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临床医生应在何时以及如何与患有精神疾病的患者分享健康记录中的细节?

When and How Should Clinicians Share Details from a Health Record with Patients with Mental Illness?

作者信息

Thom Robyn P, Farrell Helen M

机构信息

Second-year resident in the Harvard Longwood Psychiatry Residency Training Program in Boston.

Psychiatrist on staff at Beth Israel Deaconess Medical Center and an instructor at Harvard Medical School in Boston.

出版信息

AMA J Ethics. 2017 Mar 1;19(3):253-259. doi: 10.1001/journalofethics.2017.19.3.ecas3-1703.

Abstract

Stigma associated with mental illness-a public health crisis-is perpetuated by the language used to describe and document it. Psychiatric pathology and how it can be perceived among clinicians contribute to the marginalization of patients, which exacerbates their vulnerability. Clinical documentation of mental illness has long been mired in pejorative language that perpetuates negative assumptions about those with mental illness. Although patients have the legal right to view their health record, sharing mental health notes with patients remains a sensitive issue, largely due to clinicians' fears that review of this content might cause harm, specifically psychiatric destabilization. However, the ethical principles of justice, beneficence, and autonomy as well as nonmaleficence must be considered by clinicians in determining when and how to share psychiatric details from a health record with their patients.

摘要

与精神疾病相关的污名化——一场公共卫生危机——因用于描述和记录它的语言而持续存在。精神病理学以及临床医生对它的认知方式导致患者被边缘化,这加剧了他们的脆弱性。长期以来,精神疾病的临床记录一直深陷贬义词之中,这些贬义词使对患有精神疾病者的负面假设持续存在。尽管患者有权查看自己的健康记录,但与患者分享心理健康记录仍然是一个敏感问题,这主要是因为临床医生担心患者查看这些内容可能会造成伤害,特别是导致精神状态不稳定。然而,临床医生在决定何时以及如何与患者分享健康记录中的精神科细节时,必须考虑公正、行善、自主以及不伤害等伦理原则。

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