Roles of Physicians and Health Care Systems in “Difficult” Clinical Encounters

Abstract

Physicians are, by definition, contributing partners in "difficult" patientphysician encounters. Although research on relevant physician qualities is limited, common themes mirror the more extensive literature on physician burnout. Focusing on primary care, we discuss physician-level factors in difficult encounters related to psychosocial attitudes and selfawareness, communication skills, and practice environments. Potential approaches to mitigating these factors include changes to medical training, such as structured peer case discussion groups and communication skills development, and changes to workplace environments, such as integrated mental health. Modifying physicianlevel factors in difficult encounters could ease perceived difficulties and improve outcomes for both physicians and patients.

Towards better understanding of workplace factors contributing to hospitalist burden and burnout prior to COVID-19 pandemic

“…Our study results are consistent with prior studies that have identified S-T workplace factors such as lack of time to exercise ( Olson et al, 2014 ), time spent on EHR documentation ( Adler-;Milstein et al, 2020 ),( Rotenstein et al, 2018 ), time spent on tasks related to case management( Moy et al, 2021 ) and lack of collaborative patient care as determinants ( Zubatsky et al, 2018 ) of provider burnout. Furthermore, some S-T workplace factors like frequent pages or interruptions for non-emergent issues( Witherspoon et al, 2019 ) and difficult interactions with patients or families ( Goldsmith and Krebs, 2017 ; Wolkenstein and Moffic, 2019 ) have been explored in previous studies but their association with burn out in hospitalists hasn't been firmly established.…”

Tensiones éticas, causas y consecuencias del síndrome de burnout en el personal de salud en tiempos de la Covid-19

“…En el ámbito sociocultural hubo situaciones de estigma laboral, social y familiar por el burnout, como causa y consecuencia, es decir, el estigma que vivieron los profesionales por atender a pacientes afectados con la Covid-19 favoreció la aparición o el desarrollo del burnout, pero también los profesionales que padecieron el síndrome se sintieron estigmatizados, señalados y aislados. De igual forma, se reportó, tanto en médicos como en enfermeras, un deterioro de sus relaciones interpersonales, familiares y de parejas, lo incrementó el número de divorcios, así como la disfunción familiar (32,48,49). Algo similar sucedió con el reconocimiento del trabajo de la mujer en el sector salud, como causa y consecuencia, es decir, las que padecían burnout consideran que su estado de agotamiento laboral ocasionó un menor reconocimiento (28,50), pero también, ser poco reconocidas fue un factor que favoreció el desarrollo de este síndrome (20,21,50,51).…”

“…Dificultades en las relaciones profesionales, familiares y de parejas, y aumento de los divorcios (20,32,39,47,48) Sistema integral de calidad Calidad y seguridad en la atención…”

“…• Problemas de salud: gastrointestinal, migraña, trastornos de sueño y dificultades de concentración (32,48,70) Salud mental (1,32,48,(54)(55)(56)(57)(58)(59)(60) • Autopercepción negativa en los ámbitos personal, laboral y social (10).…”

Beyond Patient-Provider Relationships: Expanding the Roles and Boundaries of Families during Patient End-of-Life

“…Weaker therapeutic alliances may form, whether due to institutional policy (Back et al, 2009) or the withdrawal from relationship by HCP (Huff et al, 2015;Mack et al, 2009), resulting in feelings of abandonment among both patients and their families. During EOL, the established traditional boundaries (etiquettes, rituals, and behaviors) associated with patient and provider become difficult to achieve (Goldsmith & Krebs, 2017;West et al, 2018) and often need to be crossed or modified.…”