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[关于患者知情同意]

[On informed patient consent].

作者信息

Kayser M C, von Harder Y, Friemert B, Scherer M A

机构信息

Augenklinik Herzog Carl Theodor, München.

出版信息

Chirurg. 2006 Feb;77(2):139-49. doi: 10.1007/s00104-005-1101-3.

Abstract

One third of all lawsuits against doctors include statements of insufficient or lacking informed consent. The objectives of this prospective study in 104 patients were to elucidate the actual clinical routine of obtaining informed consent (process quality), collect information on active and passive recall 3 to 7 days p.op., and to investigate whether patient age, sex, education, profession, and cognitive function using the Mini Mental State Test, the time from obtaining consent to interview, acuity (emergency vs elective cases), and quantity of patient/doctor interaction would influence the patient's recall capabilities. In clinical routine, obtaining informed consent is a very variable procedure, and between two and 18 items were documented by the physician. Of the patients, 12.6% recalled actively and 43.5% passively. They named between 1.1 and 3.7 items on average, with "infection" as the leading complication, followed by "pain" and "lesion of nerves". Of all parameters investigated, only the number of initially documented items exhibit a significant effect on the patients' recall. The quantity of patient/physician interaction not only guarantees an increased effect on recall but also means improves patient interaction, thereby reducing the probability of imminent accusations.

摘要

针对医生的所有诉讼中,三分之一涉及知情同意不足或缺失的声明。这项针对104名患者的前瞻性研究的目的是阐明获取知情同意的实际临床常规操作(过程质量),收集术后3至7天主动和被动回忆的信息,并调查患者的年龄、性别、教育程度、职业以及使用简易精神状态检查表评估的认知功能、从获取同意到访谈的时间、病情严重程度(急诊与择期病例)以及医患互动的次数是否会影响患者的回忆能力。在临床常规操作中,获取知情同意是一个非常多变的过程,医生记录的项目在2至18项之间。患者中,12.6%能主动回忆,43.5%能被动回忆。他们平均说出1.1至3.7项内容,“感染”是最主要的并发症,其次是“疼痛”和“神经损伤”。在所有调查的参数中,只有最初记录的项目数量对患者的回忆有显著影响。医患互动的次数不仅能保证对回忆有更大影响,还意味着改善医患互动,从而降低即将面临指控的可能性。

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