Hansson Mats G, Kihlbom Ulrik, Tuvemo Torsten, Olsen Leif A, Rodriguez Alina
Centre for Bioethics at Karolinska Institutet and Uppsala University, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
BMC Med Ethics. 2007 May 24;8:6. doi: 10.1186/1472-6939-8-6.
Time and communication are important aspects of the medical consultation. Physician behavior in real-life pediatric consultations in relation to ethical practice, such as informed consent (provision of information, understanding), respect for integrity and patient autonomy (decision-making), has not been subjected to thorough empirical investigation. Such investigations are important tools in developing sound ethical praxis.
21 consultations for inguinal hernia were video recorded and observers independently assessed global impressions of provision of information, understanding, respect for integrity, and participation in decision making. The consultations were analyzed for the occurrence of specific physician verbal and nonverbal behaviors and length of time in minutes.
All of the consultations took less than 20 minutes, the majority consisting of 10 minutes or less. Despite this narrow time frame, we found strong and consistent association between increasing time and higher ratings on all components of ethical practice: information, (beta = .43), understanding (beta = .52), respect for integrity (beta = .60), and decision making (beta = .43). Positive nonverbal behaviors by physicians during the consultation were associated particularly with respect for integrity (beta =.36). Positive behaviors by physicians during the physical examination were related to respect for children's integrity.
Time was of essence for the ethical encounter. Further, verbal and nonverbal positive behaviors by the physicians also contributed to higher ratings of ethical aspects. These results can help to improve quality of ethical practice in pediatric settings and are of relevance for teaching and policy makers.
时间和沟通是医疗会诊的重要方面。在现实生活中的儿科会诊中，医生在道德实践方面的行为，如知情同意（信息提供、理解）、对完整性和患者自主性的尊重（决策），尚未受到全面的实证研究。此类调查是发展健全道德实践的重要工具。
对21例腹股沟疝会诊进行录像，观察者独立评估在信息提供、理解、对完整性的尊重以及参与决策方面的总体印象。分析会诊中医生具体的言语和非言语行为的发生情况以及以分钟为单位的时长。
所有会诊用时均不到20分钟，大多数会诊时长为10分钟或更短。尽管时间框架狭窄，但我们发现时间增加与道德实践所有组成部分的更高评分之间存在强烈且一致的关联：信息（β = 0.43）、理解（β = 0.52）、对完整性的尊重（β = 0.60）以及决策（β = 0.43）。会诊期间医生的积极非言语行为尤其与对完整性的尊重相关（β = 0.36）。体格检查期间医生的积极行为与对儿童完整性的尊重有关。
时间对于道德交流至关重要。此外，医生的言语和非言语积极行为也有助于提高道德方面的评分。这些结果有助于提高儿科环境中道德实践的质量，对教学和政策制定者具有参考价值。
