Care Left Undone Among Physicians: An Explorative Thematic Analysis.

Abstract

The concept of care left undone has been extensively studied among nurses, limited research has examined how physicians experience and respond when care is left undone. Understanding physicians' perspectives is needed for developing more comprehensive strategies to enhance care quality and safety. To explore how physicians conceptualise, experience and manage care left undone. A qualitative study was conducted using semi-structured interviews with 12 physicians active in a tertiary teaching hospital. Thematic analysis was guided by existing literature on missed care but allowed inductive insights to emerge from the data. Physicians were generally unfamiliar with the term 'care left undone', yet readily identified with the phenomenon when described, conceptualising it as a routine aspect of clinical practice shaped by time scarcity, competing demands and professional judgement. High workload, understaffing and a multitude of responsibilities were identified as main antecedents of care left undone. Omissions most frequently involved administrative tasks, psychosocial support and communication, which were deprioritised relative to diagnostic and therapeutic tasks to mitigate any negative effects on patient outcomes. Strategies to navigate care left undone included implicit triage and task delegation, often framed as expressions of clinical expertise rather than deficiencies. Reported consequences included compromised patient safety, disrupted continuity of care and adverse emotional and professional impacts on physicians, such as moral distress and burnout. Proposed solutions were identified at the organisational (eg, staffing, workload reduction, supportive environment), interpersonal (eg, enhanced collaboration) and patient levels (eg, health literacy and engagement). A cross-cutting meta-theme of professional identity and role boundaries shaped how physicians perceived, rationalised and responded to care left undone, highlighting the need for interdisciplinary, context-sensitive interventions. Care left undone is a relevant yet underexplored phenomenon among physicians active in acute care hospitals. Addressing care left undone requires profession-sensitive approaches that account for differences in role structure, decision-making autonomy and identity. Quality improvement initiatives should include physicians in the co-design of interventions to ensure they reflect clinical realities and foster engagement.