患者的威胁及其对医疗决策的影响:一个横截面的随机试验
I S Kristiansen1, O H Førde, O Aasland
1Institute of Public Health, University of Southern Denmark, DK-5000 C, Odense, Denmark. isk@sam.sdu.dk
Lancet (London, England)
|June 22, 2001
概括
医生的负面经验,如投诉,并没有改变临床决策. 然而,当医生面临患者或亲属的直接威胁时,他们改变了策略.
科学领域:
- 医学伦理 医学伦理
- 临床决策的过程
- 医生福利 医生福利
背景情况:
- 在挪威,医生常有负面经验.
- 这些经验包括投诉,媒体曝光,财务索赔和警察通知.
- 了解这些反应的原因和影响至关重要.
研究的目的:
- 调查医生面临的患者或亲属负面反应的类型和原因.
- 确定这些负面经验对后续临床决策的影响.
- 评估医生对涉及威胁的模拟临床场景的反应.
主要方法:
- 一份问卷分发给1260名挪威医生的随机样本.
- 医生还完成了五个病例模拟,其中一半接受了涉及威胁的场景.
- 分析了数据,以基于威胁存在的决策策略进行比较.
主要成果:
- 47%的回应医生报告了负面经历.
- 在案例模拟中,负面经验没有影响一般策略选择.
- 受到威胁的医生在特定情况下 (胸痛,头痛) 更有可能采用防御策略.
结论:
- 随后的临床决策不会受到之前的负面经验的显著影响.
- 患者或亲属的直接威胁可能会导致医生遵守他们的愿望.
- 医生对威胁的反应需要进一步调查.
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