Voices from the Front Lines: An Analysis of Physicians' Reflective Narratives about Flaws with the 'System'.
Medical culture
Narrative analysis
Physician narratives
System
Writing
Journal
The Journal of medical humanities
ISSN: 1573-3645
Titre abrégé: J Med Humanit
Pays: United States
ID NLM: 8917478
Informations de publication
Date de publication:
Dec 2021
Dec 2021
Historique:
accepted:
05
03
2021
pubmed:
7
4
2021
medline:
15
12
2021
entrez:
6
4
2021
Statut:
ppublish
Résumé
Physicians often express frustration with the 'system' in which they work. Over time, this frustration may put them at risk of burnout and disengagement, which may impact patient care. In this study, we aimed to understand the nature of the system flaws that physicians identified in their published narratives and to explore their self-representation as agents of change. We reviewed all reflective narratives published in four medical journals (NEJM, JAMA, CMAJ, Annals IM) between January 2015 and December 2017 (n = 282). By consensus, we identified those that addressed system flaws (n = 87). Using content and narrative analysis, we analyzed the types of flaws and the physicians' orientation to the flawed system. We identified seven recurring system flaws-five related to medical culture: failures of communication, erosive impact of the hidden curriculum, inadequate health advocacy, frenzied pace of work, and experience of stigma. Less frequently, physicians' narratives also exposed limited and disparate healthcare resources and restrictive institutional practices as impeding patient-centered care. Physicians expressed agency to create change foremost when writing about flaws related to medical culture. While physicians are challenged by system flaws, they strive to practice in ways that do not succumb to them. We saw tension between the elements outside the physician's control and those within it. This tension becomes a source of distress when the compromises that emerge from system flaws move physicians away from the values that define their professional identity.
Identifiants
pubmed: 33822310
doi: 10.1007/s10912-021-09690-6
pii: 10.1007/s10912-021-09690-6
pmc: PMC8021932
doi:
Types de publication
Journal Article
Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
737-752Informations de copyright
© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.
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