colleagues and instead develops cynical and suspicious attitudes towards others, you have a system that is likely to harm patients and, especially, those who provide services. day-to-day care. "
the JAMA The authors emphasize three initial principles for strengthening physician relationships:
- Recognize that physician-physician relationships are consistent and should receive the same level of attention and intent as patient-physician relationships and interpersonal relationships (eg, physician-nurse)
- Differences in value in perspective; exploit them as a resource
- Notice the quality of relationships at every moment. be responsible for creating models of respect and empower others to create models of respect and collaboration
"We need to put more emphasis on the mutual trust of doctors: 1) to better understand how the medical system succeeds or fails – and I believe it's currently failing – and 2) to help order for the construction, and in some cases, rebuilding the doctor to the doctor's confidence, "said Dr. Frankel. "Given the growing number of medical errors in the United States, doctors clearly need better ways to communicate and work together."
He believes that the problem must be addressed in all areas, from medical students to primary care physicians and medical specialists.
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In addition to his appointment as a researcher at the Regenstrief Institute, Dr. Frankel is a professor of medicine at the Indiana School of Medicine and a research sociologist at the Richard L. Medical Center Health Information and Communication Center. Roudebush.
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