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首页医学资讯Blog优质医学您母亲真的需要做这个手术吗?

您母亲真的需要做这个手术吗?

目前,主刀医生是手术决策过程的中心。为什么?我们又能做什么?

当我们坐在外科医生办公室为自己或家人签署手术同意书时,我们都情愿相信我们的选择是正确的。我们真的可以做一个信息全面的决定吗?

 

     大部分情况下,是在患者、其家庭与外科医生的讨论后达成决定的。有时候,也会咨询其他专家,如心脏病学家或肾病学家,但是这些咨询专家的作用是有限的,主要是帮助患者了解手术过程而非告知患者其他替代治疗方案。 原则上,外科会诊是外科医生与患者的第一次接触,这意味着缺乏对患者情况和喜好的了解是这种方式的固有问题。这一过程中,外科医生的中心性是直观的,但在很多个案中,患者在这种损耗中迷失。毕竟,外科医生都是训练有素的侵入主义者,他们不必具备恰当表达非手术疗法的素质,这一点有效阻止了患者选择非手术疗法。

 

      然而这种方式对很多高风险患者来说可能是次优的,比如面临重大手术的高龄患者。新英格兰医学杂志发表的研究揭示了一些相关统计数据。以结肠切除术为例:30%的养老院患者在术后三个月内死亡,40%的幸存者承受着功能状态的下降,12个月后的情况更加糟糕,幸存者中50%的死亡率和50%的功能受损。

 

      与之形成鲜明对比的是,三分之一的美国老人在生前最后一年做过手术和四分之三的重病患者表示如果生命维持治疗会导致严重的认知或生理受损,他们会选择中止生命维持治疗。

 

     那么有什么能做的呢?在过去几年,很多医学杂志积极宣传以病人为中心的方式的重要性。这种方式已经在多学科团队中得到验证,多学科团队由多位不同领域的专家组成,旨在讨论个案的不同方面以及给病人提供多重选择并解释每种选择的利弊。一个已经广泛应用这一方式的学科就是肿瘤学,一种叫做肿瘤董事会的会议正变成普遍做法。

 

      该新英格兰医学杂志的文章认为高危患者做手术决定可以且应当采用类似的方法。毕竟,很多事情是一样的:处理并发症、多种治疗方案选择包括“观察性等待”、需要考虑患者的意愿和对生活质量的优先次序等。

 

      该文章说:“评估各种建议并向患者全面陈述其利弊远远超出了一位经验丰富或知识全面的外科医生的能力。满足这些要求可能需要医生、护士以及社工等非临床人士的团队合作。” “目前,如果有的话,这样的团队合作通常只在临时情况下发生。但他们应当定期展示和讨论高危个案。要在病得最严重和最脆弱的患者身上获得最佳结果需要‘全村人的力量’。很难在手术当天临时创造这样一个团队并且还要在术后早期直至出院期间继续各种零碎。理想的是,这个团队有一起协调术前评估、术中护理、复苏和康复工作的经验。”

 

      做医学决定时,无论是为您自己还是您母亲,都有一个突出的挣扎,即如何平衡治愈性治疗和生活质量。这种微妙的平衡是我们每一个人都想掌握的,那么开始批判性地且有创意地考虑公认的医疗措施会有什么更好的情况?

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