Studies for Physician's Role on Informed Decision Making and Patient-Medical Staff Relationship

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In order to accomplish a well relationship between the patient and physician andresolve an ethical problem in routine office practice, to master medical interview skills with the patient is very important for physician. However, little is concerned about the extent to which physicians try to give some medical information and foster patient involvement in decision making. In the preliminary study, we investigated whether physician communicated with the patient encouraging the patient's will for decision making using a method of the interview to actual patients of Yamaguchi University Hospital. As a result, 84 % of the patients answered to be able to tell an attending physician sufficiently about their conditions or worries, 96 % of them could be explained about their clinical states and the examined results and 84 % of them also could accept their diagnosis in the hospitalThen, we try to examine how clinician makes clinical decisions with patient currently by the methods of direct observation and evaluate the completeness of informed decision making by primary care physicians. Conversations between the patient and physician were recorded by audiotape in the primary care outpatient clinic and their discussions were analyzed for elements of informed decision making. The audio taped encounters contained about four clinical decisions. Overall, except for an agreement for physical examination, informed decision making about routine laboratory test, medication and follow up appointment was completed in 51.1〜85.7 % of cases. These results indicated that much efforts were necessary to encourage the informed decision making in daily clinical practice