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

为了更好地处理医患关系，解决日常诊疗中的伦理问题，掌握与患者进行医学面谈的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，我们调查了医生是否与病人沟通，鼓励病人的意愿，为决策使用的方法采访山口大学医院的实际病人。结果，84%的患者回答能够向主治医生充分地讲述自己的病情或担忧，96%的患者能够向主治医生解释自己的临床状态和检查结果，84%的患者能够接受自己在医院的诊断。本研究尝试以直接观察的方法，检视目前临床医师如何与病患共同做出临床决策，并评估初级照护在知情决策上的完整性医生病人和医生之间的对话记录在初级保健门诊的录音带和他们的讨论进行了分析，知情决策的元素。这些录音记录了大约四个临床决策。总体而言，除同意进行体格检查外，51.1 - 85.7%的病例完成了关于常规实验室检查、药物治疗和随访预约的知情决策。这些结果表明，在日常临床实践中，需要做出更多努力来鼓励知情决策

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