Biomedical subjects

Reidun Førde

Publications and source records attributed to Reidun Førde.

21 records · Page 2Linked to original sources

PubMed2002

[What does it feel like for a physician to be a gatekeeper?].

BACKGROUND: Doctors increasingly act as gatekeepers. We have studied the effect that this function has on the doctors themselves. MATERIAL AND METHODS: Analysis of 24 questions from large surveys of representative samples of Norwegian doctors in 1993 and 2000. RESULTS: Six out of seven doctors sometimes or often met unrealistic demands from patients. More than one third experienced stress because of patient expectations about help for non-medical problems. Nearly 50% had adjusted medical certificates in order to help the patient. More than 50% sometimes or often gave more weight to patients' wishes than to their own medical judgement. 86% had chosen to come in for work themselves when they would have certified as sick a patient with the same symptoms and working situation. The proportions were significantly smaller among older doctors and doctors with a high level of job satisfaction. INTERPRETATION: The gatekeeper role has important influence on doctors' job satisfaction. A possible generation effect may imply that society will meet problems more often in the future when assigning gatekeeper functions to doctors.

Adult↗

PubMed2002

Medical end-of-life decisions in Norway.

AIM: Previous studies indicate that Norwegian physicians hold conservative attitudes towards ethically controversial end-of-life decisions. The present study was undertaken to explore whether in Norway euthanasia may be hidden under labels such as death after analgesic injections and withholding or withdrawing treatment. METHODS: A postal questionnaire containing 76 questions on ethical, collegial and professional autonomy issues was sent to a representative sample of 1616 active physicians in Norway in 2000. RESULTS: 83% responded. A total of 8.1% had terminated life-prolonging treatment based on the resource situation, while 53.5 and 40.1% respectively had stopped life prolonging treatment due to the wish of the patient and the wish of the patient's relatives. Although not significantly, anaesthesiologists more often reported to have stopped treatment due to resource considerations. One percent of the physicians reported to have shortened a patient's life intentionally (other than stopping futile treatment). All of these were men. Logistic regression showed no effect when gender, age and specialty were analysed simultaneously. 10.6%, and male more often than female physicians, had had experience of unintentional patient death in relation to pain treatment. Anaesthesiologists had had experiences of death following an analgesic injection no more than other specialists. CONCLUSIONS: Only a small minority of Norwegian physicians has committed euthanasia. However, patient death has occurred following ethically questionable decisions such as withdrawal of treatment based on resource considerations and requests from the family.

Adult↗

PubMed2002

What matters to the parents? A qualitative study of parents' experiences with life-and-death decisions concerning their premature infants.

The aim of this article is to generate knowledge about parents' participation in life-and-death decisions concerning their very premature and/or critically ill infants in hospital neonatal units. The question is: what are parents' attitudes towards their involvement in such decision making? A descriptive study design using in-depth interviews was chosen. During the period 1997-2000, 20 qualitative interviews with 35 parents of 26 children were carried out. Ten of the infants died; 16 were alive at the time of the interview. The comparative method (grounded theory) was used to analyse the data. The analysis was carried out continuously and in parallel with data collection. Six categories were revealed by the analysis: indecision and uncertainty (ambivalence); information and communication; participate, but do not decide; seeming to be included; the parents' child; and individual consideration. The findings appear to indicate that parents agree that they should not have the final word in decisions concerning their infants' future life or death. Such a responsibility would put too heavy a burden on parents who lack the medical knowledge and the professional experience needed to make such a decision, and would be likely to lead to them experiencing strong feelings of guilt. The findings show that parents should be well informed and listened to during the whole decision-making process. Their primary concern was how nurses and physicians communicate with parents who are experiencing a crisis, and how this serious information is presented.

Adaptation, Psychological↗