Rogers Wendy A
Department of General Practice, Flinders University of South Australia, GPO Box 2100, SA 5001, Australia.
Fam Pract. 2002 Apr;19(2):140-5. doi: 10.1093/fampra/19.2.140.
Respect for patient autonomy is an important ethical principle for medical practitioners; however, previous investigators have reported inconsistent attitudes amongst practitioners towards respect for patient autonomy. This study in empirical ethics used qualitative methods to investigate GPs' attitudes towards respect for patient autonomy in consultations for low back pain.
The aim of this study was to explore GPs' attitudes towards respect for patient autonomy by analysing attitudes towards four issues in the management of low back pain which raise ethical and practical dilemmas.
Participants were 21 GPs selected from general practice in South Australia by stratified, purposive sampling aimed at maximizing diversity. Semi-structured interviews were tape-recorded, transcribed and analysed using codes developed from the transcripts, with additional theoretical codes. In the analysis, attitudes towards patient autonomy in the four issues were characterized as autonomy-respecting, intermediate or controlling.
The results showed individual inconsistencies in GPs' attitudes towards respect for patient autonomy. For example, the majority of GPs accepted patient autonomy in the use of complementary therapies, but were controlling with regard to the use of analgesics. Attitudes to duration of time off work were spread evenly, whilst controlling attitudes towards use of X-rays were modified by patient requests for X-rays.
These results suggest that GP attitudes towards patient autonomy are modified by ethical and pragmatic factors, and vary depending upon the nature of the issue in question.
尊重患者自主权是医生重要的伦理原则；然而，此前的调查人员报告称，医生在尊重患者自主权方面的态度并不一致。这项实证伦理学研究采用定性方法，调查全科医生在腰痛诊疗过程中对尊重患者自主权的态度。
本研究旨在通过分析对腰痛管理中四个引发伦理和实际困境问题的态度，来探究全科医生对尊重患者自主权的态度。
通过分层、立意抽样从南澳大利亚州的普通医疗中选取了21名全科医生，旨在实现最大程度的多样性。半结构化访谈进行了录音、转录，并使用从转录本中得出的编码以及额外的理论编码进行分析。在分析中，对四个问题中患者自主权的态度被归类为尊重自主权、中间态度或控制态度。
结果显示，全科医生在尊重患者自主权的态度上存在个体差异。例如，大多数全科医生在使用补充疗法方面接受患者自主权，但在使用镇痛药方面则采取控制态度。对休假时长的态度分布较为均匀，而对使用X光检查的控制态度会因患者要求进行X光检查而有所改变。
这些结果表明，全科医生对患者自主权的态度会受到伦理和实际因素的影响，并因问题的性质而异。
