استعرض مصدر Too complex and time-consuming to fit in! Physicians’ experiences of elderly patients and their participation in medical decision making: a grounded theory study


Too complex and time-consuming to fit
in! Physicians’ experiences of elderly
patients and their participation in
medical decision making: a grounded
theory study

Anne Wissendorff Ekdahl,1,2 Ingrid Hellstro¨m,1,2 Lars Andersson,3
Maria Friedrichsen2,4

Ekdahl AW,
Hellstro¨m I, Andersson L,
et al. Too complex and
time-consuming to fit in!
Physicians’ experiences of
elderly patients and their
participation in medical
decision making: a grounded
theory study. BMJ Open
2012;2:e001063.
doi:10.1136/
bmjopen-2012-001063

ABSTRACT

Objective: To explore physicians’ thoughts and
considerations of participation in medical decision
making by hospitalised elderly patients.
Design: A qualitative study using focus group
interviews with physicians interpreted with grounded
theory and completed with a questionnaire.
Setting and participants: The setting was three
different hospitals in two counties in Sweden. Five
focus groups were conducted with physicians (n¼30)
in medical departments, with experience of care of
elderly patients.

Results: Physicians expressed frustration at not being
able to give good care to elderly patients with
multimorbidity, including letting them participate in
medical decision making. Two main categories were
found: ‘being challenged’ by this patient group and
‘being a small part of the healthcare production
machine’. Both categories were explained by the core
category ‘lacking in time’. The reasons for the feeling
of ‘being challenged’ were explained by the
subcategories ‘having a feeling of incompetence’,
‘having to take relatives into consideration’ and
‘having to take cognitive decline into account’. The
reasons for the feeling of ‘being a small part of the
healthcare production machine’ were explained by
the subcategories ‘at the mercy of routines’ and
‘inadequate remuneration system’, both of
which do not favour elderly patients with
multimorbidity.

Conclusions: Physicians find that elderly patients
with multimorbidity lead to frustration by giving
them a feeling of professional inadequacy, as they are
unable to prioritise this common and rapidly
growing patient group and enable them to participate
in medical decision making. The reason for
this feeling is explained by lack of time,
competence, holistic view, appropriate routines and
proper remuneration systems for treating these
patients.


http://bmjopen.bmj.com/content/bmjopen/2/3/e001063.full.pdf

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