title: Clinical prioritisations of healthcare for the aged--professional roles.
abstract: BACKGROUND
  Although fair distribution of healthcare services for older patients is an important challenge, qualitative research exploring clinicians' considerations in clinical prioritisation within this field is scarce.
  
  
  OBJECTIVE
  To explore how clinicians understand their professional role in clinical prioritisations in healthcare services for old patients.
  
  
  METHODS
  A semi-structured interview-guide was employed to interview 45 clinicians working with older patients. The interviews were analysed qualitatively using hermeneutical content analysis.
  
  
  METHODS
  20 physicians and 25 nurses working in public hospitals and nursing homes in different parts of Norway.
  
  
  CONCLUSIONS
  The clinicians struggle with not being able to attend to the comprehensive needs of older patients, and being unfaithful to professional ideals and expectations. There is a tendency towards lowering the standards and narrowing the role of the clinician. This is done in order to secure the vital needs of the patient, but is at the expense of good practice and holistic role modelling. Increased specialisation, advances and increase in medical interventions, economical incentives, organisational structures, and biomedical paradigms, may all contribute to a narrowing of the clinicians' role.
  
  
  CONCLUSIONS
  Distributing healthcare services in a fair way is generally not described as integral to the clinicians' role in clinical prioritisations. If considerations of justice are not included in clinicians' role, it is likely that others will shape major parts of their roles and responsibilities in clinical prioritisations. Fair distribution of healthcare services for older patients is possible only if clinicians accept responsibility in these questions.
authors.affiliation: Department of General Practice and Community Medicine, Section for Medical Ethics, University of Oslo, PO Box 1130 Blindern, NO-0318 Oslo, Norway. p.nortvedt@medisin.uio.no
authors.forename: P
authors.initials: P
authors.lastname: Nortvedt
authors.forename: R
authors.initials: R
authors.lastname: Pedersen
authors.forename: K H
authors.initials: KH
authors.lastname: Grøthe
authors.forename: M
authors.initials: M
authors.lastname: Nordhaug
authors.forename: M
authors.initials: M
authors.lastname: Kirkevold
authors.forename: A
authors.initials: A
authors.lastname: Slettebø
authors.forename: B S
authors.initials: BS
authors.lastname: Brinchmann
authors.forename: B
authors.initials: B
authors.lastname: Andersen
mesh_terms: D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D005260:Female; D015276:Health Care Rationing / Q000941:ethics*; D006299:Health Services for the Aged / Q000941:ethics / Q000592:standards / Q000600:supply & distribution*; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008503:Medical Staff; D008875:Middle Aged; D009664:Norway; D009740:Nursing Staff; D024382:Professional Role / Q000523:psychology*; D011369:Professional-Patient Relations / Q000941:ethics; D036301:Qualitative Research