Hanson L C, Danis M, Garrett J M, Mutran E
Department of Medicine, University of North Carolina at Chapel Hill, USA.
Arch Intern Med. 1996 Apr 8;156(7):785-9. doi: 10.1001/archinte.156.7.785.
Physician specialty training is associated with variations in the use of medical treatment for specific diseases.
To examine whether physicians' specialties predict differences in willingness to use life-sustaining treatments.
One hundred fifty-eight physicians (response rate, 85%) who cared for 378 hospitalized patients with end-stage congestive heart failure, chronic obstructive pulmonary disease, malignant neoplasms, or hepatic cirrhosis were interviewed to assess their thresholds for use of specific life-sustaining treatments. Their patients were then followed up to determine whether decisions were made to use or withhold cardiopulmonary resuscitation, ventilator support, or intensive care. Physicians' attitudes, their stated thresholds for treatment use, and their use of these treatments in daily practice were compared by specialty group.
Physicians recommended cardiopulmonary resuscitation and ventilator support for patients with end-stage congestive heart failure or chronic obstructive pulmonary disease if the chance for survival was at lease 48%, but they required a predicted survival of at least 74% for patients with cancer. For a patient with end-stage congestive heart failure or chronic obstructive pulmonary disease, cardiologists were consistently more willing than other physicians to use life-sustaining treatments. In practice, decisions to use or withhold such treatments were made for 151 patients with end-stage diseases. Compared with other physicians, cardiologists were least likely to issue orders to withhold treatment and most likely to use life-sustaining treatments for patients they treated. Oncologists rarely used such treatments and issued orders to withhold these treatments much more often.
Physician specialty is associated with differences in willingness to use, and in actual use of, life-sustaining treatments.
医生的专业培训与特定疾病治疗方法的使用差异有关。
研究医生的专业是否能预测其在使用维持生命治疗方面意愿的差异。
对158名医生（回复率85%）进行访谈，这些医生负责护理378名住院的终末期充血性心力衰竭、慢性阻塞性肺疾病、恶性肿瘤或肝硬化患者，以评估他们使用特定维持生命治疗的阈值。随后对他们的患者进行随访，以确定是否决定使用或不使用心肺复苏、呼吸机支持或重症监护。按专业组比较医生的态度、他们声明的治疗使用阈值以及他们在日常实践中对这些治疗的使用情况。
如果生存机会至少为48%，医生会为终末期充血性心力衰竭或慢性阻塞性肺疾病患者推荐心肺复苏和呼吸机支持，但对于癌症患者，他们要求预测生存率至少为74%。对于终末期充血性心力衰竭或慢性阻塞性肺疾病患者，心脏病专家始终比其他医生更愿意使用维持生命的治疗方法。在实践中，为151名患有终末期疾病的患者做出了使用或不使用此类治疗的决定。与其他医生相比，心脏病专家下达不进行治疗医嘱的可能性最小，而对他们治疗的患者使用维持生命治疗的可能性最大。肿瘤学家很少使用此类治疗，并且更频繁地下达不进行这些治疗的医嘱。
医生的专业与使用维持生命治疗的意愿以及实际使用情况的差异有关。
