Hester Natalie, Pang Ching-Ling, Cho Alexander, Kasivisvanathan Ramanathan, Gooneratne Mevan
Perioperative Medicine Fellow, Department of Anaesthesia, The Royal London Hospital, London.
Specialist Trainee in Paediatric Surgery and Urology Fellow, Department of Paediatric Surgery, Great Ormond Street Hospital, London.
Br J Hosp Med (Lond). 2019 Apr 2;80(4):216-219. doi: 10.12968/hmed.2019.80.4.216.
The high-risk surgical patient only constitutes approximately 4% of the elective non-cardiac surgical population but contributes to the vast majority of in-hospital deaths following surgery. This, in conjunction with a high morbidity rate, can lead to a perioperative pathway fraught with challenges. It is incredibly difficult to anticipate which complications may arise and the risks involved before surgery. It is for this reason that patients need to be engaged in the decision-making processes regarding their perioperative care involved before major surgery. A combination of good medical practice, medicolegal influences and a governmental drive have begun to result in a shift away from paternalistic medicine to a shared decision-making approach. This article defines shared decision making, explores its benefits and limitations and addresses the relevant legal literature.
高危手术患者仅占择期非心脏手术人群的约4%，但却导致了术后绝大多数的院内死亡。这一点，再加上高发病率，可能导致充满挑战的围手术期路径。在手术前很难预测可能出现哪些并发症以及涉及的风险。正因如此，在进行大手术之前，患者需要参与有关其围手术期护理的决策过程。良好的医疗实践、法医学影响和政府推动相结合，已开始导致从家长式医疗向共同决策方法的转变。本文定义了共同决策，探讨了其益处和局限性，并阐述了相关法律文献。
