Paying for performance: money, motivation, and uncertainty.
Paying for performance: money, motivation, and uncertainty.
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按绩效付费：金钱、动力和不确定性。
DOI：
10.1016/s0140-6736(16)00574-2
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发表时间：
2016
期刊：
影响因子：
--
通讯作者：
Navathe,AmolS
中科院分区：
文献类型：
--
作者：
Liao,JoshuaM;Navathe,AmolS
华生先生是我的新病人，他坐在检查台上，双手紧握。他默默地打量着地板，搓了一会儿指关节，终于抬起头来。“那么，你是出于成本考虑而反对PSA检测吗？”他说。当我完成他的身体检查时，沃森先生问我是否要做一个前列腺特异性抗原（PSA）测试，这是他以前的初级保健医生每年做的筛查。我告诉他，根据他的年龄、风险状况、有无症状以及检测的风险与益处，我认为没有必要进行检测。我的回答使他安静了下来。在他的沉默中，他的问题回响着，就像一声响亮的控诉，我慢慢地呼出一口气，以抑制喉咙里涌起的砰砰声，因为我准备解释我的决定。我强调他患危及生命的癌症的风险很低，而且不进行检测符合最新的指导方针。我还重申，作为他的初级保健医生，我的目标是帮助他做出对他最有利的决定。
Mr Watson, a new patient in my practice, sat on the examination table, clutching his hands. He studied the floor without speaking, rubbing his knuckles for a while before finally looking up.“So, are you advising against the PSA test because of the cost?”, he said. It was when I had finished his physical examination that Mr Watson had asked if I would do a prostate-specific antigen (PSA) test, something his previous primary care physician had done as yearly screening. I told him that, on the basis of his age, risk profile, absence of symptoms, and the risks versus benefits of testing, I did not think it was necessary. My reply caused him to fall quiet. In his silence, his question echoed like a loud indictment, and I exhaled slowly to suppress the pounding I felt rising into my throat as I prepared to explain my decision. I emphasised his low risk for developing a life-threatening cancer and the fact that not pursuing testing accorded with the most up-todate guidelines. I also reiterated that as his primary care physician, my goal was to help him make decisions that were in his best interest.