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

为了建立良好的医患关系，解决日常医疗实践中的伦理问题，掌握医患医学访谈技巧对医生来说是非常重要的。然而，很少有人关心医生在多大程度上试图提供一些医疗信息，并促进患者参与决策。在初步研究中，我们采用对山口大学医院的实际患者进行访谈的方法，调查医生是否与患者进行沟通，鼓励患者的决策意愿。结果,84%的病人能够回答告诉一个主治医师充分条件或担心,96%的人对他们的临床状态和可以解释检查结果,84%的人也会接受他们的诊断hospitalThen,我们试图研究目前临床医生与病人进行临床决策的方法直接观察和评估的完整性初级护理医师作出明智的决定。在初级保健门诊，病人和医生之间的对话用录音带记录下来，并分析他们的讨论，以确定知情决策的要素。录音中包含了四个临床决定。总体而言，除同意体检外，51.1 ~ 85.7%的病例完成了常规实验室检查、用药和随访预约的知情决策。这些结果表明，在日常临床实践中鼓励知情决策是必要的

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