Herz D A, Looman J E, Lewis S K
Division of Neurosurgery, Michigan State University, Grand Rapids.
Neurosurgery. 1992 Mar;30(3):453-8. doi: 10.1227/00006123-199203000-00028.
The issue of informed consent at it relates to neurosurgical professional malpractice liability and litigation has been of concern for 20 years or more. The problem persists, and the subject has been addressed by providing patient education with full disclosure regarding neurosurgical procedures. In the process of imparting informed consent, the authors studied the effectiveness of specific neurosurgical health care teaching. One hundred six persons undergoing anterior cervical fusion or lumbar laminectomy were instructed by a neurosurgeon and clinical nurse specialist with a master's degree in neurosurgery. Written testing was performed in each case immediately after a formal teaching session before surgery. Questions were simple and covered only four general topics: 1) diagnosis and surgical techniques; 2) operative risks; 3) postoperative care; and 4) goals and benefits relating to surgery. The mean score on testing immediate retention of information revealed a 43.5% overall performance rate. When patients were tested approximately 6 weeks later, the score dropped to 38.4%. This was statistically significant (chi 2, P less than 0.05). The authors encourage the concept of patient education. The data in the current study, however, suggest that the reasonable and prudent neurosurgeon making a concerted effort at patient education, with the assistance of a professional educator, cannot necessarily expect accurate patient or family recall or comprehension. Fulfillment of the doctrine of informed consent by neurosurgeons may very well be mythical.
与神经外科医疗事故责任和诉讼相关的知情同意问题已经受到关注达20多年。这个问题依然存在，并且通过向患者提供关于神经外科手术的全面信息来进行患者教育得以解决。在给予知情同意的过程中，作者研究了特定神经外科医疗教学的效果。106名接受颈椎前路融合术或腰椎椎板切除术的患者由一名神经外科医生和一名拥有神经外科学硕士学位的临床护理专家进行指导。在术前正式教学课程结束后，立即对每个病例进行书面测试。问题很简单，仅涵盖四个一般主题：1）诊断和手术技术；2）手术风险；3）术后护理；以及4）与手术相关的目标和益处。对信息即时记忆测试的平均分数显示总体表现率为43.5%。当在大约6周后对患者进行测试时，分数降至38.4%。这具有统计学意义（卡方检验，P小于0.05）。作者鼓励患者教育的理念。然而，当前研究中的数据表明，在专业教育者的协助下，合理且审慎地努力对患者进行教育的神经外科医生不一定能期望患者或其家属准确回忆或理解相关内容。神经外科医生履行知情同意原则很可能只是个神话。
