Berger J T
Department of Medicine, Winthrop-University Hospital, Mineola, New York 11501, USA.
West J Med. 1999 Feb;170(2):93-6.
The use of placebo medication, long recognized by clinicians, often has serious practical implications, such as patient deception. Past evidence has suggested that resident physicians tend to misuse placebo medication. Interns from two consecutive years of a residency program were surveyed anonymously to assess their knowledge and use of placebos. Of the 74 interns surveyed, 44 (59%) were familiar with placebo use in patient care. Fifty percent of these interns familiar with placebo use had learned about placebos from another physician. All interns who had learned about placebos during their internships had learned from another physician, whereas interns who had gained their knowledge of placebos as medical students were as likely to have learned from the medical literature as they were to have learned from a physician (P = 0.027). Interns aware of placebo use were more likely to consider placebo administration for suspected, factitious pain (P = 0.022). The present study uncovered no relationship between interns' estimations of placebo efficacy and the utility they attributed to placebos in assessing a complaint of pain. This suggests that conceptual inconsistencies underlie their use of placebos. Interns often learn of placebos as medical students and are influenced by physician-mentors. Placebo use in patient care is an area of attention for medical educators.
临床医生长期以来都认识到使用安慰剂药物往往会产生严重的实际影响,比如欺骗患者。过去的证据表明住院医师往往会滥用安慰剂药物。对连续两年参加住院医师培训项目的实习生进行了匿名调查,以评估他们对安慰剂的了解和使用情况。在接受调查的74名实习生中,44名(59%)熟悉在患者护理中使用安慰剂。这些熟悉安慰剂使用的实习生中,有50%是从另一位医生那里了解到安慰剂的。所有在实习期间了解到安慰剂的实习生都是从另一位医生那里学到的,而作为医学生了解到安慰剂知识的实习生从医学文献中学到的可能性与从医生那里学到的可能性相同(P = 0.027)。了解安慰剂使用的实习生更有可能考虑对疑似人为疼痛使用安慰剂(P = 0.022)。本研究发现实习生对安慰剂疗效的估计与他们在评估疼痛主诉时赋予安慰剂的效用之间没有关系。这表明他们使用安慰剂存在概念上的不一致。实习生通常在作为医学生时就了解到安慰剂,并受到带教医生的影响。在患者护理中使用安慰剂是医学教育工作者关注的一个领域。