对医疗诉讼的担忧影响抢救未成熟婴儿的决定
【医业网据路透社2002年7月11日纽约讯】调查结果表明，医生对家长起诉他造成医疗事故的担忧影响了是否抢救未成熟儿的决定。
医学进步让抢救极其不成熟的婴儿也成为可能，即使是孕龄仅23周或更少。但是，要做出抢救他们的决定是很困难的，因为许多婴儿很快就会死亡，即便是活下来，也很可能留下严重后遗症，如脑瘫、慢性肺病和学习能力丧失。其程序因人而异。做抢救决定时，家长的愿望起主要作用，但其它因素--如医生担心遭到医疗事故的起诉--也与此有关。从1987年到1995年，被起诉的新生儿科医生几乎增加了一倍。
为分析医生的这种担忧对抢救决定的影响，美国加州大学的贝拉德(Dustin W. Ballard)和同事调查了近600名新生儿科医师。有关结论发表于6月的《儿科学杂志》(Journal of Pediatrics 2002;140:713-718)上。“我们的研究表明，在治疗未成熟婴儿的问题上，大多数新生儿科医生都尊重父母的意见”，贝拉德告诉路透社记者，“即使是他们认为预后不好时”。其中可能有多方面的原因，如对新生儿后果的不确定性、对极其不成熟婴儿的医治缺乏国际标准、认为家长有权做决定等，此外，据作者之一、密歇根大学的乌贝尔(Peter A. Ubel)说，对法律起诉的担心也是原因之一，“医生有时放弃他们较好的医疗决定而遵从家长的愿望”。
, http://www.100md.com
在调查中，他们向医生们提供了多个抢救极不成熟新生儿的假定场合。约90%的医生尊重父母的决定，要么尽可能抢救，要么只提供安慰护理，即使这些要求与他们的判断相反。但家长对起诉的态度也可影响医生的决定：在一个假定新生儿预后极差的病例中，如果家长是个喜欢诉讼的人，医生更可能去抢救婴儿。“而当我们暗示家长不喜欢诉讼，不太可能起诉医院时，医生们更可能不顾家长的想法去做他们想做的”，乌贝尔说，本调查表明，所有家长没有其它证明以前，都被医生视作喜欢诉讼。
Fear of Lawsuits May Affect Preemie Care
Thu Jul 11, 5:54 PM ET
By Merritt McKinney
NEW YORK (Reuters Health) - A physician's perception of how likely parents are to sue for malpractice may influence the decision to resuscitate an extremely premature infant, survey findings suggest.
, 百拇医药
Medical advances have made it possible to save extremely premature infants, even babies born after just 23 weeks or less of pregnancy. The decision to resuscitate an extremely premature child, however, is difficult. Many of these children soon die or, if they survive, have serious problems, such as cerebral palsy, chronic lung disease and learning disabilities. Outcomes vary from child to child, however.
The wishes of parents play an important role in the decision to resuscitate an extremely premature child, but other factors, such as physicians' fear of being sued for malpractice, may also come into play. The number of neonatologists--doctors who specialize in caring for premature infants--who report being sued for malpractice almost doubled from 1987 to 1995.
, http://www.100md.com
To measure the effect of the fear of litigation, Dr. Dustin W. Ballard of the University of California, Davis, and colleagues surveyed nearly 600 neonatologists. The results of the survey are published in the June issue of the Journal of Pediatrics.
"Our survey-based study suggests that the vast majority of neonatologists defer to parental requests regarding the treatment of their premature infants," Ballard told Reuters Health. "This seems to be the case even when doctors believe that the prognosis is dismal."
, 百拇医药
According to Ballard, there are several possible explanations for the findings, such as the uncertainty about how an individual infant will do, the lack of a national standard of care for very premature infants, and the belief that parents should have the right to make the decision.
Legal concerns may also influence a physician's decision to resuscitate an infant, according to one of Ballard's co-authors.
, http://www.100md.com
"Neonatologists are willing to go against their better medical judgement to follow the wishes of parents," Dr. Peter A. Ubel of the Ann Arbor Veterans Affairs Medical Center and the University of Michigan told Reuters Health.
"In some cases, but definitely not all, this willingness is related to fear of malpractice," Ubel said.
In the study, the researchers presented neonatologists with several hypothetical scenarios involving very premature infants. Roughly 90% of neonatologists respected the requests of parents either to "do everything possible" or to "provide comfort care only," even when these desires went against physicians' best judgement.
, http://www.100md.com
But parents' attitudes toward lawsuits also had an effect on physicians' decisions, according to the report. In the case of a child who had a dismal prognosis, doctors were more likely to resuscitate the child if the parents were litigious.
"When we hinted that parents were not litigious, in fact had suffered a difficult time with another baby but did not sue the hospital, physicians become more willing to override the parents' preferences to do what they, the physicians, thought was best," Ubel said.
The results of the survey suggest "that all parents are viewed as litigious until proven otherwise," he said.
SOURCE: Journal of Pediatrics 2002;140:713-718., http://www.100md.com
医学进步让抢救极其不成熟的婴儿也成为可能，即使是孕龄仅23周或更少。但是，要做出抢救他们的决定是很困难的，因为许多婴儿很快就会死亡，即便是活下来，也很可能留下严重后遗症，如脑瘫、慢性肺病和学习能力丧失。其程序因人而异。做抢救决定时，家长的愿望起主要作用，但其它因素--如医生担心遭到医疗事故的起诉--也与此有关。从1987年到1995年，被起诉的新生儿科医生几乎增加了一倍。
为分析医生的这种担忧对抢救决定的影响，美国加州大学的贝拉德(Dustin W. Ballard)和同事调查了近600名新生儿科医师。有关结论发表于6月的《儿科学杂志》(Journal of Pediatrics 2002;140:713-718)上。“我们的研究表明，在治疗未成熟婴儿的问题上，大多数新生儿科医生都尊重父母的意见”，贝拉德告诉路透社记者，“即使是他们认为预后不好时”。其中可能有多方面的原因，如对新生儿后果的不确定性、对极其不成熟婴儿的医治缺乏国际标准、认为家长有权做决定等，此外，据作者之一、密歇根大学的乌贝尔(Peter A. Ubel)说，对法律起诉的担心也是原因之一，“医生有时放弃他们较好的医疗决定而遵从家长的愿望”。
, http://www.100md.com
在调查中，他们向医生们提供了多个抢救极不成熟新生儿的假定场合。约90%的医生尊重父母的决定，要么尽可能抢救，要么只提供安慰护理，即使这些要求与他们的判断相反。但家长对起诉的态度也可影响医生的决定：在一个假定新生儿预后极差的病例中，如果家长是个喜欢诉讼的人，医生更可能去抢救婴儿。“而当我们暗示家长不喜欢诉讼，不太可能起诉医院时，医生们更可能不顾家长的想法去做他们想做的”，乌贝尔说，本调查表明，所有家长没有其它证明以前，都被医生视作喜欢诉讼。
Fear of Lawsuits May Affect Preemie Care
Thu Jul 11, 5:54 PM ET
By Merritt McKinney
NEW YORK (Reuters Health) - A physician's perception of how likely parents are to sue for malpractice may influence the decision to resuscitate an extremely premature infant, survey findings suggest.
, 百拇医药
Medical advances have made it possible to save extremely premature infants, even babies born after just 23 weeks or less of pregnancy. The decision to resuscitate an extremely premature child, however, is difficult. Many of these children soon die or, if they survive, have serious problems, such as cerebral palsy, chronic lung disease and learning disabilities. Outcomes vary from child to child, however.
The wishes of parents play an important role in the decision to resuscitate an extremely premature child, but other factors, such as physicians' fear of being sued for malpractice, may also come into play. The number of neonatologists--doctors who specialize in caring for premature infants--who report being sued for malpractice almost doubled from 1987 to 1995.
, http://www.100md.com
To measure the effect of the fear of litigation, Dr. Dustin W. Ballard of the University of California, Davis, and colleagues surveyed nearly 600 neonatologists. The results of the survey are published in the June issue of the Journal of Pediatrics.
"Our survey-based study suggests that the vast majority of neonatologists defer to parental requests regarding the treatment of their premature infants," Ballard told Reuters Health. "This seems to be the case even when doctors believe that the prognosis is dismal."
, 百拇医药
According to Ballard, there are several possible explanations for the findings, such as the uncertainty about how an individual infant will do, the lack of a national standard of care for very premature infants, and the belief that parents should have the right to make the decision.
Legal concerns may also influence a physician's decision to resuscitate an infant, according to one of Ballard's co-authors.
, http://www.100md.com
"Neonatologists are willing to go against their better medical judgement to follow the wishes of parents," Dr. Peter A. Ubel of the Ann Arbor Veterans Affairs Medical Center and the University of Michigan told Reuters Health.
"In some cases, but definitely not all, this willingness is related to fear of malpractice," Ubel said.
In the study, the researchers presented neonatologists with several hypothetical scenarios involving very premature infants. Roughly 90% of neonatologists respected the requests of parents either to "do everything possible" or to "provide comfort care only," even when these desires went against physicians' best judgement.
, http://www.100md.com
But parents' attitudes toward lawsuits also had an effect on physicians' decisions, according to the report. In the case of a child who had a dismal prognosis, doctors were more likely to resuscitate the child if the parents were litigious.
"When we hinted that parents were not litigious, in fact had suffered a difficult time with another baby but did not sue the hospital, physicians become more willing to override the parents' preferences to do what they, the physicians, thought was best," Ubel said.
The results of the survey suggest "that all parents are viewed as litigious until proven otherwise," he said.
SOURCE: Journal of Pediatrics 2002;140:713-718., http://www.100md.com