Exploring role dialectics in inter-service admission handoffs: a qualitative analysis of physician communication

ABSTRACT

Admission handoffs between emergency physicians (EPs) and internal medicine/hospitalist physicians (IMHPs), a frequently occurring form of patient transfer, remain understudied despite their importance to care continuity. Handoffs function as more than simple information transfer; they require a repertoire of interpersonal skills to accomplish tasks and develop professional relationships. Relational Dialectics Theory (RDT), a perspective that asserts social life consists of oppositional and unified discourses present in personal relationships, frames the current study. We use role dialectics to more fully understand the contradictions that emerge from the competing discourses of physician roles. Data were collected from six focus groups consisting of residents and attending physicians working at a large, urban, academic medical center in the Midwest United States. Using a grounded, constant-comparative approach, analysis of transcripts reveals that these physicians encounter two key role dialectics during handoffs: autonomy–collaboration and uncertainty–certainty. Interventions for physicians and hospital decision-makers are recommended.

KEYWORDS:

• Physician communication
• emergency medicine
• inpatient medicine
• care transitions
• handoffs

Acknowledgements

The authors thank Kevin O’Leary, MD, Northwestern Memorial Hospital, Northwestern University and Dickson Cheung, MD, Sky Ridge Medical Center, Carepoint PC for their contributions to the research that informed the present study.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This project was supported by Western Michigan University under grant S2013-011.