Mogielnicki R P, Bell J, Fowler F J
Dartmouth Medical School, VT.
J Gen Intern Med. 1992 Mar-Apr;7(2):165-9. doi: 10.1007/BF02598006.
To assess the effect of patient smoking status on internists' inclinations to recommend certain types of therapy for conditions that are and conditions that are not related to smoking.
DESIGN, SETTING, AND PARTICIPANTS: Five hundred ninety-eight internists identified systematically from the Directory of Medical Specialists (first entry on each page of text) were asked to complete a questionnaire about how their treatment decisions for five therapies differed as a function of patient smoking status.
The responses of the 320 internists who completed and returned the questionnaire showed that smoking status had little effect on physicians' inclinations to recommend herniorrhaphy, hemodialysis, or bronchodilator therapy. However, physicians were considerably less inclined to recommend coronary artery bypass grafting or peripheral arterial surgery to patients who smoked. Reduced efficacy and greater risk of therapy were the most frequent reasons given for the observed decrease. Reduced entitlement by smokers to complex therapies for smoking-related diseases and the withholding of therapy as a bargaining tool to induce smokers to quit were also cited as reasons.
Some internists believe they are less likely to recommend complex therapies for smoking-related diseases to patients who continue to smoke. Some of this decrease may be attributable to the notion that smokers are less entitled to complex therapies or that withholding therapies is a permissible way to influence patients to adopt more healthful lifestyles. Whether these physician attitudes reflect actual practice is yet to be shown.
评估患者吸烟状况对内科医生针对与吸烟相关和不相关病症推荐特定类型治疗方法倾向的影响。
设计、背景与参与者：从《医学专家名录》（文本每页的首个条目）中系统识别出的598名内科医生被要求填写一份问卷，内容是关于他们对五种治疗方法的治疗决策如何因患者吸烟状况而有所不同。
完成并返回问卷的320名内科医生的回答表明，吸烟状况对医生推荐疝修补术、血液透析或支气管扩张剂治疗的倾向影响不大。然而，医生向吸烟患者推荐冠状动脉搭桥术或外周动脉手术的倾向明显较低。观察到的减少推荐的最常见原因是治疗效果降低和风险增加。吸烟者因吸烟相关疾病接受复杂治疗的资格降低以及将 withhold of therapy 作为促使吸烟者戒烟的谈判工具也被列为原因。
一些内科医生认为，他们向继续吸烟的患者推荐与吸烟相关疾病的复杂治疗方法的可能性较小。这种减少部分可能归因于这样一种观念，即吸烟者获得复杂治疗的资格较低，或者 withhold of therapy 是影响患者采取更健康生活方式的一种可接受方式。这些医生的态度是否反映实际做法尚有待证明。 （注：原文中“withholding of therapy”未准确翻译，结合语境推测为“不给予治疗”之类的意思，但因原文此处表述不清晰，所以译文可能存在一定偏差。）
