Rubin David T, Krugliak Cleveland Noa
University of Chicago Inflammatory Bowel Disease Center, Chicago, Illinois, USA.
University of Chicago MacLean Center for Clinical Medical Ethics, Chicago, Illinois, USA.
Am J Gastroenterol. 2015 Sep;110(9):1252-6. doi: 10.1038/ajg.2015.86. Epub 2015 Apr 7.
The doctor-patient relationship (DPR) in inflammatory bowel disease (IBD) has been facing new challenges, in part due to the substantial progress in medical and surgical management and also due to the rapid expansion of patient access to medical information. Not surprisingly, the complexity of IBD care and heterogeneity of the disease types may lead to conflict between a physician's therapeutic recommendations and the patient's wishes. In this commentary, we propose that the so-called "treat-to-target" approach of objective targets of disease control and serial adjustments to therapies can also strengthen the DPR in IBD by enabling defined trials of alternative approaches, followed by a more objective assessment and reconsideration of treatments. We contend that such respect for patient autonomy and the use of objective markers of disease activity improves the DPR by fostering trust and both engaging and empowering patients and physicians with the information necessary to make shared decisions about therapies.
炎症性肠病（IBD）中的医患关系面临着新的挑战，部分原因是医学和外科治疗取得了重大进展，也因为患者获取医疗信息的渠道迅速增加。毫不奇怪，IBD护理的复杂性和疾病类型的异质性可能导致医生的治疗建议与患者意愿之间产生冲突。在这篇评论中，我们提出，所谓的针对疾病控制目标和对治疗进行系列调整的“达标治疗”方法，也可以通过允许对替代方法进行明确试验，随后对治疗进行更客观的评估和重新考虑，来加强IBD中的医患关系。我们认为，这种对患者自主权的尊重以及使用疾病活动的客观指标，通过促进信任，并让患者和医生都获得做出关于治疗的共同决策所需的信息，从而增强了医患关系。
