A comprehensive primer of surgical informed consent
A comprehensive primer of surgical informed consent
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DOI：
10.1016/j.suc.2007.07.012
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发表时间：
2007-08-01
影响因子：
3.1
通讯作者：
Richman, Bruce W.
中科院分区：
文献类型：
--
作者：
Jones, James W.;McCullough, Lawrence B.;Richman, Bruce W.
知情同意过程中所需的临床技能往往不会在正式课程中教授给研究员、住院医生和医学生[1]。此外，外科住院医生在与患者沟通时很少受到监督。结果，教师和学员都放弃了识别、评估和解决住院医师与患者人际交往能力弱点的机会，特别是在知情同意对话期间。外科实践在许多方面与非外科医疗实践不同，主要是因为手术。手术治疗作为一项特定事件发生，通常需要进入患者体内；可以准确地安排治疗事件的时间（分配罪责）；患者的情绪压力较大；一旦麻醉诱导，外科患者比其他医学专业的患者扮演更加被动的角色。然后患者就无法参与术中决策；外科医生完全控制决策过程。因此，与其他专业的同事相比，外科医生在治疗过程中对积极的医患伙伴关系的认识可能不太成熟，这可能会影响他们获得知情同意的方法。外科医生还可以假设转诊医生已经做好了必要的智力和情感准备，并且有效地获得了患者对通过手术解决临床问题的同意。综合起来，这些因素可能导致不知情的外科医生低估患者参与麻醉诱导前知情同意过程的能力和意愿。结果，外科医生可能失去与患者形成有效治疗联盟的机会。
The clinical skills required in the informed consent process tend not to be taught to fellows, residents, and medical students within the formal curriculum [1]. Furthermore, surgical residents are seldom supervised during their communication with patients. As a result, faculty and trainees alike forego an opportunity to identify, evaluate, and address weaknesses in the resident's interpersonal skills with patients generally, and during the informed consent dialogue in particular. Surgical practice is distinct from nonsurgical medical practice in a number of regards, primarily because of the operation. Surgical therapy occurs as a specific event, usually requiring entry into the patient's body; the therapeutic event can be timed exactly (assigning culpability); the emotional stress on the patient is greater; and the surgical patient plays a more passive role than patients of other medical specialties once anesthesia is induced. The patient then becomes incapable of participatory intraoperative decision-making; and surgeon assumes full control of the decision-making process. Surgeons may consequently have a less fully developed sense of an active physician-patient partnership in the healing process than colleagues in other specialties, and this can affect their approach to informed consent. The surgeon may also assume that the referring physician has already made the necessary intellectual and emotional preparations and effectively has obtained the patient's consent for surgical resolution of the clinical problem. In combination, these factors can lead the unwitting surgeon to underestimate the capacity and willingness of the patient to participate in the informed consent process that should precede induction of anesthesia. As a consequence, the surgeon can lose the opportunity to form an effective therapeutic alliance with the patient.