Views and approaches toward risks and benefits among doctors who become patients
Views and approaches toward risks and benefits among doctors who become patients
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DOI：
10.1016/j.pec.2005.11.013
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发表时间：
2006-12-01
影响因子：
3.5
通讯作者：
Klitzman, Robert
中科院分区：
文献类型：
--
作者：
Klitzman, Robert
目的：为了了解关于风险和收益的观点和方法如何受到与临床角色和关系相关的动态背景和过程的影响，我们对50名因严重疾病而成为患者的医生进行了两次深入的半结构化访谈，了解他们在诊断前后的经历。作为患者，这些医生对风险和收益的沟通过程和背景有了新的见解。医生和患者在如何看待和权衡风险和益处方面往往各不相同（例如，“好”或“坏”）。这些数据表明了一个模型，在这个模型中，患者经历了几个动态过程：寻求统计数据，接受医生对统计数据的框架，受到媒体炒作的影响，将统计数据视为相关或不相关，高估风险，权衡风险和收益的重要性，将统计数据解释为好或坏，接受或否认统计数据和几率，以及做出治疗决定。这些过程受到外部因素的影响（例如，医生安排测试、构建统计数据，以及经常高估与低估风险），以及内部因素（例如，抑郁症、否认疾病、乐观与悲观、神奇的想法--医生对疾病免疫--以及合理化）。结论：医生和患者参与了复杂的动态过程，这些过程塑造了患者对风险和收益的态度。实践意义：这些数据强调需要在医学教育和护理中增加对这些问题的关注。(c)2005爱思唯尔爱尔兰有限公司保留所有权利。
Objective: To understand how views and approaches concerning risks and benefits may be affected by dynamic contexts and processes related to clinical roles and relationships.Methods: We conducted two in-depth, semi-structured interviews with 50 doctors who became patients due to serious illnesses, concerning their experiences before and after diagnosis.Results: As patients, these doctors gained critical new insights into the processes and contexts of communication about risks and benefits. Doctors and patients often varied in how they viewed and weighed risks and benefits (e.g., as "good' or "bad"). These data suggest a model in which patients undergo several dynamic processes: seeking statistics, accepting doctors' framing of statistics, being influenced by media hype, seeing statistics as relevant or not, over-valuing risks, weighing the importance of risks and benefits, interpreting statistics as good or bad, accepting or denying statistics and odds, and making treatment decisions. These processes are affected by external factors (e.g., doctors ordering tests, framing statistics, and often over-versus under-valuing risks), and internal factors (e.g., depression, denial of illness, optimism versus pessimism, magical thinking-that doctors are immune to disease-and rationalizations).Conclusions: Doctors and patients are engaged in complex, dynamic processes that shape patients' approaches toward risks and benefits. Practice Implications: These data highlight the need for increased attention toward these issues in medical educational and care. (c) 2005 Elsevier Ireland Ltd. All rights reserved.