附一：参赛人员信息表
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姓名 |
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性 别 |
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身份证号 |
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学校院系 |
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专 业 |
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年 级 |
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电 话 |
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E-mail |
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通信地址 |
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邮政编码 |
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附二：组织委员会委员名单
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姓名 |
职务/职称 |
工作单位 |
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乔旺忠 |
主任 |
教育部高等医药学校人文社科课程指导委员会 |
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周 冰 |
副总编 |
健康报社 |
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李 力 |
主编 |
英国医学杂志社（中文版） |
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杜治政 |
主编 |
医学与哲学杂志社 |
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万学红 |
教授 |
四川大学华西医学院 |
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邱鸿钟 |
教授 |
广州中医药大学 |
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何 伦 |
教授 |
东南大学医学院 |
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刘 虹 |
教授 |
南京医科大学医政学院 |
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赵明杰 |
教授 |
大连医科大学 |
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李中琳 |
教授 |
郑州大学医学院 |
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程 伟 |
教授 |
黑龙江中医药大学 |
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赵美娟 |
教授 |
解放军301医院 |
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陈晓阳 |
教授 |
山东大学医学院 |
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马燕冬 |
教授 |
北京中医药大学 |
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张新平 |
教授 |
华中科技大学同济医学院 |
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张大庆 |
教授 |
北京大学医学人文研究院 |
附三：专家评审委员会名单
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姓名 |
职务/职称 |
工作单位 |
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韩敏中 |
教授 |
北京大学外国语学院 |
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汪民安 |
教授 |
北京外国语大学外国文学研究所 |
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卢 风 |
教授 |
清华大学人文学院 |
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任定成 |
教授 |
中科院研究生院人文学院 |
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廖育群 |
教授 |
中国科学院自然科学史研究所 |
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甘绍平 |
教授 |
中国社会科学院哲学所 |
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李建会 |
教授 |
北京师范大学哲学与社会学学院 |
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孟晓捷 |
主任 |
《健康报》 |
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丛亚丽 |
教授 |
北京大学医学人文研究院 |
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郭莉萍 |
教授 |
北京大学医学人文研究院 |
Supporting Patients to Make the Best Decisions
Must be a core component of what it means to be a health professional
Imagine an intervention designed to improve patient care that a systematic review has shown to be effective, does not seem to have any serious unwanted effects, has been a central component of health policy for more than a decade, is popular with patients, and which in principle is embraced by most clinicians.
Surprisingly, perhaps, an intervention that meets these criteria does exist, in the form of shared decision making. This is a process in which patients are encouraged to participate in selecting appropriate treatment or management options on the basis of the best available evidence.
For many years policy makers in the United Kingdom have advocated a stronger role for patients, most recently in the NHS constitution, and as a central part of the current health reforms, in which “nothing about me without me” has become a defining mantra. Other countries are equally committed to the agenda. In December 2010 a group of 58 international healthcare leaders and researchers published the Salzburg statement on shared decision making, calling for a stronger commitment to what they call “co-production of health.” To mark the signing of the Salzburg statement on shared decision making the BMJ brought together 14 doctors, patients, academics, and policy makers to discuss how to involve patients in decisions about their health. In the linked feature article Anne Gulland reports the outcomes of the discussion.
The evidence in favour of shared decision making is reasonably strong, particularly when compared with that supporting most initiatives aimed at changing behaviour. The systematic review includes the results of 55 randomised controlled trials conducted over the past 25 years. It shows that patients involved in shared decision making are better informed than those who are not, and that they are less likely to be undecided about the best course of action at the end of a consultation. Patients are also more likely than their doctors to defer or decline surgical intervention, with no measurable adverse impact on health outcomes or satisfaction, and with the potential to reduce costs. Patients also seem more likely to adhere to treatment regimens and less likely to sue their doctor.
Given this evidence base and the sustained support from policy players it is surprising that shared decision making is not yet a standard feature of clinical practice. Although most clinicians claim that they involve patients in decisions, evidence suggests otherwise. Video analysis of consultations has shown that clinicians are often poor at even eliciting, never mind acting on, the patient’s agenda. The most recent national patient survey suggests that one in three patients in primary care and one in two patients in hospital would have liked greater involvement in decisions about their care.
There is clearly a gap between aspiration and reality and the reasons for this are complex. The evidence cited in favour of shared decision making relates primarily to the effectiveness of a specific set of tools called decision aids, and many clinicians find them difficult to use within the constraints of routine consultations. In addition, although the evidence underpinning their use is convincing in terms of improvements in the consultation process, there is currently little evidence that they improve clinical outcomes for patients. Some clinicians are not convinced that the overall benefits to patients outweigh the effort required to change their established routines.
But the explanation is probably more fundamental. Shared decision making is a concrete manifestation of a more substantial social process, the re-conceptualisation of the roles and responsibilities of patients and health professionals in improving health. This is challenging territory. Although clinicians are traditionally seen as the dominant player in the consultation, the interaction is increasingly being framed as a meeting between two experts. The clinician brings an understanding of the effectiveness, benefits, and harms of specific actions and the patient brings an understanding of their preferences and their attitudes to illness and risk. Shared decision making is therefore deeply counter cultural. It challenges the belief that professionals know what is best for the patient, and that patients are not able to understand complex information and are not emotionally ready to make decisions. It also challenges the view of patients that their doctor or nurse is usually making the best decision, an assumption that research increasingly shows is inaccurate. Finally, it challenges the ways in which the health system operates to deliver established patterns of practice, rather than being designed to encourage a different dynamic between patients and professionals.
Promoting shared decision making is increasingly seen as something that is needed to keep pace with changing societal expectations. It is time to move beyond isolated examples of good practice to the implementation of principles and practices at scale. Although a focus on technical tools such as decision aids is useful, it is clearly not enough.
Achieving widespread culture change requires an alignment of a range of different approaches across the whole system. The challenge for practitioners is to change attitudes and introduce new skills, and it is therefore largely an educational one. This should take place at all stages of professional development, and patients should play an active role in the educational process. Those responsible for designing and managing services need to tackle the practical constraints that inhibit shared decision making, particularly time and ease of access to high quality evidence. The implementation of standards and incentive schemes may also play a useful role in creating a culture in which purposeful shared decision making becomes the norm.
Most fundamentally, the ability to share decisions with patients must be seen as a core component of what it means to be a health professional, with the professional role changing from experts who care for patients to enablers who support patients to make decisions.
资料1：产妇丈夫拒绝剖宫产 医院不予剖宫产合法
昨天下午5时，北京市卫生局召开紧急新闻发布会，向媒体通报了“丈夫拒绝手术致孕妻死亡”一事的调查结果。市卫生局经过专家死亡病例评审后认为，孕妇李丽云就诊当日病情严重，死亡率为80%至85%，在当时的情况下，救活几率非常小，其死亡“不可避免”。手术可能挽救胎儿生命。朝阳医院京西院区当日做法是符合法律规定的。1
资料2 :产妇拒绝剖宫产 医院强行剖宫产合法
2010年12月3日清晨，一名29岁临产孕妇被转送至暨南大学附属第一医院抢救。医生检查后认为，如不尽快手术，将造成一尸两命的严重后果。但产妇坚决要自己生产。经医院相关负责人解释，产妇的丈夫同意手术，但产妇本人仍拒绝签字。为抢救产妇，医院在征得其家人同意，并由医院相关负责人签字同意，强行为产妇进行剖宫产，挽救了产妇生命。婴儿出生数小时后不幸夭亡。针对此事，邓海华表示，医务人员在患者生命垂危的情况下，征得患者家属同意，采取紧急措施，实施手术，这是对患者生命权的充分尊重，履行了医务人员的义务，是医务人员的职业操守和职业道德，符合法律精神。他表示，希望医患之间建立信任关系，使患者相信诊断并积极配合治疗，使医生增强信心，提高诊疗效率，提供优质服务。
资料3：家属拒绝抢救 医生该救还是不救
一路人在广州昌岗中路昌岗大街发现路边倒卧一中年男子，神志不清，口吐白沫，赶忙拨打120。一辆救护车将男子接到附近一家三甲医院的急诊科检查。该院急诊内科梁医生称，44岁的刘先生送来时已陷入深度昏迷，有明显酗酒迹象，紧急CT检查发现，他的大脑右侧颞叶正在出血，出血量约为60毫升，血液流入脑室系统及蛛网膜下腔，情况危急，“必须马上进行手术，否则有生命危险”。随后，刘先生的两个姐姐赶来医院。她们表示，弟弟没老婆、没工作、长期酗酒，家人多次劝阻仍我行我素，终于出事。医生对两名家属详细介绍了刘先生的病情，她们听完后，拒绝医生进行任何救治，甚至不同意办理入院手续，最终还签字放弃治疗。无奈，医生按常规给予刘先生保守治疗，但因病情过重，刘先生挨到第二天凌晨2时后死亡。
资料来源：
