Relaciones clínicas complejas y uso de tecnologías sanitariasestrategias de afrontamiento y condicionantes socioestructurales en la consulta
- Erika Valero Alzaga
- Yolanda González-Rábago
- Paola Bully
- Pedro Latorre
- Begoña Fernández-Ruanova
ISSN: 0034-9712
Year of publication: 2024
Volume: 82
Issue: 1
Type: Article
More publications in: Revista internacional de sociología
Abstract
The use of health technologies without a clinical indication leads to unnecessary healthcare costs. In this article, we analysed the perceptions of medical staff about the influence of patients’ attitudes and other contextual factors on the demand for Magnetic Resonance Imaging (MRI). For this purpose, we carried out a qualitative study based on semi-structured interviews with professionals from different medical specialties (n=36). After a content analysis, we triangulated the results within the research team. The results indicate that medical staff identify that the increasing demanding attitude of patients, in a health care context with a deficit of time in consultations and high turnover of professionals, conditions the request for MRI. We concluded that it is essential to reinforce trust and doctor-patient communication, and to provide time and stability in consultations in order to use health resources rationally.
Bibliographic References
- An, Perry G., Joseph S. Rabatin, Linda B. Manwell, Mark Linzer, Roger L. Brown y Mark D. Schwartz. 2009. "Burden of Difficult Encounters in Primary Care: Data From the Minimizing Error, Maximizing Outcomes Study." Archives of Internal Medicine 169(4):410-4. https://doi.org/10.1001/archinternmed.2008.549 PMid:19237726
- Braun, Virginia. y Victoria Clarke. 2006. "Using thematic analysis in psychology." Qualitative Research in Psychology 3(2):77-101. https://doi.org/10.1191/1478088706qp063oa
- Ministerio de Salud. S. f. Consulta Interactiva del SNS. Consultado el 12 de abril de 2022 (https://pestadistico.inteligenciadegestion.mscbs.es/publicoSNS/S).
- Corallo, Ashley N., Ruth Croxford, David C. Goodman, Elisabeth L. Bryan, Divya Srivastava y Therese A. Stukel. 2014. "A systematic review of medical practice variation in OECD countries." Health Policy 114(1): 5-14. https://doi.org/10.1016/j.healthpol.2013.08.002 PMid:24054709
- Elder, Nancy, Rick Ricer y Barbara Tobias. 2006. "How respected family physicians manage difficult patient encounters." Journal of the American Board of Family Medicine 19(6): 533-41. https://doi.org/10.3122/jabfm.19.6.533 PMid:17090786
- Espeland, Ansgar y Anders Baerheim. 2003. "Factors affecting general practitioners' decisions about plain radiography for back pain: implications for classification of guideline barriers--a qualitative study." BMC Health Services Research 3(1):8. https://pubmed.ncbi.nlm.nih.gov/12659640/. https://doi.org/10.1186/1472-6963-3-8 PMid:12659640 PMCid:PMC153534
- GBD 2019 Diseases and Injuries Collaborators. 2020. "Global burden of 369 diseases and injuries in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019." The Lancet 396:1135-59.
- Hall, Amanda M., Samantha R. Scurrey, Andrea E. Pike, Charlotte Albury, Helen L. Richmond, James Matthews, Elaine Toomey, Jill A. Hayden y Holly Etchegary. 2019. "Physician-reported barriers to using evidence-based recommendations for low back pain in clinical practice: a systematic review and synthesis of qualitative studies using the Theoretical Domains Framework." Implementation Science 14(49). https://doi.org/10.1186/s13012-019-0884-4 PMid:31064375 PMCid:PMC6505266
- Hardavella, Georgia, Ane Aamli-Gaagnat, Armin Frille, Neil Saad, Alexandra Niculescu y Pippa Powell. 2017. "Top tips to deal with challenging situations: doctor-patient interactions." Breathe 13(2):129-35. https://doi.org/10.1183/20734735.006616 PMid:28620434 PMCid:PMC5467659
- Jolín Garijo, L., M. Martín Bun, S. Prados Torres, C. Vicens Caldentey, JC. Abánades Herranz, V. Cabedo García, R. Cunillera Graño y JJ. García Díez. 1998. "Factores que influyen en la prescripción farmacológica del médico de atención primaria." Atención Primaria 22(6):391-398. https://www.elsevier.es/es-revista-atencion-primaria-27-articulo-factores-que-influyen-prescripcion-farmacologica-14925.
- Lateef, Fatimah. 2011. "Patient expectations and the paradigm shift of care in emergency medicine." Journal of Emergencies, Trauma, and Schock 4(2):163-7. https://doi.org/10.4103/0974-2700.82199 PMid:21769199 PMCid:PMC3132352
- Lázaro, J. y D. Gracia. 2006. "La relación médico-enfermo a través de la historia," Anales del Sistema Sanitario de Navarra 29(3):7-17. https://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S1137-66272006000600002. https://doi.org/10.4321/S1137-66272006000600002
- Lim, Yuan Z., Louisa Chou, Rebecca T.M. Au, KL Maheeka D. Seneviwickrama, Flavia M. Cicuttini, Andrew M. Briggs, Kaye Sullivan, Donna M. Urquhart y Anita E. Wluka. 2019. "People with low back pain want clear, consistent and personalised information on prognosis, treatment options and self-management strategies: a systematic review." Journal of Physiotherapy 65(3):124-35 https://doi.org/10.1016/j.jphys.2019.05.010 PMid:31227280
- Lorenzetti, Rosemarie C., C. H. Mitch Jacques, Carolyn Donovan, Scott Cottrell y Joy Buck. 2013. "Managing difficult encounters: Understanding physician, patient, and situational factors." American Family Physician 87(6):419-25. https://www.aafp.org/pubs/afp/issues/2013/0315/p419.html.
- Loriente-Arín, Nuria y Rafael Serrano-del-Rosal. 2009. "Hable con los pacientes, no para ellos. Análisis de las fuentes de confianza del acto médico." Revista Internacional de Sociología 67(2):309-28. https://doi.org/10.3989/RIS.2007.10.10
- Luo, Aijing, Lu Qin, Yifeng Yuan, Zhengzijin Yang, Fei Liu, Panhao Huang y Wenzhao Xie. 2022. "The Effect of Online Health Information Seeking on Physician-Patient Relationships: Systematic Review." Journal of Medical Internet Research 24(2):e23354. https://doi.org/10.2196/23354 PMid:35142620 PMCid:PMC8874798
- McClung, H. Juhling, Robert D. Murray y Leo A. Heitlinger. 1998. "The Internet as a source for current patient information." Pediatrics 101(6):e2. https://doi.org/10.1542/peds.101.6.e2 PMid:9606244
- Mendoza F., Alfonso. 2017. "La relación médico paciente: consideraciones bioéticas." Revista Peruana de Ginecología y Obstetricia 63(4):555-64. http://www.scielo.org.pe/scielo.php?script=sci_arttext&pid=S2304-51322017000400007. https://doi.org/10.31403/rpgo.v63i2029
- Mercuri, Mathew y Amiram Gafni. 2011. "Medical practice variations: what the literature tells us (or does not) about what are warranted and unwarranted variations." Journal of Evaluation in Clinical Practice 17:671-7. https://doi.org/10.1111/j.1365-2753.2011.01689.x PMid:21501341
- Merino, Irati, Aranzazu del Castillo Figueruelo y Carmina Saldaña García. 2016. "El manejo de pacientes difíciles: ¿Qué ocurre cuando paciente y terapeuta no se entienden?" Cuadernos de Medicina Psicosomática y Psiquiatría de Enlace 118:15-24. https://dialnet.unirioja.es/servlet/articulo?codigo=5565196.
- Moreno Rodríguez, Miguel A. 2006. "Ética, tecnología y clínica." Revista Cubana de Salud Pública 32(4). Consultado el 12 de abril de 2022 (http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S0864-34662006000400012).
- Morgan, Myfanwy, Linda Jenkins y Leone Ridsdale. 2007. "Patient pressure for referral for headache: a qualitative study of GPs' referral behaviour." British Journal of General Practice 57(534):29-35. https://pubmed.ncbi.nlm.nih.gov/17244421/.
- National Research Council. 2011. Clinical Practice Guidelines We Can Trust. Washington, DC: The Nacional Academies Press.
- O'Mathúna, Dónal P. 2018. "How should clinicians engage with online health information?" American Medical Association Journal of Ethics (20)11:E1059-66. https://doi.org/10.1001/amajethics.2018.1059 PMid:30499435
- Organisation for Economic Co-operation and Development (OECD). S. f. Health care use - Magnetic resonance imaging (MRI) exams - OECD Data. Consultado el 12 de abril de 2022 (https://data.oecd.org/healthcare/magnetic-resonance-imaging-mri-exams.htm).
- Organisation for Economic Co-operation and Development (OECD). 2021. Health at a Glance 2021: OECD Indicators. Consultado el 12 de abril de 2022
- Potter, Sharyn J. y John B. McKinlay. 2005. "From a relationship to encounter: an examination of longitudinal and lateral dimensions in the doctor-patient relationship." Social Science & Medicine 61(2):465-79. https://doi.org/10.1016/j.socscimed.2004.11.067 PMid:15893060
- Ruiz Moral, R., J. J. Rodríguez y R. Epstein. 2003. "What style of consultation with my patients should I adopt? Practical reflections on the doctor-patient relationship." Atencion Primaria 32(10):594-602. https://doi.org/10.1016/S0212-6567(03)79339-1 PMid:14697185
- Safiri, Saeid, Hojjat Pourfathi, Arielle Eagan, Mohammad A. Mansournia, Mohammad T. Khodayari, Mark J.M. Sullman, Jay Kaufman, Gary Collins, Haijiang Dai, Nicola L. Bragazzi, y Ali-Asghar Kolahi. 2022. "Global, regional, and national burden of migraine in 204 countries and territories, 1990 to 2019." Pain 163(2):e293-e309. https://doi.org/10.1097/j.pain.0000000000002275 PMid:34001771
- Schers, Henk, Michel Wensing, Zsuzsan Huijsmans, Maurits van Tulder y Richard Grol. 2001. "Implementation Barriers for General Practice Guidelines on Low Back Pain: A Qualitative Study." Spine 26(15):E348-E353. https://doi.org/10.1097/00007632-200108010-00013 PMid:11474367
- Sharma, Sweekriti, Adrian C. Traeger, Ben Reed, Melanie Hamilton, Denise A. O'Connor, Tammy C. Hoffmann, Carissa Bonner, Rachelle Buchbinder y Chris G. Maher. 2020. "Clinician and patient beliefs about diagnostic imaging for low back pain: a systematic qualitative evidence synthesis." BMJ Open 10:e037820. https://doi.org/10.1136/bmjopen-2020-037820 PMid:32830105 PMCid:PMC7451538
- Shye, Diana, Donald K. Freeborn, Jeffrey Romeo y Steve Eraker. 1998. "Understanding physicians' imaging test use in low back pain care: the role of focus groups." International Journal for Quality in Health Care 10(2):83-91. https://doi.org/10.1093/intqhc/10.2.83 PMid:9690881
- Slade, Susan, Peter Kent, S., Patel, T. Bucknall y R. Buchbinder. 2016. "Barriers to Primary Care Clinician Adherence to Clinical Guidelines for the Management of Low Back Pain: A Systematic Review and Metasynthesis of Qualitative Studies". Clin J Pain [Internet] 32(9). https://doi.org/10.1097/AJP.0000000000000324 PMid:26710217
- Smith, Sam. 1995. "Dealing with the difficult patient." Postgraduate Medical Journal 71(841):653-7. https://doi.org/10.1136/pgmj.71.841.653 PMid:7494768 PMCid:PMC2398339
- Soot, Laurel C., Gregory L. Moneta y James M. Edwards. 1999. "Vascular surgery and the Internet: a poor source of patient-oriented information." Journal of Vascular Surgery 30(1):84-91. https://doi.org/10.1016/S0741-5214(99)70179-5 PMid:10394157
- Stacey, Claire L., Stuart Henderson, Kelly R. MacArthur y Daniel Dohan. 2009. "Demanding patient or demanding encounter?: A case study of a cancer clinic." Social Science & Medicine 69(5):729-37. https://doi.org/10.1016/j.socscimed.2009.06.032 PMid:19619924 PMCid:PMC4397098
- Suarez-Almazor, M.E., C.J. Kendall y M. Dorgan. 2001. "Surfing the Net-information on the World Wide Web for persons with arthritis: patient empowerment or patient deceit?" The Journal of Rheumatology 28(1):185-91. https://pubmed.ncbi.nlm.nih.gov/11196523/.
- Thompson, Andrew G.H. 2007. "The meaning of patient involvement and participation in health care consultations: a taxonomy." Social Science & Medicine 64(6):1297-310. https://doi.org/10.1016/j.socscimed.2006.11.002 PMid:17174016
- Tong, Allison, Peter Sainsbury y Jonathan Craig. 2007. "Consolidated criteria for reporting qualitative research (COREQ): A 32-item checklist for interviews and focus groups." International Journal for Quality in Health Care 19(6):349-57. https://doi.org/10.1093/intqhc/mzm042 PMid:17872937
- Underwood, Raphael, Rachael Kilner y Leone Ridsdale. 2017. "Primary care management of headaches and how direct-access MRI fits: A qualitative study of UK general practitioners' views." BMJ Open 7:e018169. https://doi.org/10.1136/bmjopen-2017-018169 PMid:29127230 PMCid:PMC5695367
- Varela-Lema, Leonor, Gerardo Atienza-Merino y Marisa López-García. 2017. "Priorización de intervenciones sanitarias. Revisión de criterios, enfoques y rol de las agencias de evaluación." Gaceta Sanitaria 31(4):349-57. https://doi.org/10.1016/j.gaceta.2016.09.015 PMid:28057389