Marquié Laetitia, Sorum Paul C, Mullet Etienne
CERPP, MDR-Université Toulouse-II, Toulouse Cedex 9 31058, France.
Qual Life Res. 2007 Sep;16(7):1267-73. doi: 10.1007/s11136-007-9228-y. Epub 2007 Jun 13.
Physicians have been found to give lower ratings of patients' pain than do the patients themselves. We hypothesized that the physicians' rating depends not only on the patient's pain rating but also on other cues. We also hypothesized that these cues influence physicians' pain treatment and urgency level. We gave to 52 emergency room physicians in Toulouse, France, 45 scenarios describing patients with acute abdominal pain, representing all combinations of 5 levels of patient's pain rating, 3 levels of behavioral manifestations of pain, and three signs of the severity of the abdominal pathology (namely, the likelihood of appendicitis). The participants rated the patient's pain, selected the intensity of pain treatment, and judged the degree of urgency of calling in a surgeon. In rating pain, physicians took into account the patient's rating, behavioral manifestations of pain, and the signs of abdominal pathology. Clusters analyses showed two sets of individual differences. When rating pain and choosing pain treatment, physicians gave either a low or high weight to behavioral pain cues. In urgency judgments, physicians could be separated into those who gave considerable weight to the different levels of severity and those who did not.
研究发现，医生对患者疼痛程度的评分低于患者自身的评分。我们推测，医生的评分不仅取决于患者的疼痛评分，还取决于其他线索。我们还推测，这些线索会影响医生的疼痛治疗和紧急程度判断。我们向法国图卢兹的52名急诊室医生提供了45个描述急性腹痛患者的场景，这些场景涵盖了患者疼痛评分的5个级别、疼痛行为表现的3个级别以及腹部病变严重程度的3个迹象（即阑尾炎的可能性）的所有组合。参与者对患者的疼痛进行评分，选择疼痛治疗的强度，并判断呼叫外科医生的紧急程度。在对疼痛进行评分时，医生会考虑患者的评分、疼痛的行为表现以及腹部病变的迹象。聚类分析显示出两组个体差异。在对疼痛进行评分和选择疼痛治疗时，医生对行为疼痛线索的权重要么低要么高。在紧急程度判断方面，医生可分为对不同严重程度级别给予相当权重的医生和不给予相当权重的医生。
