Ilnyckyj Alexandra, Bernstein Charles N
Section of Gastroenterology, Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba.
Can J Gastroenterol. 2002 Nov;16(11):801-5. doi: 10.1155/2002/245256.
Irritable bowel syndrome (IBS) is a common and costly disorder in Canada. The paucity of medical treatment underscores the importance of examining every element of the management approach. Data exist supporting an increased prevalence of abuse among individuals with IBS. Importantly, the pathophysiology underlying the link between abuse and IBS is increasingly understood. Treatment recommendations by opinion leaders support an abuse inquiry. However, many clinicians view abuse inquiry as an ethical dilemma.
Canadian gastroenterologists were surveyed to determine current practice patterns and to identify barriers to inquiry. Barriers cited by clinicians were explored within an ethical context.
Abuse inquiry is not universally practised in Canada. Fifty-four per cent of the membership of Canadian Association of Gastroenterologists responded to the survey. They reported inquiring into abuse histories in approximately 50% of patients with IBS. The frequency of inquiry declined when male patients were considered. The primal barriers cited were time constraints (25%), personal comfort with abuse issues (25%) and lack of resources for addressing the abuse (33%). Importantly, only a minority (10%), cited abuse history as irrelevant to the management of the patient.
Physicians identify significant barriers to pursuing an inquiry into abuse. However, a minority cited 'clinical irrelevance' as a primal barrier, the implicit statement being that the abuse history has clinical relevance. This view is consistent with opinion leaders and published treatment recommendations. Therefore, by not inquiring into the abuse history, physicians are not fulfilling their ethical responsibility to the patient. Physicians need to resolve their barriers to inquiry. Furthermore, they need to familiarize themselves with treatment recommendations and include this review in their consultation.
肠易激综合征（IBS）在加拿大是一种常见且花费高昂的疾病。医疗治疗手段的匮乏凸显了审视管理方法中每个要素的重要性。有数据支持IBS患者中虐待行为的患病率增加。重要的是，虐待与IBS之间联系的潜在病理生理学正日益为人所理解。意见领袖的治疗建议支持进行虐待调查。然而，许多临床医生将虐待调查视为一种伦理困境。
对加拿大胃肠病学家进行调查，以确定当前的实践模式并找出调查的障碍。在伦理背景下探讨临床医生提到的障碍。
在加拿大，虐待调查并非普遍开展。加拿大胃肠病学家协会54%的成员回复了调查。他们报告在约50%的IBS患者中询问虐待史。考虑男性患者时，询问频率下降。提到的主要障碍是时间限制（25%）、对虐待问题的个人舒适度（25%）以及处理虐待问题的资源不足（33%）。重要的是，只有少数人（10%）认为虐待史与患者管理无关。
医生们认识到进行虐待调查存在重大障碍。然而，少数人将“临床无关性”列为主要障碍，这隐含着虐待史具有临床相关性的观点。这一观点与意见领袖及已发表的治疗建议一致。因此，不询问虐待史，医生就没有履行对患者的伦理责任。医生需要解决他们进行调查的障碍。此外，他们需要熟悉治疗建议并在会诊中纳入此项审查。
