Subject(s)
Decision Making , Ethics, Medical , Philosophy, Medical , Evidence-Based Medicine , HumansSubject(s)
Disease , Models, Biological , Philosophy, Medical , Europe , Human Genome Project , HumansABSTRACT
The aim of the study was to assess the reproducibility when different doctors fill in diagnoses on death certificates. Records from 40 patients who had died in 1994 during admission to a medical hospital department in Denmark were selected at random. Ten doctors filled in a death certificate for each patient (without knowledge of autopsy findings and results of examinations received after the patient's death). The agreement between the diagnoses was assessed using a rating scale with seven categories. Afterwards the 400 death certificates were mixed and coded by the Medicostatistical Section of the Danish National Board of Health. The diagnoses made by the ten doctors showed insignificant discrepancies in ten cases, larger discrepancies were found in eight cases and large discrepancies in 19 cases. In three cases the patient had died suddenly and little information was available. The coding was standardized at the Danish National Board of Health, but their diagnoses reflected the discrepancies between the doctors' diagnoses. In conclusion, the reproducibility of diagnoses on death certificates is so poor that information from the Registry of Causes of Death is of little use of administrative or scientific purposes.
Subject(s)
Cause of Death , Death Certificates , Autopsy , Denmark , Diagnosis , Hospital Departments , Humans , Internal Medicine , Observer Variation , Registries , Reproducibility of ResultsABSTRACT
It is sometimes suggested that the physician should offer the patient "just the facts," preferably in a "value-free manner," explain the different options, and then leave it to the patient to make the choice. This paper explores the extent to which this adviser model is realistic. The clinical decision process and the various components of clinical reasoning are discussed, and a distinction is made between the biological, empirical, empathic/hermeneutic and ethical components. The discussion is based on the ethical norms of the public health services in the Nordic countries, and the problems are illustrated by a clinical example. It is concluded that the adviser model is unrealistic. Patient information is important, but the complexity of clinical reasoning makes it impossible to separate facts and value judgments. It is claimed that there is an inherent element of paternalism in clinical decision-making and that clinical practice presupposes a mutual trust between physician and patient.
Subject(s)
Decision Making , Ethics, Medical , Paternalism , Patient Participation , Personal Autonomy , Physician-Patient Relations , Social Values , Adult , Beneficence , Biomedical Research , Disclosure , Empathy , Empirical Research , Female , Finland , Humans , Iceland , Informed Consent , Resource Allocation , Scandinavian and Nordic Countries , Trust , UncertaintyABSTRACT
This survey reports the attitude towards information of cancer patients as regards diagnosis and prognosis among gastroenterologists and patients (not suffering from cancer). The questions were based on a case history (a patient with colonic cancer). Most doctors informed their patients openly, and most patients expected that. Younger doctors in particular were more restrictive than patients as regards information of the spouse.
Subject(s)
Attitude of Health Personnel , Attitude to Health , Gastrointestinal Neoplasms/psychology , Patients/psychology , Physicians/psychology , Truth Disclosure , Adult , Denmark , Family/psychology , Female , Gastrointestinal Neoplasms/diagnosis , Gastrointestinal Neoplasms/mortality , Humans , Male , Middle Aged , Prognosis , Surveys and QuestionnairesSubject(s)
Cerebral Hemorrhage/chemically induced , Cerebral Hemorrhage/epidemiology , Heparin/therapeutic use , Outcome Assessment, Health Care , Quality of Life , Risk Assessment , Streptokinase/therapeutic use , Thrombophlebitis/drug therapy , Humans , Resource Allocation , Risk Factors , Social Values , Survival Rate , Thrombophlebitis/psychologyABSTRACT
Medicine is both a scientific and a humanistic discipline. The foundation for clinical decisions has four components (two scientific and two humanistic). 1) The biological component (reasoning based on biological theory). Biological thinking is currently being revolutionised, partly through the development of systems theory. 2) The empirical component (reasoning based on experience from earlier patients), which comprises both uncontrolled and controlled experience. 3) The empathic-hermeneutic component (reasoning based on an understanding of the patient as a fellow human being). Empathy requires hermeneutic knowledge which can be acquired through personal experience and by qualitative research. 4) The ethical component which comprises both utilitarian and deontological considerations.
Subject(s)
Decision Making , Ethics, Medical , Philosophy, Medical , Clinical Competence , Empathy , HumansSubject(s)
Ethics, Medical , Liver Transplantation , Brain Death , Denmark , Humans , Tissue and Organ ProcurementABSTRACT
This survey concerns the variation in attitudes among European gastroenterologists to truth telling in cases of cancer. Gastroenterologists in all parts of Europe were asked to consider a case of colonic cancer and to state what they would tell the patient and the patient's spouse. 260 replied. Gastroenterologists in northern Europe would usually reveal the diagnosis to both the patient and the patient's spouse, but some would inform only the spouse with the patient's permission. They would sometimes embellish the truth if the cancer had metastasised. Gastroenterologists in southern and eastern Europe would usually conceal the diagnosis from the patient, in many cases even when the patient asked to be told the truth. Most, however, would tell the spouse the full truth about both diagnosis and prognosis. The variation probably reflects differences in both doctors' attitudes and patients' expectations.
Subject(s)
Gastrointestinal Neoplasms/psychology , Internationality , Physician-Patient Relations , Truth Disclosure , Attitude of Health Personnel , Europe , Gastroenterology , Humans , Surveys and QuestionnairesABSTRACT
In this commentary on the article by Arthur L. Caplan [1] the philosophy of medicine is viewed from a medical perspective. Philosophical studies have a long tradition in medicine, especially during periods of paradigmatic unrest, and they serve the same goal as other medical activities: the prevention and treatment of disease. The medical profession needs the help of professional philosophers in much the same way as it needs the cooperation of basic scientists. Philosophy of medicine may not deserve the status of a philosophical subspecialty or field, but is so closely linked to the main trends of contemporary medical thinking that it must be regarded as an emerging (or reemerging) medical subdiscipline.
Subject(s)
Philosophy, Medical , Ethics, Medical , Humans , Interdisciplinary Communication , TherapeuticsSubject(s)
Autopsy , Pathology Department, Hospital , Autopsy/legislation & jurisprudence , Denmark , HumansABSTRACT
Medical progress requires a well-balanced research effort in a number of different fields, and this paper lists those types of research which will be needed in the future. The author analyses the foundation of clinical decisions and stresses the importance of continued biological laboratory research and controlled clinical studies. He also stresses the need for new types of research such as quality assurance, medical audit and humanistic studies (qualitative research, descriptive ethical studies and philosophical enquiries).
