Abu Dabrh A M, Gallacher K, Boehmer K R, Hargraves I G, Mair F S
F Mair, Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow G12 9LX, UK. Email
J R Coll Physicians Edinb. 2015;45(2):114-7. doi: 10.4997/JRCPE.2015.205.
Patients with chronic conditions or multimorbidity, and often their caregivers, have to adjust their lives and mobilise their capacity (ability) to respond to the workload (demands) imposed by treatments and the care of their conditions. There is a continuous and complex interaction between workload and capacity. When capacity proves insufficient to address the treatment workload, creating a burden, patients may place a lower priority on other aspects of their lives, or reduce engagement with healthcare. Guidelines usually focus on disease-centred outcomes without consideration of limited capacity or demanding workload (burden) from treatment regimens. It seems reasonable to consider that healthcare needs reshaping so that care that pursues goals important to patients as well as those suggested by evidence-based medicine. This can be achieved by using shared decision approaches guided by the expertise of clinicians to deliver optimal care while minimising the burden of treatment on patients, their caregivers, and the healthcare system. What we need is minimally disruptive medicine.
患有慢性病或多种疾病的患者，以及他们的护理人员，往往不得不调整自己的生活，并调动自身能力来应对治疗和病情护理所带来的工作量（要求）。工作量和能力之间存在持续且复杂的相互作用。当能力被证明不足以应对治疗工作量而产生负担时，患者可能会降低对生活中其他方面的重视程度，或者减少与医疗保健的接触。指南通常侧重于以疾病为中心的结果，而不考虑能力有限或治疗方案带来的高工作量（负担）。认为医疗保健需要重塑是合理的，这样的护理既要追求对患者重要的目标，也要遵循循证医学的建议。这可以通过采用以临床医生专业知识为指导的共同决策方法来实现，以提供最佳护理，同时将治疗对患者、其护理人员和医疗保健系统的负担降至最低。我们需要的是对生活干扰最小的医学。
