中国医务人员对不必要核磁共振检查需求的态度及影响因素分析

 一项针对全国9省份医务人员问卷调查结果揭示：超过80%的医务人员不会拒绝患者不必要核磁共振检查要求,揭示出医务人员在尊重患者自主性和坚持医生专业自主性方面存在伦理困惑。调查同时发现,医务人员合法权益保障情况、患者对医生的信任情况、执业环境和媒体营造的医患语境等因素与医务人员能否坚持专业自主性具有相关性。本文从伦理学角度对医务人员的困惑进行了分析,指出医生应该尊重患者的价值观,但尊重患者自主性并非没有边界,患者自主性更不能僭越医生专业自主性。结合伦理学论证和调查结果提出以下建议： 1）医务人员尊重患者自主性,首先应该做到充分告知医疗信息; 2）医患之间应该加强沟通,建立信任的医患关系; 3）有关部门应该重视保障医务人员合法权益,改善执业环境,同时加强对媒体的管理,营造和谐的医患语境。

Medical personnel's attitudes toward request of unnecessary MRI investigation request and relevant factors

A recent survey reveals that more than 80% of medical personnel would order unnecessary MRI investigation in response to patient's request. The survey result reflects that health care practitioners may face a dilemma of how to balance between "respecting patient's autonomy" and "insisting on professional autonomy". The survey also reveals that an adequate protection for medical personnel's legal rights and interests, the trust-based doctor-patient relationship, the better operating environment and the harmonious public opinion context may encourage medical personnel to stick to their professional decision. This paper analyses the ethical confusions implied by the survey result and argues that the physicians have duty to respect patient's values. However, it is also shown that the patient's autonomy should be respected only under certain conditions and protecting patient's autonomy shall not become the argument for violating physician's professional autonomy. Based on further ethical analysis and empirical study, this paper proposes that:1. Physicians have moral responsibility to fully disclose all relevant medical information to patients. 2. Improving the communication between doctors and patients is essential for a trust-based doctor-patient partnership. 3. To create a harmonious doctor-patient relationship, it is necessary to provide an adequate protection for physician's legal rights and interests, improve the operating environment and strengthen the regulation of the press.