从疾病谱的演变看临床决策的变迁  

Transformation of Clinical Decision-making Through the Evolution of the Disease Spectrum

作　　者：姜宣竹 孙宏亮 于洋 刘宪伟[4] JIANG Xuanzhu;SUN Hongliang;YU Yang;LIU Xianwei(The First Clinical College,Dalian Medical University,Dalian 116011,China;College of Humanities and Social Sciences,Dalian Medical University,Dalian 116044,China;Department of Foreign Language,Dalian Medical University,Dalian 116044,China;Blue Bay Division,The Second Affiliated Hospital of Dalian Medical University,Dalian 116044,China)

机构地区：[1]大连医科大学第一临床学院,辽宁大连116011 [2]大连医科大学人文与社会科学学院,辽宁大连116044 [3]大连医科大学外语教研部,辽宁大连116044 [4]大连医科大学附属第二医院蓝湾院区,辽宁大连116044

出　　处：《医学与哲学》2024年第7期19-23,35,共6页Medicine and Philosophy

基　　金：2022年辽宁省社会科学规划基金项目(L22ASH001);2022年辽宁省研究生教育教学改革研究项目(LNYJG2022329)。

摘　　要：针对家长式决策是否应当被全盘否定、知情决策是否仅仅是权利运动的结果、共享决策是否在当今具有实际价值的问题,通过分析不同历史时期的疾病谱类型、疾病产生原因和疾病特点,研究疾病与同时期的临床决策之间的内在联系,以及不同类型的临床决策模式在当今对于不同类型的疾病诊疗的意义和作用,最后指出三种临床决策模式之间并没有优劣之分并探讨推动形成以共享决策为主体,多种决策模式协同发展的临床决策模式的必要性。Focusing on the issues of whether paternalistic model should be completely denied,whether informed decisionmaking model is merely a result of power dynamics,and whether shared decision-making model holds practical value in today's context,this research aims to investigate the interrelation between diseases and clinical decision-making during different historical periods by analyzing the types,causes,and the characteristics of diseases in those periods.Additionally,it examines the significance and role of different decision-making models in diagnosing and treating various types of diseases in today's context.Finally,it highlights that no single model is superior to others,and discusses the necessity of promoting a clinical decision-making model that emphasizes shared decision-making as the main approach while fostering the coordinated development of multiple forms of clinical decision-making models.

关 键 词：临床决策 疾病负担 医患沟通 共享决策 

分 类 号：R-02[医药卫生]