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从防御性医疗到四级预防:巴基斯坦所需的转变。

From Defensive Medicine to Quaternary Prevention: The Transition That Pakistan Needs.

作者信息

Mahmood Samar, Tabraze Muqadus

机构信息

Department of Internal Medicine, Dow University of Health Sciences (DUHS), Karachi, Pakistan.

出版信息

Cureus. 2018 Apr 8;10(4):e2449. doi: 10.7759/cureus.2449.

Abstract

The issue of overprescribing laboratory investigations is an old one in the world of medical practice and it has unfortunately seen a tremendous increase with the digitalisation of medicine, in more recent times. Phrased usually as 'defensive medicine,' this kind of overmedicalisation steers medical practice away from the ethical, skill-refining fronts on the part of doctors and imposes an unnecessary financial burden on the patients' pockets, adding to their suffering. Pakistan has not been able to save itself either, from the impropriety that roots out of what is now almost a norm in medical practice. The existent low literacy and awareness rates in the masses of the country, coupled with the cultural respect for doctors and lack of financial resources amongst the poor patients to stand up to doctors or the hospitals, have all made it even easier for physicians to get away with ordering whatever investigations they choose. The issue is a grave one and its rampancy demands that attention is drawn to it and efforts are made to transition into the practice of evidence-based medicine and quaternary prevention.

摘要

在医学实践领域,过度开具实验室检查单的问题由来已久,不幸的是,随着近年来医学数字化的发展,这一现象急剧增加。这种过度医疗通常被称为“防御性医疗”,它使医疗实践偏离了医生应有的道德和技能提升方向,给患者带来不必要的经济负担,加重了他们的痛苦。巴基斯坦也未能幸免这种在医疗实践中几乎已成为常态的不当行为。该国大众现有的低识字率和低认知度,再加上文化上对医生的尊重以及贫困患者缺乏与医生或医院抗衡的财力,使得医生更容易随意开具任何他们选择的检查单而不受惩罚。这个问题很严重,其猖獗程度需要引起关注,并努力向循证医学和四级预防的实践转变。

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本文引用的文献

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Pakistan cannot afford defensive medicine.
J Coll Physicians Surg Pak. 2014 Oct;24(10):703-4. doi: 10.2014/JCPSP.703704.
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Br Med J. 1980 Dec 13;281(6255):1610-1. doi: 10.1136/bmj.281.6255.1610.

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