Pallin Daniel J, Harris Rachel, Johnson Camille I, Giraldez Ediza
Department of Emergency Medicine, Brigham and Women's Hospital, Children's Hospital Boston (DJP), Boston, MA, USA.
Acad Emerg Med. 2008 Dec;15(12):1304-8. doi: 10.1111/j.1553-2712.2008.00269.x. Epub 2008 Oct 25.
Medical care requires consent and consent requires information. Prior studies have shown that patients are poorly informed about the medical training hierarchy. The authors assessed the impact of "informed" on "consent," by assessing willingness to be seen by trainees before and after information about trainee's credentials.
A convenience sample of patients in an urban emergency department (ED) waiting room was surveyed, ascertaining willingness to be seen before and after information about trainees credentials, using Likert scales. McNemar's test, linear regression, and mixed models were used to assess statistical significance of information in changing preferences and patient characteristics predicting knowledge, willingness, and change in willingness to be seen with more information.
The authors approached 397 patients, and 199 (50%) English speakers participated. Initially, 45% of subjects knew the meaning of "medical student," and 35%"intern" and "resident." In a controlled multivariate linear regression, educational attainment (p < 0.0001) predicted more knowledge, Hispanic ethnicity predicted less (p = 0.03). Subjects were less willing to be seen by lower-ranking trainees (p < 0.001). Information about trainees caused a significant increase in unwillingness to be seen by medical students (17% to 28%, p = 0.004) and interns (8% to 13%, p = 0.029).
Substantial numbers of ED patients would prefer not to be seen by trainees. When patients are informed about trainees' credentials, they become less willing to be seen by more junior trainees. Further research should clarify informed consent for care among non-English speakers and should address these issues in other medical settings.
医疗护理需要患者的同意，而同意需要相关信息。先前的研究表明，患者对医学培训层级了解不足。作者通过评估在知晓实习医生资质前后患者接受其诊治的意愿，来评估“知情”对“同意”的影响。
对城市急诊科候诊室的患者进行便利抽样调查，使用李克特量表确定在知晓实习医生资质前后患者接受其诊治的意愿。采用麦克尼马尔检验、线性回归和混合模型来评估信息在改变偏好方面的统计学意义，以及预测知识、意愿和在知晓更多信息后接受诊治意愿变化的患者特征。
作者接触了397名患者，199名（50%）说英语的患者参与了调查。最初，45%的受试者知道“医学生”的含义，35%知道“实习医生”和“住院医生”的含义。在一项控制多元线性回归中，受教育程度（p<0.0001）预示着更多的知识，西班牙裔种族预示着更少的知识（p=0.03）。受试者不太愿意让级别较低的实习医生诊治（p<0.001）。关于实习医生的信息导致不愿让医学生诊治的比例显著增加（从17%增至28%，p=0.004），不愿让实习医生诊治的比例也显著增加（从8%增至13%，p=0.029）。
大量急诊科患者不愿让实习医生诊治。当患者知晓实习医生的资质后，他们更不愿意让级别较低的实习医生诊治。进一步的研究应阐明非英语患者的医疗护理知情同意问题，并应在其他医疗环境中解决这些问题。
