Cosmi Franco, Tarquini Barbara, Mariottoni Beatrice, Cosmi Deborah
Già Direttore Cardiologia, Ospedale di Cortona (AR).
Cardiologia, Ospedale di Cortona (AR).
G Ital Cardiol (Rome). 2024 Apr;25(4):221-228. doi: 10.1714/4244.42203.
At the dawn of "metaclinical medicine" era, shared decision-making represents the overcoming of modern medicine guidelines and classical medicine experience. The patient's life plan, the doctor's health plan, the scientist's evidence-based plan, the administrator's plan and the beliefs of the society for healthcare options should be integrated into the shared decision-making process to avoid patient's unrealistic expectations, doctor's self-referential and defensive medicine, the science without compassion of the scientist, the administered medicine of the politician, the herd mentality of artificial intelligence. For a doctor who must evaluate according to science and conscience, it becomes difficult to make decisions about a patient who thinks that there can be "no decisions about me without me". It risks being a pure declamatory statement in the absence of clinical knowledge and the associated concept of probability. The idea of moving from informed consent to shared probability is convenient for both the doctor and the patient but not for litigation professionals. Even in metaclinical medicine, clinical decision support systems, if well governed, would facilitate the choice of the best treatment according to the definition of absolute risk reduction and the number of patients to be treated to avoid an event, leaving it up to the doctor-patient relationship the narrative and the choice of the most appropriate treatment, which also requires taking care of the emotional and compassionate aspects.
在“超临床医学”时代的曙光中，共同决策代表着对现代医学指南和传统医学经验的超越。患者的生活规划、医生的健康计划、科学家基于证据的计划、管理者的计划以及社会对医疗选择的信念，都应融入共同决策过程，以避免患者不切实际的期望、医生的自我参照和防御性医疗、科学家缺乏人文关怀的科学、政治家的行政式医疗、人工智能的从众心理。对于必须依据科学和良知进行评估的医生而言，面对认为“没有我参与就不能对我做决策”的患者，做出决策变得困难。在缺乏临床知识及相关概率概念的情况下，这有可能只是一句纯粹的慷慨陈词。从知情同意转向共同概率的理念，对医生和患者都很便利，但对诉讼专业人士却并非如此。即便在超临床医学中，临床决策支持系统若管理得当，将根据绝对风险降低率的定义以及为避免某事件所需治疗的患者数量，协助选择最佳治疗方案，而将叙述以及最合适治疗方案的选择留给医患关系，这也需要关注情感和人文关怀方面。
