Lehmann L S, Brancati F L, Chen M C, Roter D, Dobs A S
Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD 21205-2223, USA.
N Engl J Med. 1997 Apr 17;336(16):1150-5. doi: 10.1056/NEJM199704173361606.
Concern that case presentations at the bedside may make patients uncomfortable has led many residency programs to move presentations to the conference room. We performed a randomized, controlled trial of the effect of these two approaches on patients' perceptions of their care.
The study patients were adults admitted to the general medical service of a teaching hospital. Four house-staff "firms" (each comprising teams of physicians) were randomly assigned to make their case presentations during morning rounds either at the patient's bedside or in a conference room for one week, to switch to the alternate site for a second week, and to return to the initial site for a third week. To assess patients' perceptions, a questionnaire was administered within 24 hours of admission.
During the three weeks of the study, 95 patients had bedside presentations and 87 patients had conference-room presentations. When the former were compared with the latter, the patients with bedside presentations reported that their doctors spent more time with them on morning rounds (10 vs. 6 minutes, P<0.001). The patients with bedside presentations were also somewhat more likely to report favorable perceptions of their inpatient care (range of adjusted odds ratios, 1.12 to 2.17), although none of the associations were statistically significant. Better-educated patients were less likely to report that physicians used confusing terminology and explained tests and medications inadequately than were patients who had not completed high school.
These data suggest that from the patient's perspective, bedside case presentations are at least as good as conference-room presentations, and perhaps preferable. When physicians make presentations at the bedside of less well educated patients, they should be especially careful to avoid medical jargon and to explain fully their plans for inpatient care.
由于担心床边病例报告会让患者感到不适，许多住院医师培训项目已将病例报告转移至会议室进行。我们针对这两种方式对患者护理认知的影响开展了一项随机对照试验。
研究对象为入住一家教学医院普通内科的成年患者。四个住院医师“医疗小组”（每个小组由医师团队组成）被随机分配，在早查房时于患者床边或会议室进行病例报告，为期一周，第二周切换至另一地点，第三周再回到初始地点。为评估患者的认知情况，在患者入院后24小时内进行问卷调查。
在研究的三周内，95名患者接受了床边病例报告，87名患者接受了会议室病例报告。将前者与后者进行比较时，接受床边病例报告的患者称其医生在早查房时与他们相处的时间更长（10分钟对6分钟，P<0.001）。接受床边病例报告的患者也更倾向于对住院护理给予积极评价（调整后的优势比范围为1.12至2.17），尽管这些关联均无统计学意义。与未完成高中学业的患者相比，受教育程度较高的患者较少报告医生使用令人困惑的术语以及对检查和药物解释不充分的情况。
这些数据表明，从患者的角度来看，床边病例报告至少与会议室病例报告一样好，甚至可能更优。当医生在受教育程度较低的患者床边进行病例报告时，应特别注意避免使用医学术语，并充分解释其住院护理计划。
