Butler C C, Kinnersley P, Prout H, Rollnick S, Edwards A, Elwyn G
McMaster University, Faculty of Health Sciences, 1200 Main Street West, HSC 2V14, Hamilton, Ontario, Canada L8N 3Z5.
J Antimicrob Chemother. 2001 Sep;48(3):435-40. doi: 10.1093/jac/48.3.435.
Antibiotics are often prescribed to patients with respiratory tract infections who are unlikely to benefit. Models of physician-patient interaction may help understanding of this problem and inform the design of communication skills interventions to enhance appropriate prescribing. The 'paternalistic model' of the consultation remains common in the setting of acute respiratory tract infections. However, the four assumptions that could support this model are not valid for most of these patients, because: best treatment is controversial; management is inconsistent; physicians are not in the best position to evaluate trade-offs between management options without understanding patients' perspectives; and many pressures (apart from patients' agendas) intrude into the consultation. One alternative is the 'informed model' of consulting, but this does not take society's interests into account. The 'shared decision-making model', however, provides a framework for addressing both clinicians' and patients' agendas, and could guide the development and evaluation of specific consultation strategies to promote more appropriate use of antibiotics in primary care.
抗生素常常被开给不太可能从中受益的呼吸道感染患者。医患互动模式可能有助于理解这一问题，并为提高合理用药的沟通技巧干预措施的设计提供依据。在急性呼吸道感染的情况下，“家长式模式”的会诊仍然很常见。然而，支持这种模式的四个假设对大多数这类患者并不成立，原因如下：最佳治疗方案存在争议；治疗方法不一致；医生若不了解患者的观点，就无法处于最佳位置来评估不同治疗方案之间的权衡；而且许多压力（除了患者的诉求之外）会干扰会诊。另一种选择是“知情模式”的会诊，但这种模式没有考虑到社会利益。然而，“共同决策模式”为解决临床医生和患者的诉求提供了一个框架，并可以指导制定和评估具体的会诊策略，以促进在初级医疗中更合理地使用抗生素。
